Obesity

Is an imbalance between energy intake and expenditure truly the root cause of obesity, or are there many other contributing factors? In reality, obesity is influenced by a combination of genetic, physiological, behavioural, and environmental factors. • Mitochondrial impairment - Obesity is often associated with mitochondrial dysfunction which leads to reduced energy production and increased fat storage. • Insulin resistance - When body becomes resistant to insulin, it leads to excess insulin production and improper regulation of blood sugar levels, which can contribute to weight gain and obesity. • Inflammation - Obesity is associated with a state of chronic low-grade inflammation in the body, which further increases insulin resistance and risk of other metabolic disorders. • Over-eating coupled with a sedentary lifestyle are major contributors to obesity (Sidik & Rampal, 2009) (Herrera et al., 2011). Regular consumption of ultra-processed, high-fat, and sugary foods, along with frequent takeout or dining out, can lead to rapid weight gain. (Mozaffarian, 2017) According to the Centers for Disease Control and Prevention, 150 minutes of moderate-intensity aerobic exercise per week is recommended to sustain current weight. • Genetic factors also play an important role in determining an individual's susceptibility to obesity. • Hormonal imbalances such as those seen in thyroid disorders, Cushing's syndrome, polycystic ovary syndrome and even menopause can also lead to weight gain and obesity. (Watanabe et al., 2023) • Deficiency of certain nutrients like Vitamin D, Iron, Vitamin Bs etc can also increase the risk of obesity. • Gut microbiome imbalance has also been linked to obesity. • Stress, depressive disorder, psycho-social factors, certain medications and exposure to toxins may also contribute to the development of obesity. • Poor quality sleep can elevate cortisol levels, which in turn promotes inflammation, contributing to weight gain and metabolic imbalances. Since there are so many factors that affect obesity, a comprehensive root-cause analysis is necessary to understand the specific drivers in each individual. Additionally, treatment plans should be personalized, as no single weight loss method works for everyone.

Obesity is associated with a wide range of health complications including: • Cardiovascular diseases such as hypertension, heart attack, and stroke. • Type 2 Diabetes Mellitus • Certain types of cancer, including breast, colon, endometrial, and kidney cancer • Osteoarthritis and other musculoskeletal disorders • Respiratory issues like sleep apnoea due to fat deposition around the neck • Fatty liver disease and other gastrointestinal disorders • Reproductive and sexual dysfunction • Other chronic and autoimmune conditions Obese individuals also have an increased risk of mental health problems like depression and anxiety.

The primary goal of obesity treatment is to achieve and maintain a healthy body weight through a combination of lifestyle modifications, pharmacotherapy, and in some cases, bariatric surgery. Lifestyle modifications - These are considered the first-line approach to weight management. A combination of reduced caloric intake, increased consumption of nutrient-dense whole foods, and regular exercise has been shown to be effective for weight loss and maintenance. (Foss & Dyrstad, 2011) (Mackey et al., 2012) Diet rich in fruits, vegetables, whole grains, nuts, legumes, yogurt can help promote weight loss. It is important to avoid processed, high calorie, sugar and fat-laden foods. Avoid eating overly large amounts at meals, alcohol, and sugary drinks. Add cruciferous vegetables (broccoli, cauliflower, kale, Brussels sprouts, etc.) to aid in oestrogen balance and boost glutathione, a powerful antioxidant. Include leafy greens to provide folate, which supports healthy methylation, a crucial process for DNA repair and detoxification. Berries and turmeric are rich in antioxidants, helping to reduce inflammation and oxidative stress. Regular physical activity for at least 150-300 minutes per week is recommended for weight loss and maintenance. Maintaining a healthy sleep pattern and practising stress management techniques like yoga and meditation are also important. Medical management - There are many weight lowering drugs like orlistat, phentermine, and liraglutide that can be used along with lifestyle changes to achieve weight loss. These medications can help reduce weight by suppressing appetite, increasing feeling of fullness, and/or preventing the absorption of fat. It is important to use these drugs cautiously under strict medical supervision as they can have many side effects and may not be suitable for everyone. Therefore, it is very important to treat the root causes of obesity for long term weight management. Surgical management - Bariatric surgery including procedures like gastric bypass, sleeve gastrectomy, biliopancreatic diversion with duodenal switch and gastric banding is an option for severely obese individuals (BMI>40 or BMI>35 with comorbidities) who have not been able to lose weight through lifestyle interventions or medications. Endoscopic procedures like Endoscopic Sleeve Gastroplasty, Intragastric Balloon, Endoscopic Gastric Botox Injection and Aspire Assist Device are less invasive methods that are becoming more common. It must be noted that these procedures only treat the symptoms and not the underlying causes, so treating the root causes must remain the primary focus. Inflammation can be reduced by following an anti-inflammatory diet, incorporating antioxidants, and limiting ultra-processed and sugary foods. Adopting a low glycemic diet along with strength training helps improve insulin sensitivity. Mitochondrial function can be enhanced by consuming foods rich in antioxidants like CoQ10. Maintaining hormonal balance, especially thyroid health, requires a diet rich in iodine, zinc, and vitamin D while addressing nutrient deficiencies. Supporting detoxification pathways involves consuming cruciferous vegetables and staying well-hydrated.

Several supplements have been studied for their potential benefits in obesity management: • Fibre - Soluble fibre can help promote feelings of fullness and regulate blood sugar levels (Lyon & Kacinik, 2012). • Omega-3 fatty acids - May help reduce inflammation and improve metabolic parameters. • Probiotics - Can help restore gut microbiome balance and improve metabolism. • Multivitamins like Vitamin D, Vitamin Bs, Vitamin E. • Chromium - Essential mineral that can enhance insulin sensitivity and carbohydrate metabolism. • Magnesium - Involved in glucose and insulin homeostasis, may help prevent metabolic disorders. • Glucomannan - A soluble dietary fibre that has been shown to promote weight loss. • Conjugated linoleic acid - May help reduce body fat percentage. • Antioxidants like Vitamin C, CoQ10, alpha lipoic acid - Can help reduce obesity-related oxidative stress. • Herbs like green tea extract, bitter orange, Garcinia cambogia, cayenne, ginger and turmeric may have weight lowering benefits. • Berberine - Helps improve insulin sensitivity. • L carnitine - Enhances fat metabolism. • Digestive enzymes - Can help digestion and nutrient absorption. • Chitosan - A dietary fibre that may help reduce fat absorption (Lawrence & Kopelman, 2004).

Addressing obesity is more complex than suggested by the diet industry. A holistic and integrative medicine approach targets the root causes, promoting natural and sustainable weight loss rather than looking for quick fixes.