Integrative Medicine Approach to Overweight & Obesity

©2008 Robert A. Weissberg, MD

This is a very common problem. It may seem simple at first—eat more calories than you burn, and you store them as fat tissue; eat less, and you lose fat tissue. This may be true from a strictly thermodynamic viewpoint, but then the complexity begins. Each human being has a certain metabolic set point, activity level, and "idle speed", or rate of energy use at rest, for utilization and storage of energy. The multitude of factors which relate to overweight include: genetics; early life experiences; family and community based learning; cultural issues; psychological and stress factors; hormone balance; body composition; brain chemistry; the quality of food; activity levels; and, many more.

When people lose weight rapidly, they certainly do burn fat, but also protein from muscle tissue. When they resume the previous habits and gain weight back, it is usually as fat. Repeated cycles of this result the percentage of the body that is fat—at any weight—increasing over time. Fat, as a storage tissue, doesn't burn much energy at rest. Muscle does use energy, with activity, and at rest. This, as the body's percentage of fat increases, the energy use at rest, or basal metabolic rate, decreases. This makes it even harder to lose weight later. This effect can be partially offset by always combining regular exercise with weight loss programs, including adequate amounts of quality protein, and certain dietary supplements, and avoiding extremes. Extreme "dieting" or fasting can actually force the body into an emergency conservation mode, which remains part of the set point later. The body composition can be easily analyzed, which can guide further diet and exercise measures.

Woman and Men can experience weight gains associated with changes in hormonal status. Female menopause is well known, and is often associated with weight gain. Correcting hormone imbalances can he very helpful. Andropause, related to falling testosterone and DHEA levels in some men, is less well recognized, but significant. Men in this situation may gain or lose weight, but usually develop a loss of muscle tissue, with a greater percentage of body fat. Hormonal analysis and thorough evaluation can further determine the best course of therapy.

Metabolic Syndrome includes: elevated fats in the blood; hypertension; high uric acid in the blood; high-normal blood sugars; abdominal obesity. In this condition, the body becomes less sensitive to its own insulin. Insulin is secreted by the pancreas, and enables glucose to enter many cells, including fat and inactive muscle cells. Genetic factors, chronic overweight, chronic stress, and chronic over-exposure to high amounts of sugar are important factors in this Syndrome. About ¼ of people with Metabolic Syndrome can go on to develop Type II Diabetes. The rest of them still have an increased risk of heart attack, stroke, and retinal disease. Metabolic Syndrome can be diagnosed with simple blood tests. Even a modest weight loss can improve insulin resistance, and measures such as aerobic exercise, weight training, reduction of carbohydrate intake, use of certain supplements, can help a great deal. The best approach is maintaining ideal body weight.

Mind-Body approaches are useful in helping people generate the motivation and accomplish the habit changes that are necessary to address overweight. These include: hypnosis; guided imagery; NLP; meditation; coaching; psychotherapy.

It is important to take a whole person/whole system approach to overweight, as so many factors can be involved. This starts with a thorough evaluation by the primary provider, and to then go further, and take an individualized approach, as dictated by the initial findings. Collaboration between the physician, whether MD, DO, DC, ND, dietitian or nutritionist, and other practitioners, is essential for the best possible treatment.