My first year of practice was in Chicago, IL. As a new grad and Institute of Functional Medicine provider I felt naively confident in treating patients with optimistic weight loss goals. I knew there was a decent amount of evidence to suggest that lifestyle interventions were an effective treatment option for overweight or obese individuals. At least that’s what I was reading in the journals at the time. And then there was Katrina, my first weight loss patient. A 45-year-old mom who was an avid cross fitter and was doing everything right from both a dietary and lifestyle perspective. The 6-month weight loss journey that I was lucky enough to be a part of humbled me.
Approximately 70% of adults are overweight or obese and it’s becoming an increasingly common topic during my office visits. Medically speaking, excess weight can increase and individuals’ susceptibility to serious health complications including heart disease, fatty liver, diabetes, and high blood pressure. The prevalence of obesity has grown exponentially in the past four decades which points towards a mismatch between an individual’s gene and their environment.
Weight loss and gain is a complex biological phenomenon with a seemingly infinite number of variables that can disrupt the physiological “set point”. Essentially, the set point theory states that the human body tries to maintain its weight within a physiologically preferred range. Deviations from this set point range through dietary modifications can lead to alterations in metabolism, macronutrient absorption, and hormones that mediate hunger and satiety signaling. These factors can make it difficult to lose weight and or difficult to keep the weight off.
Dietary and lifestyle interventions are usually a first line therapy used in overweight and obese patients that have been appropriately screened to rule out overt pathology that may contribute to weight gain. Lifestyle interventions alone usually offers some tangible benefits to an individual’s BMI and quality of life.
Outside of diet and exercise researchers have found that both sleep quality and stress management also play an imperative role in the weight loss elixir. If an individual is getting insufficient sleep it can lead to excess weight gain through disruptions in satiety hormone signaling. Additionally, hypercortisolemia secondary to excessive life stress can increase an individual’s proclivity towards weight gain. This is where a personalized Functional Medicine approach proves to be most effective.
The novel application of GLP-1 agonists has also started to gain traction as a viable treatment option thanks to some new compelling research. This is especially true for those who have failed to respond to conservative lifestyle interventions alone. These emerging pharmacological therapies seem to be more attractive than the more aggressive, yet effective, surgeries used to induce sustainable weight loss.
I worked with Katrina for 6 months and in that time learned a lot. Weight loss is very complex and non-uniform and as a result takes a certain level of nuance and personalization to treat effectively. After 6 months of ebbs and flows we finally achieved a new biological set point, about 5 pounds under her target goal weight which to this day is one of the most memorable outcomes I’ve had with a patient so far in my clinical career.
Dr. Tanner Wilson, DC, IFMCP is a Functional Medicine provider that specializes in the treatment and management of Chronic Disease.