We live in a highly obesogenic environment today, and that’s reflected in the alarming obesity statistics. We’re all familiar with the potential (and quite common) consequences of obesity: heart disease and diabetes. But there are less known ones such as cancer, depression, fertility problems, elevated pregnancy risks, fatty liver, autoimmune disease, altered gut flora and elevated low-grade inflammation. Clearly, obesity is worth addressing.
Let me make an important statement right here: If you’re not overweight or attracted to sweets and calorie-dense foods you’re a lucky bastard — not a person with a superior moral character. Eating too much unhealthy food is a perfectly normal response to an abnormal environment. But there’s also much more to the obesity epidemic than junk food and calorie intake. If there is one thing I really took to heart during my doctoral research on obesity and diabetes it would be this: never blame the individual.
Let’s take a step back and have a serious look at all known causes of excess weight, and how to address them.
1. You are eating the wrong foods (for a reason)
This is the big one. There are two possible reasons for this:
A) You believe you are eating well but what you’ve been taught is out of date
This subject has been extensively summarised by others and the simplified, take-home message is: Almost everything you’ve been told is wrong.
Most naturally occurring fats (yes, even saturated) are healthy. Animal protein is good for you, salt is probably ok, while a lot of carbs is probably not great for most people. Sugar and many grains really are quite remarkably bad for you.
I’m a huge fan of lower carb diets, sometimes even ketogenic diets. It’s certainly not right for everyone but a surprising number of people respond exceptionally well to a reduction in carbohydrate intake (while keeping a high veggie intake), both for weight loss and for treating other symptoms. Some studies also support this (ref1, ref2). However, I wouldn’t say a very low carb diet is necessarily more natural than a moderate or higher carb diet. This subject is interesting but very complex and requires a post of its own.
One reason sugar and carbs are such effective drivers of weight gain are their effects on appetite. Another is their effect on inflammation. A third is their effect on insulin, a hormone I’ve studied particularly closely in my research projects.
When you eat carbs, your pancreas releases insulin. Insulin then promotes uptake of glucose and fat into cells in liver, muscle and fat tissue. It’s a powerful signal to fat cells to store energy and grow, grow, grow! Insulin’s main role, however, is anti-catabolic: it blocks the use of energy. Among other things, insulin inhibits a process called lipolysis (the breakdown of fat inside cells). So if insulin is unnaturally high throughout the day the breakdown of body fat can be effectively blocked, making it hard to lose weight. In fact, one symptom of untreated type 1 diabetes (when you can’t produce enough insulin) is rapid weight loss despite unchanged energy intake. By trying a low carb diet you could get the positive effects of low insulin without the dangerous effects of high glucose and ketoacidosis.
I also believe that looking beyond macronutrient (protein/carbs/fat) composition can be vital. Many report that excessive dairy intake can stall weight loss even when total carbs are low, so adopting a paleolithic or paleo-ish diet can improve weight loss further — possibly by fixing underlying problems such as inflammation, gut microbiota composition and secondary hormonal issues.
Solution: Try a paleo diet, a low carb diet, or a combination thereof. Observe how you respond.
B) You are well-informed about what you should and should not be ingesting but it’s virtually impossible for you to consistently follow any diet at all
If you’re indeed up-to-date on what to eat to be healthy and you’ve tried to change your diet but can’t manage to stay with it, food cravings or addictions could be involved.
Your brain might’ve been viciously kidnapped by the sugar reward system, which works in a particularly sly manner, involving both dopamine and opioid effects. Meals with a high glycemic index (GI) will produce more cravings than low GI meals; the more sugar you have, the more you crave.
Sugar in the amounts that we’re exposed to today is so new that we’re not equipped to handle it. This much sugar has never been available and throughout our history it was never crucial for Homo sapiens as an organism to develop a mechanism for moderating sugar intake. And it’s increased from 1.8 kg per person and year in 1700 to around 65 kg in 2000 (when merging data from UK and US populations). That’s a 36-fold increase in the last 300 years!
Sugar addiction is real and can make you behave like a lunatic. You may steal candy from your kids, drive to the store in the middle of the night, frantically raid kitchen cupboards and end up stuffing your mouth with anything sugary you can find like caramel topping straight from the container (been there, done that!).
Staying away from sugar completely over a longer period of time will usually cause your cravings to go away. However: one slip could throw you back on the wrong track, no mercy. If you’re particularly sensitive, even fruits can trigger cravings for more and “heavier stuff”.
Dietary fat intake, on the other hand, leads to the release of satiety hormones and does not trigger hunger.
Other types of cravings
Besides sugar, there are other components of modern food that can trigger cravings or excess food intake.
- Monosodium glutamate (MSG), often found in processed food, has been associated with weight gain and is known to stimulate appetite. However, there are also contradictory findings.
- Gluteomorphin is an opioid which gets formed during the incomplete digestion of the protein gluten (from grains) in the human digestive tract. It’s capable of passing into the bloodstream and cross the blood brain barrier. Hypothetically, gluteomorphins can trigger wheat addiction. I’m not surprised. Not when you look at the way people (and I) behave around bread.
- Caseomorphins from dairy. See the point above.
- Carbohydrate cravings driven by a lack of serotonin can contribute to over-eating behavior.
Food palatability and accessibility
Researchers sometimes talk of the hyperpalatability of food. Food today is so extraordinarily palatable that it’s a mystery how not all of us are dangerously fat. Human beings (and all species) are hard-wired to search for energy-dense foods, to come back for more again and again.
Also, food is so accessible that we can go for months and years without ever needing to feel truly hungry. Many of us (including myself) almost panic when hunger strikes, as if we might perish right then and there.
Listen to your body? Please don’t
I’ve heard people claim that particular cravings is the body’s way of getting nutrients that we are deficient in, such as vitamins and minerals. Thus, you should “listen to what your body signals” and eat what you are craving. I definitely cannot support this, in general. It might be true in a more natural setting, i.e. in an environment where bodily signals are not overridden by the extreme palatability of the foods on offer. But it’s not true today: just look at where our cravings has led us. If it was true people would be craving nutrient dense foods, but they aren’t. Craving ice cream is something altogether different from craving non-nutritive substances such as in the case of pica.
Cravings induced by microbes
It’s known that some intestinal microorganisms cause cravings and a few mechanisms underlying that has been identified. Many bacteria and parasites influence their hosts’ behavior to their own advantage, i.e. makes hosts eat or do things that increase their own growth or ability to spread. Some claim that fungal overgrowth in the intestines (usually of Candida albicans) can cause sugar cravings. Fungi thrive on sugar, so it makes sense and it might be true, even though I haven’t yet found any scientific studies that have investigated this particular subject.
Solution: Try to completely exclude foods that induce cravings, especially sugar, and observe if your cravings subside. I realise that doing this is the very problem for people with food addictions, but knowing that even small amounts can trigger cravings is perhaps helpful. Remove these foods entirely from your house if you can, as reduced accessibility is the key to success here. If you suspect Candida overgrowth, test for it.
2. You are exposed to (or expose yourself to) a high level of stress
Weight gain because of stress can be due to 1) a direct hormonal response to stress and its metabolic consequences or 2) overeating as a self-soothing technique.
Metabolic consequences of stress
While there are several “stress hormones”, cortisol is the no 1. Released from the adrenal as a response to stressful situations, it affects multiple processes in the body. Our species is adapted to short-term bursts of cortisol, but less so to chronically elevated levels commonly seen in the modern way of life. Different types of stress can cause prolonged cortisol release, such as abuse, work-related stress, conflict, low socioeconomic status, financial stress and trauma. Cortisol has been shown to cause weight gain through mechanisms that involve hyperactivation of the hypothalamic-pituitary-adrenocortical (HPA) axis, increased appetite, and metabolic hormonal dysregulation.
In both women and men, stress leads to a central distribution of adipose tissue, i.e. belly fat – fat accumulation in the abdominal area and between the internal organs. This kind of central fat tissue, called visceral fat, is believed to have dangerous metabolic consequences.
Overeating because of stress
This is something I’m all too familiar with myself. Indulgence as a stress-reducing or self-soothing technique may be quite effective in the (very) short-term, but can be devastating in the long run — especially when stressors are frequent (this thing we call daily life), and/or severe (such as being bullied). In this type of situation, energy-dense foods are primarily chosen (lettuce doesn’t quite do the trick). Stress-eating behavior has been connected to weight gain and binge eating.
Solution: 1) Stress-reduction is paramount to health. Reduce your exposure to stress as best you can. What sources of stress can you eliminate completely? Which can be reduced? 2) Change the way you deal with stress. Learn stress-reducing techniques. 3) Eat a nutrient-dense diet, and possibly, add supplements that help your body moderate your stress response. 4) Exercise 5) If you believe that you’ve developed an abnormal, extreme sensitivity to stress, try to find out the cause. 6) If you want to investigate your stress hormone levels, test for it using a cortisol 24h salivary test, or the more comprehensive DUTCH test.
3. You have hormonal issues interfering with metabolism (caused by something)
Hormonal disturbances, such as testosterone deficiency and low levels of thyroid hormones as seen in Hashimoto’s can cause an inability to lose weight, despite holding back on energy intake. Note that hormonal problems can be both a consequence and an effect of obesity, and that such issues always have a cause – often inflammatory. Hormone replacement therapy is a bandaid and doesn’t deal with the underlying causes.
Solution: Take a test to reveal any hormonal issues, such as a common thyroid panel and/or the DUTCH test. Find and treat the underlying causes of those issues.
If you decide to take a thyroid panel, it should preferably measure free T4, free T3, TSH, reverse T3, anti-TPO, anti-TRAK, and anti-thyroglobulin antibodies.
4. You are inflamed (caused by something)
While it’s established that obesity is a state of elevated inflammation, partly because of inflammation coming from the fat tissue itself, inflammation can also cause weight gain. Inflammation can both be a cause and consequence of obesity. Excess inflammation, probably from any source (summarised in part 1 of my article series), can cause both unwanted weight loss and weight gain, depending on the individual response. Inflammation can lead to loss of insulin sensitivity, which in turn causes metabolic issues such as type 2 diabetes.
Solution: If you have other signs of inflammation (such as any from this list), find the underlying causes and address them.
5. You have gut bacteria disturbances (caused by something)
Scientists have found that certain fecal bacteria become more plentiful as people (and mice) gain weight.
Firmicutes and Bacteroidetes are the two major species groups of bacteria in our intestines. Firmicutes seems to promote inflammation and weight gain, whereas Bacteroidetes seem to promote weight loss. This study shows that Firmicutes dominate in western countries, it also shows an extreme difference in the intestinal microbiota composition between children eating a western diet vs. a more traditional African high fiber diet. Another study found that obese people had about 90% less Bacteroidetes than those of normal weight. The same study demonstrated that weight loss reduces Firmicutes while increasing Bacteroidetes. Further, a non-diverse (western) diet depletes the microbiome, while larger microbial diversity (hosting many different types of bacteria) improves satiety signaling.
Conclusion 1: A western diet, and weight gain, changes the proportions of different kinds of intestinal bacteria.
Firmicutes extract energy from foods more efficiently, which leads to weight gain in their host. This really cool study showed that transferring feces from an obese human twin to the colon of a normal weight mouse makes the mouse gain weight. Conversely, transferring feces from the other (skinny) twin to an obese mouse didn’t cause weight gain.
The same has been done with mice, where the weight gain following transplantation occurred without any increase food consumption.
Conclusion 2: The change in bacterial balance further consolidates the overweight state by increasing energy uptake from food.
In summary, the relative abundance of certain intestinal bacteria is both a cause and a consequence of obesity, and fecal microbiota transplantation is gaining traction as a way of treating some ailments. First emerging as the most effective treatment for Clostiridium difficile, some people and researchers also report high success rates in the treatment of both inflammatory bowel diseases and other autoimmune conditions.
The future will reveal whether fecal transplants will ever be a standard treatment for obesity. Some people are performing DIY transplants at home. This carries some risk (you have to test for infections and parasites in the donor etc.), but I consider it an interesting development and I always inform my clients about the existence of fecal transplants when I believe it potentially helpful.
However, intestinal flora is not static and it might be possible to alter it substantially without resorting to fecal transplantation.
Solution: Test your gut flora composition (not always necessary). Take actions to improve gut flora by changing and diversifying your diet, adding probiotics (although the efficacy of oral probiotic supplementation is debated), taking probiotic enemas, reducing stress, getting enough sleep, or exploring other methods such as fecal microbiota transplants.
6. You have a medical condition affecting adipose tissue
There are several probably underdiagnosed medical conditions affecting adipose tissue, such as Dercum’s disease (adiposis dolorosa) and lipedema. Fat tissue pains and lumps are often part of the picture, and sometimes (but not always) so is a sudden and dramatic weight gain. Inflammation seems to be a very important component, and onset is sometimes slow, sometimes rapid. Lipedema often manifests as exaggerated fat accumulation on hips and legs. These diseases are much more common in women but also occur in men. Some with these conditions appear to respond well to diet changes and various treatments. I’m currently involved with a research team, and if we’re able to raise research funding I will join them and work part-time to investigate the pathology and etiology of Dercum’s disease, and to pinpoint what differentiates Dercum’s disease from lipedema.
Also, if you suffer from unexplained weight gain, you might have to rule out Cushing’s disease which is caused by a state of excess cortisol, sometimes due to a tumor.
7. You are on pharmaceutical drugs that cause weight gain
Solution: If you are on prednisone, anti-diabetic drugs or antidepressants, aim to find the underlying causes of your symptoms (i.e. inflammatory disease/diabetes/depression). If you manage to pin them down and find the appropriate solutions, you can hopefully get off medication and perhaps enjoy weight loss as a side-effect.
You could have a rare genetic condition affecting the leptin or leptin receptor gene or other genes. In people suffering from monogenic mutations (mutations in a single gene) causing obesity the signs are clear early in childhood. (Although weight gain already in childhood is obviously not usually a signs of a genetic condition – it’s much more likely to have another cause.) In general, studies on the genetics of obesity have been largely disappointing (read my critical comment on research of the genetic origin of modern diseases here). If obesity was predominantly genetic we would simply not see the steep increase we observe today. Therefore, I consider the genetic contribution thoroughly uninteresting and irrelevant if we want to understand what’s really going on. Studies on genetics and obesity are generally unhelpful to the individual.
9. You suffer from sleep disturbances or a disturbed circadian rhythm
Not getting enough sleep has been linked to higher risks of weight gain, through several mechanisms. One of them is an altered gut flora. Also, if you stay up when it’s dark and sleep until late in the day your circadian rhythm is out of sync with your body’s evolutionary preferences. This can be voluntary or demanded by your work schedule. Nevertheless, it has been coupled to obesity and a disturbed metabolism.
Solution: Find out the cause of your sleep disturbances. Can’t fall asleep or wake up early? Something is causing a disturbance in your neurotransmitter levels, be it stress, blue light exposure, a chronic infection or something else. Are you voluntarily staying up late at night? Do what you can to turn your body’s clock back.
10. You have been exposed to obesogens
Obesogens are compounds of dietary, pharmaceutical or industrial origin that can cause weight gain, usually by disrupting normal metabolism. I’ve already mentioned a few of them. Hormonal effects are sometimes involved. Some additional obesogens are bisphenol A, some pesticides and phytoestrogens from soy. There are also obesogenic viruses that are more common in the obese.
What about exercise?
You may have noticed that I don’t mention exercise. It’s not that I think exercise is irrelevant to health (quite the contrary), it’s just that some scientists believe that exercise is not a very efficient way of losing weight, at least not in the short run.
There are several reasons for this. You may end up eating even more after exercise, either as a treat or because your hunger increases. Some studies suggest our bodies – tenacious energy savers as they are – tend to want to decrease energy usage after exercise, so that small movements (fidgeting) we otherwise tend to make stop, and the net energy loss ends up as zero.
It’s also hard to “burn off” foods of a western diet by exercising. You would have to walk or run for a very long time to burn the energy contained in a cheese sandwich. It may simply be that single bouts of intense exercise a few times a week can’t measure up to the way our hunter-gatherer ancestors moved. But some researchers don’t agree, and maintain that exercise can aid weight loss. Personally, I’m still undecided. But at least we can conclude that exercise is definitely not required for weight loss.
Which category do you fall into?
If you are struggling with weight loss, how do you know which category you fall into? Perhaps you even fall into more than one category. Talk to someone able to take a good history and recommend the right tests, preferably someone in the complementary medical field as conventional medicine sadly often fails in this regard.
If you have a love of dry scientific writing you can read my doctoral research thesis to get a detailed review on fat tissue, fat cells, diabetes and the connection to inflammation. All the dusty poor doctoral theses of the world would do anything to get a little bit of love and attention. 😉