To answer that, it’s important to establish what we know about the biology and behaviors associated with obesity and to clarify the myths with the help of scientific evidence.
Obesity conforms to the first law of thermodynamics – that is, it results from the imbalance between calories that go in and calories that come out. Although that simple equation remains true, we now recognize the complexity of appetite regulation, physical activity patterns, eating behaviors, and metabolism of individual nutrients. Therefore, managing obesity requires a personalized approach that involves many permutations of the traditional “eat less, exercise more” adage.
Is There a Genetic Component?
Obesity is highly heritable. However, genetic variations have shown only a modest effect and therefore cannot explain fully the predisposition to obesity. Obesity in a mother prior to conception and during pregnancy also increases the risk in her offspring for obesity. These effects can be perpetuated into the next generation, creating a vicious cycle of obesity.
Why We Eat And How We Eat?
Signals from our gut and fat stores relay information in a bidirectional pathway to our brain to tell us when we are hungry or full. While some of these signals translate into conscious decision-making, many do not. So, what determines when we eat, particularly when food is always available? It usually comes down to habit, convenience, cost, and social factors.
Eating patterns are affected by more than the caloric and nutritional value of food. Our consumptive behaviors are driven by previous experiences, timing, and the emotional and pleasurable aspects of eating. Modern foods and drinks are not only ultra-processed with added sugar, but they are also ultra-appealing to many of our senses, seducing us to consume even more, to the extent that we become almost “addicted” to some of these foods.
Often, we are simply unaware that we are eating too much (our signalling pathways may be faulty). So simply going by “listen to your stomach” can be dangerous.
What Changes Occur When We Lose Weight?
When a person loses weight, adaptive responses of the metabolic, neuroendocrine, and autonomic pathways are invoked to reset weight to the previous higher weight, such as:
- Levels of the hunger hormone, ghrelin, rise robustly;
- Levels of leptin, the key suppressor of food intake, fall;
- The resting metabolic rate (especially in case of muscle loss) declines;
- Skeletal muscle adapts to become more efficient, requiring fewer calories for the same work (progressive overload is needed).
How Important Are Diet & Exercise?
Exercise is looked upon as a means of having fun, burning calories to lose weight and socialising rather than maximising performance. When the intent is faulty how can it lead to optimal results? A structured program that defines and balances weight training and cardio with a diet that complements it is the way to go. These can definitely counter some of the adaptive responses that come with weight loss as mentioned above and help sustain the loss.
And finally, modern day automation has taken away even the most modest of physical activity that even an hour of intense exercise cannot offset. So we need to sit less and move more- throughout the day!
What About Psychological Effects?
Exercise has definitely proven to optimize behavioral change as daily stressors can put us off track easily.
Despite initial adherence and discipline to lifestyle changes, the novelty of weight loss begins to wear off and behavioral “fatigue” sets in. Many weight-loss interventions fail because of a short-term duration and lack of follow-up.
Unfortunately, despite the number of modalities for treating obesity, there’s no quick fix. Even with the most extreme of interventions (ie, starvation and weight loss surgery), without making lifestyle modifications, the weight loss will not be maintained.
Losing weight – and more important, maintaining it (two distinct entities)—require a lifelong commitment to lifestyle modifications. Only when that individual perseveres will he or she prevail at keeping the weight off. Results are self perpetuating.