Obesity or being overweight is when a person has high energy intake and low expenditure. The excess calories will compile in the form of fat. This excessive accumulation of fats in the body threatens the body's physical and biological wellbeing. A measure used to quantify body fat is the body mass index (BMI). It is the ratio of the body's weight in pounds or kilograms to the square of height in feet or metres, respectively. A person with a BMI of 25 or more is considered overweight, while a person with a BMI of 30 or more is categorized as obese.
The excessive fat leaves a number of symptoms in the body, including difficulty in regular physical activities, increased sweating, breathlessness, snoring at night, feelings of tiredness, back and joint pain, low self-esteem, low confidence, low social acceptance, feelings of social isolation and increased risk of various health issues and metabolic diseases. To avoid these issues, weight management is necessary.
Weight loss refers to a program aimed at achieving the ideal weight. It is a comprehensive program involving diet management and maintaining a healthy lifestyle e.g., stresses management and physical activities. This program must be implemented to achieve weight loss, preferably at a steady rate of 1-2 pounds weekly. Before moving towards these plans, a person should be aware of what is causing weight gain. The answer is an imbalance between calorie intake and expenditure.
Obesity and overweight result from complicated interactions between environmental, behavioural and genetic factors. The most important factors responsible for obesity that need a weight loss program are the lack of physical activities and exercises, calorie-rich diet, genetic factors, environmental factors, the use of some medications, some health issues like polycystic ovaries, Cushing’s Syndrome, sleep deprivation or poor quality sleep, emotional factors, stress and different social and workplace factors.
What is Weight Loss?
Weight loss refers to a reduction in the total body mass, either through the loss of excess body fluids, loss of lean mass like connective tissues, minerals, and muscles or the loss of adipose tissue (fat).
Weight loss occurs either intentionally or unintentionally. Unintentional weight loss occurs due to some diseases or malnutrition, resulting in excessive weakness and physical wasting. Intentional weight loss results from planned efforts to improve the perceived or actual state of obesity or being overweight.. Another type of weight loss is unexplained weight loss, which occurs without any known cause and is a sign of serious health issues like hepatitis.
Be mindful that weight loss typically demands a full-spectrum approach, incorporating calorie management, active and wholesome activity habits, and in certain situations, the appropriate use of medical aids like Wegovy.
What is the medical term for Weight Loss?
Various terms used for weight loss are slimming down, melting down, emaciation, thinning, fat reduction etc. These medical terms are used differently. For example, weight loss and thinning refer to the results of a planned weight loss plan, while emaciation and melting down are used for weight loss resulting from some underlying health condition. The bariatric surgeon is a medical professional engaged in the medical and surgical treatment of obesity and excessive fat accumulation.
How does Weight Loss work?
Weight loss is a complex phenomenon that happens in several phases or stages. Typically, weight loss occurs in two rapid and shorter stages, followed by a slower and longer phase.
Phase 1 (Faster weight loss): It is called the glycogen depletion phase and covers the first six weeks of the weight loss journey. During this phase, most weight loss occurs, and the person begins to note a difference in cloth fitting and the self appearance. However, most of the weight loss in this phase is due to the loss of water, proteins and stored carbohydrates, and only a minor part is from the stored fat.
This phase occurs more swiftly in the people who use the keto or low-carb diet than those following a low-fat diet plan, as the body's stores of water and carbohydrates deplete much earlier in these people. Besides the diet, various other factors like level of physical activities, starting weight, age and gender also influence the rate. Men will lose weight more rapidly than women; similarly, older people will also lose weight more quickly than younger ones.
Phase 2: The steady and slower weight loss phase starts after six weeks or more and is slower. The weight loss in this phase occurs mainly due to body fat loss. It is the most important phase of weight loss.
The major success during this phase is to develop a workable diet plan according to the lifestyle and make proper, timely adjustments if and when needed. The weight loss plan should focus on maintaining muscle mass as it is vital for physical health and mobility, reducing metabolism and blood sugar levels. The adjustments should focus on the reduction of body fat only. It can be achieved by improving the protein intake while causing the caloric deficit by reducing the caloric intake and engaging in strenuous physical activities.
Phase 3: Sometimes, a weight loss plateau is noted by some people with no visible weight loss. It is due to the body's metabolic adaptations, which reduce the rate of metabolism or the use of overly restrictive diets, which are very hard to follow.
Phase 4: It is the phase of metabolic recovery. During this phase, recovery diets are used to regain the rate of metabolism, which was lowered in response to the weight loss diets. The diets during this phase should allow a steady weight and metabolism according to a person’s physical demands.
Weight gain can reoccur during phase 4, and studies have noted that most of the people regained half of the lost weight within two years, and this percentage jumped to more than 80% within five years. Some lifestyle and dietary practices like engaging in more enjoyable physical activities (like outdoor games, climbing the stairs, walking, jumping, swimming, and biking), self-monitoring of the behaviours, the use of digital devices to track the physical activities and diets, taking healthy foods like vegetables and fruits and ensuring that they are always available, reducing stress, prioritizing sleep and choosing whole foods over the processed foods helps to achieve a more smooth and steady weight loss.
What is the importance of Weight Loss?
The reasons to lose weight are obvious, particularly for people with excess body fat. Even a minor decrease in body weight causes enormous benefits for the body. A minor decrease in body weight causes a major decrease in the risk of diseases like hyperglycemia, hypertension, and hypercholesterolemia and a lower risk of heart disease. The list of benefits is too long to be summarized in a few lines. Here are the reasons why a person should lose weight.
A 5% reduction in body weight promises following benefits;
Better blood glucose levels: People with type 2 diabetes produce insulin, but they are not sensitive to it. Weight loss improves insulin sensitivity. Higher fatty tissues in the body lead to inflammations and disrupt insulin functions and a decrease in the fatty tissues through weight loss improves glucose levels.
Better heart health: The pressure on the arteries in a fatty pérson is very high. It means the heart has to work harder to circulate blood in an obese person. Excessive fat in the body also increases blood pressure and bad cholesterol (LDL). So, no matter how a person loses weight, it will benefit their heart health. Research by Joshua Brown and colleagues in 2016 found that people losing 5-10% of body weight experienced significant reductions in LDL cholesterol, triglycerides and fasting glucose levels, and all of these factors contributed to improvements in heart health.
Lower chances of a cardiac stroke: Due to hypertension, obese men are more likely to have a sudden cardiac stroke. Losing body weight causes the blood vessels to become less constructive and significantly improves the efficiency of the heart functions, thus reducing the risk of heart diseases. Research by a team of researchers headed by Jung-Hwan Cho in 2019 reported that the risk of cardiac stroke was much higher in the people who experienced weight gain or weight loss than those who maintained their weight.
Better sleep: One of the causes of sleep deprivation is sleep apnea, in which the sleep is disrupted during sleeping. It is due to excessive fat deposits in the neck due to obesity. The research has found that reducing 10% of the body weight significantly improved sleep quality by causing a 26% reduction in the apnea-hypopnea index.
Better mobility A higher weight means a higher burden on the joints and knees. The studies have noted that a little cut in body weight causes a significant drop in the constraints on mobility during climbing stairs and walking.
Lower joint pains: Excessive weight puts pressure on the joints causing them to become inflamed, damaged and stressed and losing weight alleviates all these issues. The population studies have noted that losing 10% or more body weight causes significant improvements in joint pains and functions.
Better self-esteem and mood: Although no direct association between these factors is expected, the studies have found that losing weight through any means improves self-confidence and mood by creating a sense of enhanced social acceptance. A review by Miller-Kovach and colleagues noted that weight loss caused enormous benefits for psychological health by causing improvements in general well-being and an improved sense of self-worth and body image.
Better energy throughout the day: Weight loss improves sleep and creates positive feelings, which keep a person energized throughout the day. Being overweight is alone enough to cause tiredness as the body has to lift a heavy weight during movement. Losing extra pounds improve mobility and respiratory functions and keep a person active and well-energized.
Lower risk of some cancers: Cancers are due to various negative activities in the body, and obesity increases the activities. According to the National Institute of Health, excessive body fat causes a 17% increased risk of cancer-specific mortality. Obesity increases the risk of pancreatic cancer, endometrial cancer, liver cancer, kidney cancer, and breast cancer, particularly in postmenopausal women.
The exact link between cancer and obesity is unknown, but a higher internal inflammation in obese people is thought to have a role.
Better libido and erection: The research to understand the link between sex drive, erectile functions and obesity is underway. However, weight loss causes an increase in the levels of sex hormone binding globulin (SHBG), the protein which bounds testosterone and improves testosterone levels. The testosterone level is directly related to an improved libido and erection functions.
Why do people Lose weight?
Obesity is prevalent in the UK, and a 2021 health survey showed that 25.9% of adults in the country are obese, and a further 37.9% of adults are overweight. It also does not come alone and is accompanied by various physiological and mental health issues. So, there is no wonder why people want to lose weight. The motivations and reasons to lose weight can be summarized as follows;
Better health: Health is wealth, and the most common motivation for losing weight is to achieve better health. A 2018 review by David Silva and colleagues noted better health as the top motivation for weight loss. Obesity is associated with an increased risk of diseases like type 2 diabetes, cancers, stroke and a higher risk of various cardiac health risk factors. The World Health Organization has noted that obesity is the fifth most important cause of death globally.
Healthier body: Embracing a healthier lifestyle to achieve a body that feels strong and energetic is a popular goal for many. Beyond the essential health benefits, people often find that this journey improves their self-image and confidence. While it is unfortunate that society has biases, with a focus on slimmer figures often highlighted in the media, it's encouraging to see a growing movement towards inclusivity and diversity in body types. Many are now advocating for a culture that values individuals for their skills and talents, fostering environments where everyone, regardless of size, can thrive professionally and personally. Positive change is on the horizon, as more voices join the conversation to celebrate beauty in all its forms.
Better mode: Health issues and the insecurities about being discriminated against by society create depression and frustrations, causing poor self-esteem. Ample evidence is there that depression and obesity are linked and that obesity is often a precursor to various mental health problems like bipolar disorder. Sluggishness and fatigue associated with obesity also contribute to depression, and losing weight helps manage all these issues. According to Rajat Garg, an Indian military psychiatrist, 12% of obese people have a risk of moderate depression, while 54% have a risk of moderate depression.
Fitness: Better fitness is often a motivation for people who are otherwise healthy but are overweight and want to improve their fitness. Losing weight is also very promising for people who want to participate in physical activities or sports and improve their athletic performance.
How long does it take to Lose weight?
There is no fixed speed at which weight loss occurs for all people. The rate of weight loss depends upon various factors like age, gender, starting weight, the specific weight loss plan used, how much a person stuck to the plan, sleep, medical conditions, genetics and family history and caloric deficit.
Generally speaking, if a person aims to lose weight on a long-term basis, the aim should be to lose 1-2 pounds per week. For this purpose, a person has to spend 500-750 more calories than the caloric intake depending upon the level of physical activity and diet. The factors influencing the speed of weight loss are;
Age: As a person ages, the body composition changes, resulting in a body with more fat and less muscle mass. This issue, coupled with the lower needs of the major organs, causes a decrease in the resting metabolic rate. The lower RMR makes the weight loss journey difficult.
Gender: The fat-to-muscle ratio differs for different fenders; women typically have more fat. Consequently, their RMR is 5-10% lower than men's. Simply speaking, it means that women will burn fewer calories than men, so men are more likely to lose weight rapidly than women.
Starting weight: The composition and mass of the body at the starting point also influence the rate of weight loss. A heavier person will lose more absolute weight than a less heavier person. However, the percentage of body weight is often the same for both.
Caloric deficit: Weight loss needs a caloric deficit to work. So, the weight loss rate depends on how much caloric deficit a person can create and for how long. For example, a caloric deficit of 500 for six weeks causes more weight loss than a caloric deficit of 200 for six weeks.
Sleep: Sleep is often overlooked; however, it strongly influences the rate of weight loss. Chronic sleep deprivation causes a significant decrease in the rate of weight loss. Chronic sleep deprivation is also linked to a higher risk of cancers, heart diseases, type 2 diabetes and obesity. According to Arlet Nedeltcheva (MD, the University of Chicago), people who had 8.5 hours of daily sleep lost 55% more fat in a 14-day intervention program than people having 5.5 hours of daily sleep.
Drugs, health conditions and genetics: The drugs like antipsychotics and antidepressants cause weight gain or hinder weight loss. Some medical conditions like hypothyroidism cause weight gain and make weight loss targets difficult to achieve. Obesity is often associated with some inherited factors, and people with a family history of obesity find it very difficult to lose weight.
What are the different Types of Weight Loss?
Depending upon the body composition and diet plan being followed, various types of weight loss exist.
- Rapid weight loss: It is experienced in the first 6-8 weeks of weight loss experience. In this phase, a rapid decrease in body weight is experienced as a person shifts to extremely low-calorie diets and heavy exercises. It is due to the loss of water and fats from the body. After this phase, a stable plateau is often experienced.
- Fat loss: Fat (adipose tissue) is the major storehouse of excessive sugars, and losing it is the target of most weight loss programs.
- Healthy weight loss: Healthy weight loss is an intentional and programmed weight loss to achieve the desired health benefits. It differs from unintentional weight loss, often in response to some ailments.
- Water weight loss: The fats retain more fats in the body than muscles. As a result, water is also lost when the fat is mobilised. It accounts for a very rapid weight loss at the initial phase of a weight loss program.
- Muscle loss: Once the fat is lost, the body mobilises the muscles to compensate for the caloric deficit. It is not desired in most cases and is experienced in unintentional weight loss.
- Surgical weight loss: Bariatric surgery is the surgery which is fine to remove excess fat from the body. It is often done when other weight loss methods are not working, and excessive fat is endangering life. Different weight loss surgical procedures are available, like gastric bypass, gastric sleeve, adjustable gastric band, biliopancreatic diversion, and duodenal switch.
Rapid weight loss
Rapid weight loss occurs when too much caloric deprivation is created in a very short time. For example, if a person consuming 3000 calories suddenly shifts to a 1200-calorie diet, the extreme caloric deficit will cause a rapid decline in the body weight, which is more than the desired target of 1-2 pounds per week.
During rapid weight loss, the body identifies the extreme caloric deficit as a sign of reduced food supply. It enters starvation mode, leading to the mobilisation of fats from the body and the removal of excessive water, leading to severe weight loss. For some people, the difference in body shape and weight is apparent after two weeks, while for others, it takes 4-6 weeks.
Despite giving a very rapid weight loss, the rapid weight loss strategy is not recommended as it can cause excessive loss of water (leading to dehydration), muscles, bone mass, bone density and the development of stones like gallstones. Moreover, it causes excessive weakness, and a person finds it difficult to carry on routine activities.
It is also unsafe and is associated with several side effects like muscle loss, hair loss, irregularities of the menstrual cycle, constipation, dizziness, fatigue, irritability and fatigue. The dangers of rapid weight loss increase as the time spend on this plan increases. Using a zero-protein or even low-protein diet is even more dangerous. Other side effects are gallstones (experienced by 12-25% of the people losing large weights within free weeks), dehydration (which can be avoided by consuming fresh and simple water), malnutrition due to deficiency of proteins and vitamins and electrolyte imbalances which can sometimes be life-threatening.
Although it is associated with many side effects, rapid weight loss of often recommended for obese people with a BMI of 30 or more and who need fast weight loss due to some emergency surgeries. However, the very low-calorie diets required for rapid weight loss are often very expensive and formulated by nutritionists and doctors. Although they promise a 12-25% body weight loss in 3 months, they are challenging to follow, and many people stop using them in the middle.
The weight loss achieved through diet pills, very low-calorie diets, supplements, weight loss devices and sometimes during some diseases like cancer therapy and hepatitis is the examples of rapid weight loss.
Fat loss refers to weight loss that is specifically due to a decrease in the fat mass in the body. It is a desirable form of weight loss and is more useful than losing muscles. The skinfold calliper or the body fat scale is used to monitor if the weight loss is due to loss in body fat. The traditionally used measure, i.e., the total body weight measurement, is not very useful.
Fat loss occurs when the prolonged caloric deficit cause the mobilisation of body fat. The adipocytes (the fat cells) release their stored fat into circulation to maintain the energy supply. The major stimulus for fat mobilisation is provided by fat burners, which are the low-calorie diets, exercises or supplements that cause increased weight loss, impair the absorption of fats and increase the rate of fat metabolism. An excellent fat burner should break the fat cells, burn the stored in these cells and increase the rate of metabolism.
If weight loss is at the top of priorities, a person should aim for fat loss which is the recommended form of weight loss. Working to lose fats will prevent the loss of muscles, minerals, bone mass and water, which are harmful to overall health. It helps to lower the risk of various issues like chronic inflammation. It will help lower the excess fat but preserves the lean muscles, which maintain strength and agility and allow one to burn more calories even at rest. Working to lose fat also helps remove visceral fat, the most dangerous type of fat. It improves the body shape as the fat is the loose part of the flesh that damages the body shape. It also improves the quality and quality of sleep, the health of blood vessels and lowers the risk of diabetes, cancers and heart diseases.
Various strategies can help to lose fats like strength training, high protein foods, improving the quality and quantity of sleep, replacing unhealthy fats (saturated) with healthy ones (unsaturated), avoiding sweetened beverages, eating more fibre, replacing refined grains with the whole grains, practice cardiovascular exercises, drinking coffee, trying high-intensity interval training (HIITs), adding probiotics to the diet, and using intermittent fasting.
Water Weight Loss
The weight of water held in the body is known as the water weight, and water weight loss refers to the loss of body weight due to the loss of excess water from the body. As soon as a person shifts to a low-calorie diet, the water weight is the first thing to go down.
The body of an average human being is composed of around 60% water. However the water contents of different organs are different. Excessive body fats and consuming salty diets cause extra water retention, adding to the body weight. Additionally, as a person shifts to a low-calorie diet, the body first mobilizes the glycogen stores in the liver to provide necessary glucose. The mobilization of glycogen releases water. Once the glycogen is depleted, the body starts mobilizing fats. The metabolism of fats produces water, energy and carbon dioxide. The oxidation of 100g of fats produces 107-112g of water (using oxygen from respiration). This water from dieting is eliminated from the body, causing the first visible drop in body weight.
Water loss is an inevitable consequence of glycogen and fat mobilization. Drinking more water is recommended during the weight loss program to compensate for the body's water loss. It also suppresses the appetite, boosts the metabolism, and, at the same time, lowers the risk of dehydration and also allows a person to follow an exercise plan.
Water loss is necessary for the weight loss plan to be successful, and most weight loss is associated with the loss of water. So, it is perfectly healthy to lose water unless there is no risk of dehydration, as it can complicate the weight loss program. Allow the body to remove excess water while drinking water to avoid the risk of dehydration. Use only simple water with zero caloric value. Several ways to reduce the water weight are reducing sodium intake (sodium retains water), exercising regularly, using dietary supplements, taking electrolytes, having a healthy sleep, taking healthy foods, and using diuretics (water pills) after discussing with the doctor and increasing the intake of water.
Muscle loss means the shrinkage, weakening and loss of muscles caused by nutritional and dietary deficiencies, disease, and lack of use or injuries. It is not a desired type of weight loss.
The human body contains hundreds (~600) of different muscles, most of which are the skeletal muscles attached to the bones and help move the body. These muscles form 40-50% of the total body weight. Besides this, the cardiac muscles keep the heart beating while the smooth muscles help function internal organs. Muscle loss (muscle atrophy) is due to various reasons like prolonged physical inactivity (the body breaks down the inactive muscles to conserve energy), poor nutrition, particularly a diet deficient in proteins and vitamins, advanced age, genetic factors (e.g., susceptibility to spinal muscular atrophy is determined by different genetic factors), neurological problems and diseases like myositis and polio.
It is not normal for the body to lose muscles. It negatively impacts endurance, strength and functional performance. With time, routine activities become difficult, like performance in sports, jumping, and running, walking, and shipping. In severe cases, basic activities like eating, drinking and dressing also become very difficult. Therefore, it is not recommended to lose muscles as they are very difficult to develop again (not impossible), and muscle building improves body shape and image.
The loss of muscles and body proteins also lowers the ability to cope with diseases and other health challenges like injuries and infections. Excessive weakness often results in dangerous falls, leading to disabilities, fractures and even death. In short, the dietary and exercise plans should be aimed at causing a decrease in fat mass and maintaining or improving muscle mass.
A normal and steady muscle loss occurs with age at a steady rate of 3-8% in each decade after age 30, and this loss gains speed after 50 and 60. This involuntary muscle loss is responsible for losing strength in older age. Besides normal age-related muscle loss, the loss of muscles is also experienced in some diseases known as muscle wasting diseases. These diseases include cancer, heart failure, chronic kidney disease, chronic heart disease, chronic obstructive pulmonary disease (COPD) and prolonged periods of physical inactivity. The loss of muscle mass is a sign to worry about in any disease as it is associated with high mortality and poor disease prognosis.
Surgical Weight Loss
Bariatric surgery is a surgical process that helps a person lose weight by inducing different changes in the digestive system. It is done when other methods like food and exercise do not give any or very few results, and excessive weight endangers the person's life. Different types of weight loss surgeries are available with different methods and pros and cons. For example;
Gastric sleeve: In this procedure, the majority (75-80%) of the stomach tissues are removed, leaving behind only a long, thin tube (called the sleeve). It reduces the food-holding capacity of the stomach and a lower desire to eat by decreasing the production of ghrelin hormone. It is a safer method as a shorter duration of hospitalization is required, and significant weight loss is also reported.
Gastric bypass: It is the most common and reversible surgical weight loss method. It works by decreasing the amount of food a person can eat and reducing nutrient absorption. The surgeon makes an incision at the stomach top and cuts this section from the remaining part, leaving behind just a walnut-sized stomach that can hold no more than one ounce of food at any given time. The surgeon also cuts the portions from small intestines and reduces their length. It is called bypass surgery because the food bypasses most of the stomach and the first portion of the small intestine and directly reaches the middle of the small intestine.
Biliopancreatic diversion with duodenal switch: It is a two-step surgery, and the first step is very similar to sleeve gastrectomy. In the second step, the end part of the duodenum is attached directly to the ending part of the intestine near the biliopancreatic diversion. These steps effectively bypass most parts of the intestines, limiting food absorption and retention. The process is very effective but has some risks, like vitamin and mineral deficiencies and malnutrition.
Bariatric surgery is recommended for a person with extreme obesity (BMI of 40 or more) and those with a BMI of 35-39.9 but with other serious health issues like hypertension, sleep apnea and type 2 diabetes. Sometimes, it is also recommended for people with BMI below 35 who have serious weight-related issues. Bariatric surgery is recommended after a tough screening, and long-term follow-up programs are needed to facilitate the patients and allow smooth recovery.
Although not s substitute for regular exercise and a healthy diet, bariatric surgery is still a healthy, effective and safe option for people with severe obesity. However, it is far from being 100% safe. It is associated with several risks like failure to lose sufficient weight or weight gain, infections, obstructions in the stomach, inability to enjoy food, oesophageal dilation, chronic vomiting and nausea and acid reflux. Long-term complications and risks are hernias, bowel obstructions, ulcers, vomiting, hypoglycemia, malnutrition and dumping syndrome, causing dizziness and nausea. There are also many other disadvantages associated with a particular method or technique.
What are the Symptoms of Weight Loss?
Weight loss is an arduous journey and requires high motivation for success. Still, most people want to know if they are moving in the right or wrong direction and if the weight loss program is working. Here are the symptoms of weight loss, which show that the program is working well.
- A person experiences an improved sense of well-being and feels lightweight. Besides physical health, there is a noticeable emotional and psychological surge.
- The appetite is reduced. It particularly happens if high protein and low carb diets are used as the proteins (particularly the vegetable proteins) cause stronger satisfaction signals than the fats and carbohydrates.
- Muscle tone and strength begin to improve, particularly if muscle-building workouts and a protein diet are added to the plan. Losing fat also causes the muscles to emerge.
- The previously tight-fitting clothes are now fitting easily. The effect is usually very small initially, but it gives the motivation to carry on.
- The person also begins to see improvements in chronic pains, like joint, muscle and bone pain. The studies have found that losing 20% of body weight reduces inflammation and associated pain in arthritic patients, knee pain and the pain around the weight-bearing bones.
- Changes in the body measurements are observable, like reduced waist size, improved chest size and the associated improvement in health outcomes like cholesterol, blood glucose levels and blood pressure.
- Changes in the visits to the bathroom occur due to changes in bowel movement. Adding more greens and limiting the intake of animal foods improves intestinal motility and lowers the risk of constipation.
- The blood pressure is moving under control as lowering the weight reduces the strain on the heart muscles and blood pressure in the core areas, leading to a reduced risk of diabetes and heart diseases.
- Loud snores are no more. Although the relationship between snoring and body weight is more complicated, losing weight is recommended for people with loud snoring and sleep apnea. It will also be comforting for your partner.
- The improvements in mood are noticeable, and the person experiences better energy.
What are the Risks that Might Cause Weight Loss?
Losing weight is not always desired, and an unexplained weight loss without effort is a sign of some diseases. A person should visit the doctor in case of a rapid weight loss of 5% or more of body weight in 6-12 months. However, all causes of weight loss are not serious, and it also occurs in response to a stressful life event. The risk factors responsible for unexplained and rapid weight loss are;
- Hyperthyroidism: During hyperthyroidism, the levels of thyroid hormones increase. These hormones control metabolism, so the rate of metabolism increases. A person with overactive thyroid will burn calories and lose weight even with sufficient food intake. The other symptoms of overactive thyroid, i.e., tremors, disturbed sleep, heat intolerance, fatigue, anxiety and irregular and fast heartbeat, will also be present.
- Diabetes: During diabetes, low insulin means a person becomes unable to use glucose properly. This glucose leaves the body with its rich treasure of calories, leading to excessive thirst and hunger, fatigue, weight loss, blurred vision, frequent urination and dehydration. However, weight loss programs improve insulin, and research published by the American Diabetes Association found that losing 7% of body weight causes significant improvement in insulin sensitivity.
- Inflammatory bowel disease (IBD): An unexplained and rapid weight loss is one of the signs of IBD. IBD is a diverse syndrome, including various diseases like ulcerative colitis and Crohn's disease. The IBD causes the body to go into a catabolic phase, leading to more loss of proteins, digested food and calories. It also lowers the secretion of ghrelin, the appetite hormone. The other symptoms of IBD are fatigue, bloody stools, bloating, diarrhoea and stomach pain.
- Chronic depression: The negative emotions associated with depression negatively influence the appetite, food intake, digestion and absorption. Depression also causes central depression of the appetite leading to weight loss. The symptoms of depression vary from person to person, and some people observe an increase in weight gain and appetite. Depression influences weight more complexly, as some people experience emotional eating and consequent weight gain due to chronic depression.
- Chronic obstructive pulmonary disease (COPD): It is a progressive and chronic disease of the lungs, causing bronchitis and emphysema. Both of these issues damage the lungs and airways, causing poor oxygenation of the tissues. The resultant laboured breathing uses a lot of calories, and some people will note weight loss as a person with COPD needs 10x more calories to breathe normally than a normal person.
- Tuberculosis: It is a highly contagious bacterial infection caused by Mycobacterium tuberculosis and causes chronic and unexplained weight loss and poor appetite. It causes weight loss by disrupting pulmonary and digestive health, as a chronic cough with laboured breathing and chronic wasting diarrhoea are common symptoms. If respiratory signs accompany weight loss, the patient should consult the doctor for the testing of tuberculosis.
- Cancer: Cancer occurs when there is out-of-control growth of cells in the body, and unexplained and sustained weight loss is one of the early signs and is reported by 40% of the patients as the first sign. The patients report a weight loss of around 10 pounds in few months. The uncontrolled cell growth means the resting energy requirements of the body are increased. Cancer also causes internal inflammation, which disrupts the hormones that regulate the appetite causing chronic wasting and weight loss.
- HIV: HIV causes immunosuppression and reduces the ability of the body to fight infections. In advanced stages, a severe immunosuppression occurs, leading to weight loss and other symptoms. Similarly, other symptoms like mouth sores, sore throat and excessive fatigue make eating difficult. HIV also results in an increased risk of secondary bacterial infections and inflammations, resulting in suppression of appetite and an increase in the resting energy requirements.
- Heart failure: Weight loss also occurs in congestive heart failure, a condition known as cardiac cachexia, and 8-42% of cardiac patients experience it. In this condition, the heart can't fill the lungs to cause proper oxygenation of the tissues, or it can't pump blood into the tissues leading to poor tissue oxygenation. The digestive system will not receive enough blood for proper digestion and absorption of the food, and laboured breathing also occurs, which causes the loss of calories. All of these factors contribute the weight reduction.
- Addison's disease: It is an autoimmune disease of the adrenal gland in which the immune system attacks the adrenal tissues, causing tissue destruction. It leads to the deficiency of adrenal hormones like aldosterone and cortisol, which control appetite and metabolism. Lower levels of these hormones will result in poor appetite and weight loss. The other symptoms like salt cravings, hyperpigmentation, muscular wasting Andy weakness, chronic fatigue, and low blood pressure and sugar levels also accompany.
What are the Benefits of Weight Loss?
Weight loss is not easy; many lose interest, are frustrated with poor results, and have difficulty dieting. But here are a lot of health benefits of weight loss which would keep a person motivated. A good thing to note is that a huge weight loss is not needed to experience these benefits, and just a 5% decrease in body weight causes enormous benefits to the body. Here are some health benefits of weight loss which a person need to be aware of;
- A better regulation of blood glucose and diabetes: Weight loss improves glucose sensitivity, often lost in type 2 diabetes. The loss of body fat allows the body to manage blood glucose levels effectively, and losing just 5% of body weight is enough to experience these benefits.
- Better heart health: Weight loss lowers the pressure on the blood vessels, as the heart doesn't have to exert strong pressure to pump blood through a lean body. Lower blood pressure and LDL cholesterol (bad cholesterol) levels reduce the risk of adverse cardiac health events. It doesn't matter if the weight loss is due to exercise, dieting or weight loss surgeries; the benefits for heart health are always there. Obese and overweight people are recommended to lose 5-10% of their body weight to lower the risk of adverse cardiac health events.
- Protection from stroke: Obesity causes hypertension, and this higher pressure strains the blood vessels, increasing the risk of stroke clots. Weight loss helps improve the efficiency of cardiac functions and relieved the blood vessels of this pressure.
- Better mobility: Weight loss reduces pressure on the joints and thus allows better and easy mobility. The studies have found that even a minor 1% decrease in body weight causes a much more significant increase in mobility.
- Improved sleep: Obesity causes sleep apnea which causes sleep disruption at night. It is partially due to the obstruction of airways due to excessive fat in the neck. Sleep apnea is, however complex issue and losing weight will not solve it completely. Yet, a 10-15% loss in body weight help lowers the severity of sleep apnea by 50%.
- Better energy: Better nighttime sleep energises a person throughout the day. Excessive weight means more power is required to move the body. Weight loss also improves respiratory functions, providing better oxygenation to the tissues.
- Relief in joint pains: Excessive weight causes stress and damage to the joints, causing inflammation. An NIH report has noted that losing 10-20% of body weight causes a more significant decrease in joint pain and inflammation than a 5% decrease in body weight. Excessive weight puts heavy pressure on the cartilage, causing excessive wear, tear, and pain.
- Better self-confidence and self-esteem: Weight loss improves self-confidence and mood by enhancing the sense of social acceptance. Weight loss causes a self-perceived improvement in self-worth by causing a feeling of better body shape and body image.
- Better libido: The research on understanding the correlation between libido and body weight is ongoing as many factors are involved. However, weight loss is known to improve the levels of sex hormone binding globulin (SHBG), the protein that bounds testosterone. It causes a decrease in the levels of free testosterone and an increase in the bound testosterone, thus improving the sex drive.
- Lower risk of some cancers: Obesity is a direct cause of 5% of cancers in men and 11% in women. Obesity increases the risk of pancreatic, liver, and breast cancer in postmenopausal women and endometrial and kidney cancer in all women. The association of cancer with obesity is not fully understood. However, it is known that the increased inflammation of internal organs due to the excessive visceral fat surrounding them has a role.
How does GP diagnose Weight Loss?
The unintentional and unexplained weight loss is a sign of some internal health issues which need to be addressed by the doctor. The doctor first takes careful history to pinpoint the cause of the problem. Then, the physician will undertake a thorough physical examination to rule out the factors like external tumours, parasitic infestations, infections, or lesions of any chronic and lingering disease. The physicians also review the nutritional plans of the patient. Given these findings, the doctors often recommend blood tests, radiological examinations, and urine or faecal tests to explore the cause further. The patient must collaborate with the doctor and avoid hiding signs or symptoms. The following tests help medical professionals to diagnose the cause of weight loss.
Blood tests: The choice of blood tests depends upon the initial clinical findings. The Common blood tests are:
- Complete Blood Count (CBC): The CBC helps diagnose cases like anaemia (loss of RBCs) and infections. Anaemia is often the cause of unexplained weight loss in women. Likewise, internal conditions are also diagnosed by CBC.
- Liver function tests: These tests diagnose the liver diseases like hepatitis, liver cirrhosis etc.
- Thyroid panel: It diagnoses hypothyroidism and hyperthyroidism.
- Kidney function tests to detect kidney diseases.
- Electrolyte tests: The electrolytes, especially calcium, sodium, potassium and chloride, are lost during diarrhoea, vomiting, dehydration and severe burns, causing weight loss. These tests help the doctor to initiate fluid and electrolyte therapy.
- Inflammation markers: Some tests like C-Reactive protein and erythrocyte sedimentation rate detect the non-specific causes of internal inflammation.
Testing procedures: Some testing procedures are also helpful. For example, endoscopic procedures like colonoscopy or upper gastrointestinal tract endoscopy are done to search for the intestinal issues responsible for weight loss, like stomach and intestinal ulcers and cancers. The echocardiogram helps to diagnose the heart infections like the infections of heart valves.
Imagining tests: Some functional imaging tests are chest x-ray, which diagnoses the conditions like lung cancer, pneumonia etc.; computerised tomography scan (CT scan), which scans the abdomen and chest for any problems; magnetic resonance imaging and some advanced tests like positron emission tomography (PET) to identify the metastatic cancers.
How can a GP determine if Weight Loss is intentional or unintentional?
Unintentional weight loss is when a person loses 5% or more body weight in 6-12 months without any known cause, like illness or injuries. Although various diagnostic tests help to diagnose it, it remains a diagnostic challenge as its cause for many reasons remains elusive. The differential diagnosis becomes particularly tricky if the person strives to lose weight and experiences more weight loss than expected. In that situation, the testing, in addition to the following differential criteria, is helpful;
Intentional: Intentional weight loss is the expected consequence of weight loss programs, including exercises, nutritional management or bariatric surgery. However, if a person becomes stable after reaching the desired targets and suddenly starts losing weight, it should be considered unintentional weight loss. Similarly, if the past weight loss occurred due to some known cause, and a new wave of weight loss is noted after a stable period, the patient has been exposed to an unknown reason. Some red flags suggest that the weight loss was more due to unintentional causes than intentional ones. These are generalised lymphadenopathy (swelling of lymph nodes all over the body), fever, night sweats, bone pain, hemoptysis (coughing up blood), coughing, dyspnea, polyuria (excessive urination) and polydipsia (excessive thirst), excessive fear of obesity, particularly in young or adolescents girls, visual disturbances in older people, jaw claudication discomfort and pain in the jaw typically after chewing), headaches, Janeway lesions, Roth spots and splinter haemorrhages.
What information should patients provide their GP about their Weight Loss for an accurate diagnosis?
People with obesity often want to lose weight and achieve their weight loss targets, but they mostly find it hard to discuss their problems with the doctor. However, speaking directly with the doctor and cooperating correctly plays a vital role in achieving the weight loss targets. The patient must be plain about his problems and talk freely about their physical and mental health. The following information should be provided to the doctor for accurate diagnosis.
The use of any medications: Some medications used for diabetes, hormones, and drugs for psychiatric issues cause weight gain or make it difficult to achieve the desired target. So, the patient should inform the doctor about the current or past use of drugs.
Eating and drinking habits: The person should inform the doctor plainly about the foods or drinks they are using, their eating pattern (for example, eating only when hungry or using food as a comfort when bored or stressed) and any changes in the dietary habits in the past. The frequency of outings and their choices and likeness of foods should also be explained.
The pattern of physical activities: The patient should inform the doctor about any levels and practices of physical activity like what type of exercises or activities they like, what is the frequency and intensity of these activities, how much time is spent on these activities and if these activities are done alone or in a group.
Medical history: The patient should inform the doctor about current or past illnesses, how they influenced the body weight, the treatments used, and the rises or falls in the body weight during and after the treatment—any chemotherapy in the past, blood disorders and, in short everything about the health. If possible, visit the doctor with a complete health record, like the changes in BMI over the last year, the changes in waist size, and the fluctuations in body weight over the previous few years.
Currently ongoing chronic conditions: The patient should inform the doctor about persistent chronic illnesses like diabetes, heart disease, chronic liver or kidney disease, hypertension, hypercholesterolemia, hypotension, joint and bone pain etc.
Emotional issues: Many times, weight fluctuations are related to emotional health. The patients need to explain everything related to relationship issues, family issues, and past or currently ongoing emotional trauma and how they respond to trauma by increasing or decreasing their food intake.
Information about past attempts to lose weight should be provided, like what sort of treatment was used, how long it was carried out and how it influenced the body weight.
Information about sexual life like erectile dysfunction, the long-term use of ED drugs, the use of hormones as hormone replacement therapy, the use of hormonal contraceptives, pregnancy, menopause, miscarriages, cancers in the reproductive organs and the issues like polycystic ovaries, prostate cancers, or any sudden changes in the sexual functions and activities.
Information about recreational drugs like alcohol, smoking, addictive drugs, nicotine-free vapes etc., should be provided. Information about past and discounted use should also be provided.
What are Treatments for Weight Loss?
Given the risks associated with obesity, the doctors recommend to lose weight. Treatment for weight loss needs a comprehensive program and heavy commitment by the patients. The program should include the following:
- Nutritional management.
- Weight loss drug.
- Control of lifestyle risk factors.
- Changing habits.
- Use of digital devices for monitoring physical activities.
- Dietary supplements.
- Use of special purpose diets and bariatric surgery in severe cases.
Weight loss is, however, not limited to these options, and obese people need to consult weight loss professionals for guidance about more effective and safer methods.
Weight loss medications
The doctors often prescribe the weight loss medications or diet pills to people in the age group 18-65 years, have a BMI of 30 or more and have other obesity-related health issues like diabetes, hypercholesterolemia and hypertension and need immediate treatment. These anti-obesity drugs use various mechanisms to work, like reducing food cravings and appetite, and many weight loss pills have entered the market over the last few years. The approved medications recommended for weight loss are;
- Phentermine (Lomaira, Adipex)
- Phentermine/ topiramate (Qsymia)
- Lorcaserin (Belviq)
- Naltrexone/ bupropion HCL
- Liraglutide (Sexenda)
- Victoza (Liraglutide)
Phentermine is a stimulant, just like amphetamines. It suppresses the appetite and is among the oldest available treatments for obesity. Lorcaserin is a recently approved weight loss pill. It selectively targets the hunger receptors in the brain and thus reduces food intake by making a person feel full. Topomax/ topiramate reduces appetite and encourages weight loss. It is an anticonvulsant used to treat convulsions, seizures and migraines. A low dose of this drug is enough for weight loss treatment.
Contrave has two drugs, bupropion HCL (an antidepressant) and naltrexone HCL (used for treating opiate addiction). Both of these medications work together and suppress food cravings and appetite. Victoza (Liraglutide) is an injectable drug that suppresses food cravings and lowers the appetite. Diabetic people also use it to reduce blood glucose levels. Saxenda (Liraglutide) is an injectable drug that controls food cravings and suppresses appetite. These are prescription drugs and need to be prescribed by the doctor, and self-medication should be avoided.
Weight loss devices
Some weight loss devices have entered the market with a claim to treat obesity that is not responding to other treatments. Since they are novel ideas, the information about their safety and efficacy could be more extensive. The following types of devices have entered the market.
Stomach balloon system: The doctor places a few balloons in the stomach through a tube from the mouth. After placing the balloons in the stomach, they are filled with salt water to create a sense of gastric fullness. This sense reduces appetite by lowering the neurogenic stimulus of desire.
Stomach emptying systems: This system uses pumping to drain some stomach contents after meals. This system has a tube connecting the stomach's interior to the outside. After 20-30 minutes of the meal, the pump drains the stomach contents into the toilet.
Electric stimulation systems: These systems use a device the surgeons place in the stomach through laparoscopic surgery. These devices block the neurogenic communication between the brain and the gut.
Weight management programs
The weight management programs are comprehensive programs formulated by weight loss experts who also help during the program's implementation. Different weight loss techniques like exercises, low-calorie diets and changing lifestyle and eating habits are used. The key to success is to stick to these protocols. Some specialists offer services in groups or individual sessions, and digital devices like pedometers, smartphones and accelerometers are used to measure how a person is sticking to the plan. Several websites are also offering online weight management programs.
Change of habits
New habits are easy to plan but difficult to stick to. However, with a proper plan, patience, regular support, and continued effort, it is possible to lose weight and improve health through better habits. The following practices will allow a person to stick to any plan successfully.
Accept that setbacks are normal: Nothing works 100% according to the plan, and occasional lapses like eating heavily at some family or friend gathering or events in normal. However, the important thing is to return to the weight loss plan as soon as possible. A person should eat only when at the kitchen table or in the dining room. Avoid random eating or treats at home or the workplace and use digital monitoring devices to track physical activity and food intake.
Set flexible goals: Setting goals helps a person follow the plans. However, these goals should be flexible and adjustable to changing situations. For example, rather than having a regular walk for 20 minutes, set a target to spend 20-30 minutes on the walk after a meal. If a person misses a walk on Sunday, it should be done the next day.
Seek regular support whenever needed: Help from the healthcare professionals and encouragement from family, friends and colleagues is very helpful. If missing, a person can request it, or another practical alternative is to join some important community support groups.
These surgical procedures help in weight loss by making several changes in the digestive system. Bariatric surgery is often the last resort for people with extreme obesity (BMI of 35 or more), and when other methods have failed and the patient's life is in danger. It is also an option for lower levels of obesity which is complicated with other complications like sleep apnea and type 2 diabetes.
This technique used an alternate day approach means a fed day with average and unrestricted calorie intake, followed by a fast day with zero or taking just 25% of the required calories. Although anecdotal evidence is available, no long-term studies have been done to explore its efficacy and safety.
Special purpose diets
Special-purpose diets like low-calorie diets are designed to reduce caloric intake heavily. For women, these diets are designed to provide 1200-1500 calories daily, and for men, they are designed to provide 1500-1800 calories daily. However, it should be adjusted according to the person's specific needs. A low-calorie diet, including all essential nutrients, allows to lose weight without experiencing nutritional deficiencies.
What Are Some Common Myths About Weight Loss?
Weight loss is a widespread fantasy, and there is a lot of gossip about it in society. Sometimes, traditions and myths are so common that it becomes impossible to separate facts from myths. Here are some myths about weight loss and their scientific reality.
The following are common myths about weight loss:Starving is the best weight loss treatment.
Cutting drastically on diets doesn't give any good results. Such a course of action often results in cessation of treatment in between and causes more weight gain. Such a diet is missing essential nutrients and is extremely hard to be maintained for a long. Cutting the vital nutrients results in severe and often uncontrollable food cravings, more eating and more weight gain.
Heavy exercise is the best way to lose weight.
It is not necessarily true, and making small but persistent changes in lifestyle, physical activities and dieting is better than heavy and unsustainable exercises.
Healthier foods are costly.
It depends upon local market factors and what a person perceives as healthy food. Healthier foods are simple fruits and vegetables that are way less costly than fast foods, energy, and sugary drinks.
Carbohydrates cause weight gain.
While it is true in some sense, carbohydrates are necessary for health and should not be viewed as the sole cause of weight gain. Wholemeal carbohydrates like bread, brown rice, and potatoes without frying and with skin, and whole grains are a source of fibre and help in the weight loss journey.
Some foods boost the metabolism and help in weight loss.
Metabolism is the sum of all the chemical reactions in the body and is necessary for life. While some drinks and foods are available in the market that claims to increase the rate of metabolism and burn calories, the scientific evidence supporting these claims is lacking, and sometimes, these foods add more calories to the diet.
Slimming pills are safe for weight loss.
While some slimming pills are practical, not all do so. Some often contain harmful ingredients that are damaging to health.
Drinking more water allows a person to lose more weight.
Water has zero calories and reduces the cravings for snacks. However, it doesn't cause weight loss in itself. It aids in the weight loss journey by keeping a person properly hydrated.
Skipping regular meals is an excellent option to lose weight.
Weight loss needs cutting on regular calories, and just skipping meals is not a good idea. It results in a deficiency of essential nutrients and tiredness. It also increases the likeness or cravings for unhealthy snacks.
Leaving snacks helps you lose weight.
Although some unhealthy snacks cause disturbance in weight loss, snacks are not a problem. Sometimes, people with a healthy lifestyle need a snack in between meals to maintain energy levels. It is better to replace unhealthy snacks (chocolate, crisps) etc., with healthy snacks (fruits and vegetables).
Foods with low-fat labels are a good choice
It is not always true, and a person must read the labels carefully before choosing food.
Is it better to focus on Diet for Weight Loss?
No, focusing just on diets promises little. Any results will likely be temporary, and a comprehensive weight loss program is required. Various low-calorie diets have demonstrated their effectiveness in causing weight loss. However, it is essential to note that focusing just on dieting is not helpful as weight loss due to diets only is likely to be temporary, and weight gain starts again as soon as a person reverts to the regular dieting routine. After all, it is impossible or difficult to stick to low-calorie diets for life. Fats are mobilised much earlier and faster but regain quickly, while muscles take harder and longer to get a shape, but this change will likely be more permanent. So, it is better to include a better diet as a part of a more comprehensive weight loss program involving other aspects like exercises, diet pills etc.
Another thing to note is that the diet is an effective way to create a caloric deficit. However, low-calorie diets take a lot of work to follow for a long time. On the other hand, an approach involving a good diet and physical exercises seems more sound as activities boost the metabolism and help burn calories.
In contrast, a good diet takes care of nutritional deficiencies. A well-balanced diet containing various nutrient-dense foods like healthy fats, vegetables, fruits and lean proteins is good for weight loss. The foods to be avoided on a weight loss plan are sugary, high energy and processed foods. Other things to consider while using the diet for weight loss are to eat mindfully and reduce portion size.
Is it better to focus on Exercise for Weight Loss?
No, it is not a good idea to focus entirely on the exercises for weight loss. Although exercise helps achieve the desired weight, it is not the only factor. Nutrition and dietetics play a more crucial role in weight loss. If a person takes high calories through sugary drinks and high-energy foods, the exercises can't help achieve the targets. However, activities have many other benefits that benefit overall health, like better endurance, muscle health, healthy cognitive functions, better mode, lower risk of cardiovascular diseases, and lower risk of metabolic diseases like hypertension, heart diseases, diabetes and hypercholesterolemia. All of these factors indirectly help in the weight loss journey. Exercises are helpful as they prevent a regain of weight after initial weight loss once the initial goals have been reached.
Finally, it is essential to note that nutrition and weight loss have benefits, and the exact choice of strategy varies for each person. Generally, nutritional factors have a more prominent role, as the exercise plans work only with better nutrition. However, better food still helps without heavy exercise. Since exercises add many other benefits to overall health, they add to the overall weight loss journey.
Can Weight Loss Supplements or Diet Pills be Effective for Weight Loss?
Yes, weight loss supplements and diet pills are adequate, but their effectiveness depends on various factors. Some of these products, like fat burners, have some ingredients like Capsaicin, caffeine, L-carnitine, Resveratrol, conjugated linoleic acid, green tea etc., that lower fat absorption, suppress appetite and improve the metabolism. However, they are effective only when tied to a weight loss program and are primarily ineffective when not used with dietary modifications.
Despite various claims by the manufacturers and anecdotal evidence, scientific investigations have not verified these claims. These pills and supplements are dietary products, not pharmacologically active drugs, and no healthcare agencies must prove their efficacy. Limited double-blind, randomised and good-quality studies have been conducted for these products.
Some diet medications like Saxenda and Contrave, having pharmacologically active ingredients, should be prescribed by the doctor and used under their supervision. These pills have the potential to cause side effects and are not safe for everyone. Even if found effective, the results of these pills are not magical. They should be combined with other weight loss strategies like stress management, getting proper sleep, increased physical exercises, eating a healthy diet and making appropriate lifestyle changes. Moreover, these supplements should be used after consulting the doctor, and all potential side effects should be reported back.
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