LivingObesity: It is not solved only with diet and...

Obesity: It is not solved only with diet and exercise

Maybe you think I’m exaggerating, after all, it’s a matter of energy balances, right? A person is obese or overweight when they consume more calories than they expend, right? Therefore, the opposite is also true, to lose weight it is enough to “burn” more than what is consumed.

Well, the reality, dear reader, is much more complicated. The first thing to consider is that obesity is, in itself, a disease. Even so, the most common thing when someone thinks about obesity is that they do not even think about the concept of disease. And I am not referring to those cases that are obese because they suffer from a disease, I am referring to the fact that obesity is itself a disease , and those who suffer from it are sick. And this is not what I say, it was officially declared by the World Health Organization (WHO) in 2014.

Here it should already be suspected that the matter is not as simple as subtracting the calories that are “burned” from those that are ingested . And being that we are talking about a disease that is already at an epidemic (and even pandemic) scale, obviously it is not a problem that we have known how to handle correctly. In fact, since 1975, obesity has nearly tripled worldwide . And today it affects so many people (5 years ago, more than 1.9 billion adults who were at least overweight, and more than 340 million children and adolescents -from 5 to 19 years old-) that it seems normal to many of us. seeing sick people everywhere or even in ourselves.

The problem with a simplistic approach such as energy balance is that it is part of the reasons that are listed for which we have reached this increase in the rate of obesity.

 

So… What is obesity?

Obesity is a multifactorial disorder. This means that there are many factors involved in its development (more than a hundred, in fact). With more than a hundred factors related to obesity, the reduction of energy balance seems more and more absurd, don’t you think? Genetics, environment, development, and behavior all play a role in how likely a person is to be obese.

 

Let’s start with the complex: the adipostato

There is a theoretical mechanism in our brain that works like a thermostat, keeping a person’s body fat level within a narrow range despite considerable variation in diet and activity (set point theory). In other words, this concept tells us that your brain has its own sense of how much body fat you should have . And it has a complex system that very precisely regulates your energy consumption and expenditure to keep you within the so-called “body fat reference point”. So that whole energy balance equation, which, yes, makes sense on paper, but it’s not something you voluntarily control. Your brain regulates the calories you eat based on the calories you burn. You may have times of having a few kilos more or less, but the usual thing is that you always move in the same range . And to stay within that range (which, by the way, is regulated by the part of your brain known as the hypothalamus) your brain needs to know how much energy you have available at all times , and it knows this by “listening” to hormones like leptin, that is produced in your body fat (after receiving these signals from the intestines, pancreas and stomach).

You can think of this as a car. Leptin is the gas gauge that tells your brain how much gas is in your tank . But leptin is only one piece of the puzzle. You have a lot of other hormonal signals that are also involved.

So what happens if a person decides to go on a diet to lose weight? After all, obese people should eat less, right?

 

Not everything is leptin…

The hormones in our body usually live in a balance . That is, if something stimulates X, it is likely that there is something that inhibits it, so that X does not tend to only increase or decrease. Thus, if before we talked about leptin, that hormone that is produced both in adipose tissue (in the long term) and in the stomach (in the short term) and produces a feeling of satiety, ghrelin is also worth mentioning.

Ghrelin is a hormone that, unlike leptin, stimulates appetite (it is produced in the stomach and by neurons in the hypothalamus). We also know of another hormone whose effect is to stimulate appetite, anandamide. This is produced exclusively in the small intestine.

Of course there are a lot of other hormones involved in all this (insulin, CCK, PYY…).

 

What does science have to say about all this?

The quality of the food is (vastly) more important than the calories in the food . This is because the brain cares more about the quality of calories than their quantity. And we have already seen that the thing is about the brain and its stimuli, right?

Regarding exercise, when a healthy person exercises, they maintain their weight . However, what do sick people with obesity usually do in a gym? Try to lose weight. And when they don’t get it (despite the exercise) in a sustained way, it’s a matter of time before they leave the gym. Of course, what many people don’t realize is that even if they didn’t lose weight, they didn’t gain it either. That is, they remained, just as most people would have done in a normal weight range. But of course, that was not the goal, so they stop exercising.

Furthermore, we know from large meta-analyses that the main role of physical activity is to help maintain weight, not to drive very significant weight loss.

There are many more factors related to how our brain regulates weight besides diet and exercise . For example, this process is also affected by many of the medications we take, insufficient or poor quality sleep, or alterations in our sleep-wake cycle, for example in those of us who work at night.

There are also other factors, less modifiable, such as thermogenesis. Thermogenesis is the amount we burn at rest and with activity, and much of it is determined by our genetics.

 

The importance of diet and exercise

If there is one idea that you should NOT take away from this article, it is that diet or exercise are not important . No way! Both are things with an overwhelming amount of evidence that, independent of other factors, they help improve the quality and quantity of life.

Giving up watching what we eat and exercising regularly can be one of the worst decisions of our lives . For this reason, I have felt inclined to make this warning, because this is the Internet, and it is not difficult for someone to misunderstand “the cure for X is not Y” for “Y is useless”. That is not the message.

The message is that there are many factors that contribute to this disease we call obesity. From medical factors, to social, psychological, economic, environmental and even related to fetal development. And that, of course, since it is a disease, it is not a lifestyle choice . Blaming those who suffer from it is not only a flagrant display of ignorance, it is an act lacking empathy, compassion and respect.

 

 

Referencias:

Farias, M. M., Cuevas, A. M., & Rodriguez, F. (2011, 24 de Marzo). Set-Point Theory and Obesity. Metabolic Syndrome and Related Disorders, 9(2), 85–89. https://doi.org/10.1089/met.2010.0090

Harris, R. B. S. (1990, 1 de Diciembre). Role of set‐point theory in regulation of body weight. The FASEB Journal, 4(15), 3310–3318. https://doi.org/10.1096/fasebj.4.15.2253845

Müller, M. J., Bosy-Westphal, A., & Heymsfield, S. B. (2010, 9 de Agosto). Is there evidence for a set point that regulates human body weight? F1000 Medicine Reports, 2. https://doi.org/10.3410/m2-59

‌Müller, M. J., Geisler, C., Heymsfield, S. B., & Bosy-Westphal, A. (2018, 9 de Julio). Recent advances in understanding body weight homeostasis in humans. F1000Research, 7, 1025. https://doi.org/10.12688/f1000research.14151.1

‌Yu, Y.-H. (2017, 17 de Enero). Making sense of metabolic obesity and hedonic obesity. Journal of Diabetes, 9(7), 656–666. https://doi.org/10.1111/1753-0407.12529

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