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As an Obesity Medicine Physician, I have seen firsthand the complex relationship between stress and weight gain in my patients. In today’s fast-paced world, stress has become a common factor in many people’s lives, and its impact on our health, including weight gain, cannot be overlooked.

How does stress affect weight gain?

Cortisol response in Stress

Stress triggers a cascade of physiological responses in our bodies, including the release of cortisol, often referred to as the “stress hormone.” Cortisol plays a crucial role in our body’s fight-or-flight response, helping us to cope with stressful situations. However, chronic stress can lead to persistently high levels of cortisol, which can have negative effects on our metabolism and contribute to weight gain.

Emotional eating and Stress:

One way in which stress can lead to weight gain is through emotional eating. Many people turn to food as a coping mechanism when they are stressed, seeking comfort in high-calorie, sugary, or fatty foods. This can create a cycle of stress eating, where food becomes a temporary escape from stress, leading to weight gain over time.

Sleep and Stress:

Moreover, stress can also disrupt our sleep patterns, another factor that is closely linked to weight gain. Lack of sleep can affect our hunger hormones, leading to increased cravings for unhealthy foods and a decreased ability to regulate our food intake. This can further contribute to weight gain and make it harder to maintain a healthy weight.

Effects of Stress in making lifestyle choices

In addition to its direct impact on weight gain, stress can also indirectly influence our weight through lifestyle factors. When we are stressed, we may be less likely to prioritize healthy habits such as regular exercise, meal planning, and self-care. This can further exacerbate weight gain and make it harder to achieve weight loss goals.

As an Obesity Medicine Physician, I work closely 1 on 1 with my patients to address the underlying factors contributing to their weight gain, including stress. By helping them develop healthy coping mechanisms for stress, such as mindfulness, exercise, or therapy, we can work towards breaking the cycle of stress eating and promoting sustainable weight loss. It is important for all of us to recognize the impact that stress can have on our health and weight, and to prioritize self-care and stress management strategies in our daily lives. By taking steps to reduce stress and its effects on our bodies, we can not only improve our overall health but also work towards achieving and maintaining a healthy weight.

Come work with us to get started on this journey to health and open a new world of health related possibilities for yourself to be able to enjoy it to the fullest! CALL US NOW!

Speaking of four pillars of treatment of obesity, adequate good quality sleep has an extremely important role in treatment of obesity and excess weight. Patients with

sleep disorders (e.g., too little or too much sleep) or altered sleep patterns or daylight exposure are at much higher risk of weight gain and sub-optimal results from any attempts at losing weight or maintaining weight loss.

How much sleep is necessary for optimal health and to prevent weight gain?

7-9 hours per night of uninterrupted, good quality sleep is recommended to prevent weight gain.

Adverse health effects of inadequate sleep :

Altered sleep and eating patterns may promote obesity by unhealthy effects on body composition making it harder to lose weight if not optimised and treated.

In addition, poor sleep increases chances of having elevated blood pressure, blood glucose and cholesterol levels as well as increased risk of heart disease and stroke.

Obstructive sleep apnea (OSA) :

In addition, obese patients are much more likely to have Obstructive sleep apnea (OSA) . It is paramount to diagnose and treat OSA as it can further increase the risk of numerous medical issues.

OSA typically is suspected in individuals with 1 or more of following symptoms:

• Snoring (usually loudly)
• Headaches
• Daytime sleepiness
• Fatigue
• Insomnia
• Restless sleep
• Sudden waking up with choking or gasping for breath
• Forgetfulness
• Motor vehicle accidents (a potential. complication of sleep disorders)
• Mood fluctuations
• Low libido
• Individuals with neck circumference as: Men > 17 inches; Women > 16 inches
• Jaw abnormalities,
• Cardiopulmonary abnormalities like leg swelling, heart rhythm problems, high blood pressure

How to confirm diagnosis of OSA?

Your physician may order additional testing with In-lab overnight sleep studies or home sleep test.

Adverse Consequences of Untreated Obstructive Sleep Apnea

• Worsening obesity
• Congestive heart failure
• Atrial fibrillation
• Nocturnal dysrhythmias
• Stroke
• High blood pressure
• Type 2 diabetes mellitus
• Pulmonary hypertension

Treatment of OSA

• Maintaining healthy weight: The most important factor in treatment of OSA is treating obesity/ excess weight.
• Behavior therapy to improve sleep patterns.
• Oral appliances like mandibular reposition devices or tongue retaining devices can be used
• Nasal expiratory positive airway
• Continuous positive airway pressure
• Adaptive servo-ventilation
• Surgery
  o Laser-assisted uvulopalatoplasty
  o Radiofrequency ablation
  o Palatal implants
  o Electrical stimulation of upper airway muscles
  o Skeletal surgery procedures

At AllWell Clinic, we work diligently to identify any sleep problems and to treat sleep disorders and OSA as necessary, by making appropriate referrals to sleep specialist physician. In addition, by working on optimising other important factors in weight loss like Nutrition, Physical activity, switching any medications that could be contributing to weight gain, we help patients with OSA make significant improvements. We accomplish all of this under the expert guidance of Obesity Medicine Board certified physician. We welcome you to reach out of us if we can be of any help with any weight and metabolic issues!

Physical activity in any form of moderate intensity is recommended as an adjunct to any weight loss plan. Even as the role of nutrition is much bigger than the role of exercise in weight loss, it contributes towards creating the caloric deficit.

Exercise is a much more effective tool for weight maintenance after weight loss than causing the actual weight loss.

I recommend looking at exercise as a way of staying healthy and maintaining weight and somewhat help with weight loss. What that means is even the patients who are not obese or overweight, they need physical activity to stay healthy and reduce the risk of heart disease, diabetes, insulin resistance, cancers, NASH.

If you are looking for serious weight loss, you most return on investment is on focusing on your diet as we discussed in previous post.

So how long you need to be physically active for ?

Per CDC guidance, each week adults need 150 minutes of moderate-intensity physical activity and 2 days of muscle strengthening activity to stay healthy.

Alternately, same benefits can be achieved by 75 minutes of vigorous-intensity exercise and 2 days of muscle strengthening activity.

For weight loss, 150-300 minutes of moderate intensity activity is the recommendation with increased benefits with longer duration. This equals to 1 hour, 5 days a week.

Start small!

Rome wasn’t built ina day, neither can anyone’s habit. So starting small and staying on it is the key. If you can manage to walk just 10 minutes a day, then starting there and slowly building on it is the best way to build exercise habit. Eventually small changes add up pretty quickly, and help build lasting habits with bigger health gains.

Any activity is better than nothing

Don’t let the fear of not being able to do enough, prevent you from getting any at all. Something is better than nothing. This is one place where trying to achieve the recommended activity goal in perfect way every day, could become deterrent to doing any at all, if we have all or none approach.

Consistency of doing something even a few minutes a day is way more important than the perfect 1 week of 300 minutes of exercise but not doing any exercise on an ongoing basis.

Moderate-intensity aerobic physical activity means you’re working hard enough to raise your heart rate and break a sweat. The intensity of activity is such that you’ll be able to talk, but not sing the words to your favorite song.

Some examples include:

• Walking briskly
• Water aerobics
• Riding indoor or outdooor bike
• Playing tennis – doubles game
• Pushing a lawn mower

Vigorous-intensity aerobic activity means you’re working and breathing hard and fast, and your hear rate goes up signficantly. If you’re being active at a vigorous level, you won’t be able to say more than a few words without pausing for a breath.

Some examples of this include:

• Jogging or running
• Swimming laps
• Riding a bike fast or on hills
• Playing singles tennis
• Playing basketball

When you work with us, we guide you and hold your hand each step of the way to help you make these choices by not only educating about it, but by real life problem -solving to help you accomplish your goals. We, at AllWell Clinic are committed to your weight loss success with evidence based strategies and MD’s advice.

This post is meant for all the folks who have decided to take charge of their health and hoping to achieve their weight loss goals, but just do not know where to start since there is so much confusing information out there. Here are few pointers that are evidence based and have worked for me personally and for many of my patients!

Please remember these things alone may be enough for many people, but there are significant number of patients out there who would still not fully get the results they want. That’s where medications are helpful because even medications alone would not be helpful and have to be used as a part of comprehensive approach including optimising nutrition, physical activity, sleep , stress levels, and behavorial changes

Let’s call obesity for what it is, a chronic disease, just like high blood pressure, diabetes or heart disease. Ironically, there is no stigma around having high BP and diabetes or taking medication help to treat them. On the other hand, negativity around taking meds to improve your excess weight- the most important contributing factor for a constellation of these conditions – high BP, ischemic heart disease, heart failure, atrial fibrillation, high cholesterol, fatty liver, cancers, osteoarthritis of knees, hips, spine problems, is unbelievable.

We would start with discussing each of these inportant factors one by one.

NUTRITION :

To lose weight you would need a nutritional plan. There is no clearcut scientific evidence that one kind of diet works better than the other. The diet I recommend to my patients is the one that is most pleasant to you and you could do it for ‘the rest of your life’. Yes! rest of your life… …which many times means changing the way you shop, changing the way you cook, even changing the way you unwind at the end of a stressful day or socialise.

Caloric deficit : The core principle of any effective weight loss diet plan is to create a caloric deficit. Physiologically, it is not possible to lose weight if you are eating more calories than you are spending, no matter whatever someone claims.

Fortunately, there are quite a few options in diets available to choose from. Again, it comes down to what you could actually do in real life and stay on as a long term lifestyle change.

Few popular ones are: Healthy flexible eating (and the one I like best), Mediterranean, plant -based, paleo, keto. Each one has its own strengths and downsides, but eventually it comes down to personal preference and ability to stick with it long-term.

Ideally, your plate should look something like this : Half of it should be vegetables, quarter of it protein, rest quarter could be mix of fat and carbohydrates.

Logging food: As humans we are inherently terrible at guessing. So the key to long term success is logging everything you eat, every time -no matter what. It’s hard to change what we can’t see. In addition, logging inherently brings an additional layer of mindfulness to what we eat by having to pay attention to portion size and content of our meal. Few popular apps are – Myfitnesspal, Lose it, Sparkpeople, Chronometer.

Preparing meals at home: Its easy to drive through a fast food restaurant, or even order a home delivery at the end of a stressful day. Restaurant foods are notorious for sneaking in extra fat, salt, sugar, refined carbs to make food tastier. so if you making a serious effort to lose those extra pounds and in general healthier, it would be a better choice to cook at home more often and order out less.

Prioritizing protein and fiber:

Protein releases chemical signals to brain to indicate satiety. Fiber achieves the same goal by mechanical feeling of fullness with less calorie dense foods. Both protein and fiber work together to create the feeling of fullness without ingesting too many calories.

When you work with us, we help you each step of the way to help you make these choices by not only educating about it, but by real life trouble -shooting to help you accomplish your goals. We, at AllWell Clinic are committed to your weight loss success with evidence based recommendations and Obesity Medicine board certified physician’s advice.

If someone were to ask about one thing that changes it all when it comes to weight management, it would be ‘mindset’. Mindset is the key secret sauce that actually brings your goals closer to reality.

What are the words you choose when you describe yourself or your life? Do you call yourself lazy, or not motivated enough, can’t lose weight? I would like you really think about what words you use to describe yourself.

Any change starts with optimizing your words. Your words are a window to what you believe about yourself and world around you. The cool thing about words is they not only reflect your beliefs, they also help shape your beliefs. And your beliefs about yourself shape your actions. In the end, the words you use when you talk about yourself end up becoming a self-fulfilling prophecy. Whatever you believe about yourself, you would find evidence to prove yourself correct. If you tell yourself that you are too busy to exercise, your brain then decides that it is too busy to exercise or eat healthy or log your food. ‘Too busy’ then becomes your truth!

When you use words like ‘ too tired’ or in ‘survival mode’, you will find a way to prove yourself right. The point is not to deny your experience, but to acknowledge and help ‘own’ the experience. Once you take ownership of the experience, you would be able to see what kind of results your beliefs about yourself are producing in your life.

The two most disempowering and self -limiting phrases that you could use for yourself would be ‘I can’t’ and ‘I shouldn’t’. Both these phrases take away your own agency from your life. These phrases help your mind talk you out of things that you are actually capable of achieving and doing. Many times, these beliefs come with tremendous guilt or shame. The decisions you make from a negative place of shame of guilt CANNOT bring a lasting, genuine change in your behavior. So, how do you talk to yourself about yourself?

Instead, using ‘I choose to’ would help you get out of your own way and make things you thought were impossible, possible. I choose to ‘not eat that cookie’, I choose to ‘wake up at 5.30 am every morning to exercise’; is much more effective way to bring a change in your behavior instead of “I can’t exercise’, ‘I shouldn’t eat that cookie’. It feels so much better to chase a positive thing than avoid a negative change. Doing things out of your choice helps to take charge of your life in your hands and foster self-efficacy, where you actually believe that you could change and do more of the right things. Using ‘I choose’ helps your actions align with your core values and things that are actually important to you, free of anyone else’s expectations or obligations.

Hardest thing you would do to change your life is – following through on things you said you would do and feel all the unpleasant feelings that come with that! Remember, you always have a choice. Framing your decisions as ‘I choose’ fosters personal responsibility and autonomy. Take your authority back from whatever external or internal limitations- real or imagined, you have given it to.

In the end, it always comes back to your thoughts and mindset! Choose words for yourself that reinforce your own self-efficacy and control and see the magic happening!

Remember, what comes out of your mouth, comes in your life!

When you work with us, we help foster your self-efficacy and come with real life solutions for effective lasting behavior changes! I am so excited to help you on this journey that you have embarked on to gain health!!

Everyday patients or even friends / family members, reach out saying that they are doing everything they can to lose weight with lifestyle measures alone without success. Many times, if they had lost weight with these changes before, they are not working anymore. This brings us to THE realisation that something doesn’t not quite add up. It became abundantly clear to me over and over again that for many patients lifestyle alone was not going to treat their obesity.

The key reason behind this is metabolic adaptation. So what is metabolic adaptation?

Metabolic adaptation is as you continue to lose weight, metabolic rate goes down disproportionate to the amount of weight you lose. We all know caloric deficit is the key to losing weight. Metabolic adaptation makes it very hard to stay in enough calorie deficit to continue to lose weight or even to keep off the weight one had previously lost with the exact same things that were working before. The neurohormonal basis for this adaptation is increased production of hunger producing hormone ghrelin and reduced levels of leptin hormone that helps us stay full.

That is the exact reason why many people would require medication or surgery for continued meaningful weight loss.

So should we stop eating healthy and doing physical activity? We still need to eat healthy and exercise to reap the metabolic health benefits of a healthy diet and exercise in terms of preserving muscle mass, strengthening our bones, lower the risk of high blood pressure, improved heart health, lower risk of many cancers and diabetes among so many other benefits.

I am a board certified Obesity Medicine specialist. Let us help you live a healthful life with our expertise and guidance in not only losing weight but also gaining health! Let’s connect!!

As an obesity medicine physician, I have witnessed firsthand the devastating impact of obesity on individuals’ health and well-being. One of the critical puzzle pieces in this battle is insulin resistance. In this blog post, we will delve into the intricacies of insulin resistance, its profound impact on obesity, and the strategies we can employ to conquer this challenge.

What is Insulin Resistance? Insulin is a hormone produced by the pancreas that plays a crucial role in regulating blood sugar levels. When we consume carbohydrates, our body breaks them down into glucose, which enters the bloodstream. In response, the pancreas releases insulin to help transport glucose into cells, where it can be used for energy.

However, in individuals with insulin resistance, the body’s cells become less responsive to the effects of insulin. As a result, the pancreas compensates by producing more insulin, leading to higher levels of this hormone in the bloodstream. Over time, this can create a vicious cycle, as the body becomes less sensitive to insulin, requiring even higher levels to maintain normal blood sugar levels.

The Connection between Insulin Resistance and Obesity:

Insulin resistance and obesity often go hand in hand. Excess body fat, particularly in the abdominal area, is strongly associated with insulin resistance. Adipose tissue, or fat cells, release certain substances that interfere with insulin’s ability to function properly. As a result, the body’s cells struggle to take in glucose efficiently, leading to elevated blood sugar levels. Furthermore, when insulin levels are high, the body tends to store more fat, making it harder to shed those extra pounds. This can create a frustrating cycle, as weight gain further exacerbates insulin resistance, perpetuating the problem.

Diagnosing insulin resistance:

Several clues point towards insulin resistance including Acanthosis nigricans, skin tags, PCOS (but not always), OGTT, elevated fasting plasma glucose, pre-diabetes (elevated HbA1c), diabetes. Elevated fasting insulin, fasting insulin:glucose ratio – HOMA-IR or QUICKI (QUantitative Insulin sensitivity ChecK Index), NMR LipoProfile® are being increasingly utilised for earlier diagnosis of insulin resistance.

Addressing Insulin Resistance in Obesity Management:

Here are a few key approaches that obesity medicine physicians employ:

1. Lifestyle Modifications: Encouraging individuals to adopt a healthy lifestyle is paramount. Regular exercise, a balanced diet rich in whole foods, and stress management techniques can all help improve insulin sensitivity and reduce insulin resistance.

2. Medications: In certain cases, medications may be prescribed to help manage insulin resistance. These medications can enhance insulin sensitivity, lower blood sugar levels, and aid in weight loss efforts. Metformin, Thiazolidinediones like Pioglitazone are typically recommended. GLP- 1 agonists like Semaglutide, and GLP-1 + GIP agonists like Tirzepatide have been found to help in recent studies.

3. Bariatric Surgery: For individuals with severe obesity and insulin resistance, bariatric surgery may be considered. This surgical intervention can lead to significant weight loss, improve insulin sensitivity, and even reverse type 2 diabetes in some cases.

4. Individualized Approach: Every patient is unique, and tailoring treatment plans to their specific needs is crucial. Providing ongoing education and support can help individuals make informed choices and stay motivated on their weight loss journey.

We, as an Obesity medicine physician led practice, work closely with patients to develop personalized strategies that address insulin resistance and promote sustainable weight loss.

Insulin resistance is a significant hurdle in the fight against obesity, but it is not insurmountable. Together, we can unlock the mystery of insulin resistance and pave the way for a healthier, happier future.

We, at AllWell Clinic are uniquely privileged to help you in best evidence based manner with Metabolic Health and Obesity Medicine Board certified MD.

Reach out to us to see how we can help!

As I speak from my personal experience as well treating numerous patients, losing weight is a journey that many embark upon, but few find easy to navigate.

Despite our best intentions, shedding those extra pounds can often feel like an uphill battle. In this blog post, we’ll explore some of the reasons why losing weight can be so challenging, shedding light on the complexities of this common struggle.

1. Biological Factors: Our bodies are designed to store energy for survival, which means that losing weight goes against our natural instincts. The human body is highly efficient at conserving energy, making it difficult to create a calorie deficit necessary for weight loss. Additionally, genetic factors can influence our metabolism, making it harder for some individuals to lose weight compared to others. We work with you to facilitate and NOT fight against biology!

2. Psychological Factors: Weight loss is not just a physical journey; it’s also a mental one. Emotional eating, stress, and cravings can all sabotage our efforts to stick to a healthy eating plan. Our relationship with food is deeply rooted in our emotions, making it challenging to break free from unhealthy habits and establish new, sustainable ones.

3. Lifestyle and Environmental Factors: Modern lifestyles often promote sedentary behavior and make unhealthy food choices readily available. Busy schedules, lack of time, and convenience-driven options can all contribute to weight gain. Additionally, our environment plays a significant role, with factors such as food advertising, portion sizes, and societal norms influencing our eating habits.

4. Plateauing and Slow Progress: Losing weight is not a linear process. After an initial period of rapid progress, it’s common to hit a plateau where weight loss slows down or even stalls. This can be demotivating and make it harder to stay on track. It’s important to remember that weight loss is not always a straightforward journey and that patience and perseverance are key.

5. Lack of Support and Accountability: Embarking on a weight loss journey alone can be challenging. Lack of support and accountability can make it harder to stay motivated and committed to your goals. Having a strong support system, whether it’s through friends, family, or professional guidance, can make a significant difference in your weight loss success.

Conclusion: Losing weight is undoubtedly a difficult endeavor, but understanding the reasons behind the struggle can help us navigate the challenges more effectively. By acknowledging the biological, psychological, lifestyle, and environmental factors that contribute to the difficulty of weight loss, we can develop strategies to overcome them. Remember, a sustainable and healthy approach to weight loss is a marathon, not a sprint. With perseverance, support, and a positive mindset, you can achieve your goals and embark on a lifelong journey of health and well-being.

We are here to support you in your journey in ways that ACTUALLY work with support of a Obesity Medicine trained MD ! Reach out to us to get started today!!

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