A Structured Approach to Weight Management

“Eat less, move more”– a phrase that will have anyone who has really struggled with their weight grimacing. It’s a great principle in theory, but in reality, there are so many reasons that it doesn’t necessarily work. There is a plethora of complicating factors to consider, not only the physical eating and moving but factors such as stress, hormones and sleep, which all play an influential part in how easy or difficult weight management is. 

 

This paper will focus on the complexities of adults losing weight. However, it fully acknowledges the in-depth issues related to eating disorders and psychological conditions related to the underweight patient. 

 

When treatment planning for a patient to reduce their weight, there are numerous things to consider.

In order to provide some process and structure at East Riding Aesthetics & Wellness, we follow a pathway (which is tailored for each patient) built on the fundamental principles of:

 

Whilst the issues are complex and multiple, some common themes are explained below.

 

This is the starting point for all our interventions. Without this, our patients are uninformed and disempowered. Education takes up a huge percentage of our time with the patient and includes providing information regarding factors including:

 

Once on the more mature side, metabolism is slightly slower, and often patients are more sedentary. This, alongside comorbidities which can impede adopting a healthier lifestyle, often need some clever workarounds to address effectively.  

 

Of course, exercise is really important. As the saying says, ‘you can’t outrun a bad diet’, which is true, but there are options when it comes to exercise, which can be used to promote our health and wellbeing and optimise our ability to have a good metabolic rate. It’s not just doing exercise which matters, it is the kind of exercise, and when undertaken, that can make a massive difference. Cardiovascular work is brilliant for maintaining heart health and stamina, but it does very little to promote muscle mass which is important for our metabolic health. Both cardiovascular and resistance work can positively impact weight management. However, resistance exercise does have the edge for this purpose.

 

We can do all the right things, but weight management can still be a struggle if we’re not absorbing and digesting our food properly. The gut microbiome is critical in our digestive function, and it’s vitally important to educate our patients regarding this and provide a treatment plan to support good gut bacteria proliferation.

 

Hormones are also closely linked to weight management, particularly for ladies in perimenopause and menopause, which can play havoc with their ability to control their weight.  

 

Insulin is a massively important hormone when it comes to weight management alongside Leptin and Ghrelin. This trio balances hunger, satiety and blood sugar levels; however, it is a fine balance and can therefore be easily disrupted. Amongst other things, excessive stress will do this, as will poor sleep.  

 

When we eat, the body produces insulin in order to manage rising blood sugar levels. The kind of food that we are eating will influence the level of insulin required in order to manage the blood sugar response. 

 

Problems happen when people start to eat the moment they get up and ingest a high sugar/simple carbohydrate diet. This provokes a very high blood sugar response and therefore requires a lot of insulin to reduce blood glucose. If we start the day with a high sugar/carbohydrate breakfast and then have multiple snacks and meals throughout the day, the insulin level required to manage the blood sugar level remains high and gets pushed even higher. 

 

Over time, this becomes a problem for our patients as their body needs to produce increasing amounts of insulin to manage higher blood sugar levels. They also become used to the levels of insulin that are being produced and need to produce even more in order to get similar effects. I often relate this to that of somebody who drinks alcohol to excess. When they first start drinking, they feel the effects of the alcohol quite acutely. Over time they become more used to the effect of the alcohol and therefore need to ingest even more in order to feel the same effects.  

 

This is very similar to how insulin works in our bodies. The problem is that insulin is not an infinite resource. If we have to produce increasing levels of insulin to manage high blood sugar levels, eventually, the pancreas that produces the insulin is going to give up. This is when we step into the realm of type two diabetes. The other side of this is wherever high levels of insulin are being produced. People will put on weight; high levels of insulin will make that an absolute certainty. 

 

Promoting behaviours and dietary habits which keep insulin levels in a normal range and avoiding spikes due to high sugar/carbohydrate intake is one of our key approaches.

 

Mindset is a huge part of the puzzle. We discussed how stress could be an influencing factor when it comes to weight gain, and that’s not just because we might be feeling stressed and therefore comfort eating. It is because of the additional cortisol in our blood which causes a rise in our blood sugar levels which then causes an insulin response. 

 

Therefore, one of the critical pieces of work I tend to do with my patients is around mindset. It can all sound a bit unconventional. However, there is significant evidence to support that having a positive mindset helps to reduce stress. Reducing stress will reduce the cortisol response, and when we have less cortisol, we will have lower blood sugar levels and insulin response. 

 

Helping patients understand a mindset approach can be quite challenging because it feels very unscientific. However, once patients understand how biology works, it’s often much easier to take this approach. 

 

Things I encourage with my patients are simple activities like putting on some music and dancing to help them feel good in their own bodies, to help them move to raise their pulse rate just a little bit and improve their mood while reducing levels of stress. 

 

This can you look different for every patient. Dancing might not be their ‘thing’, but there are any number of other activities that are uplifting and help promote overall wellbeing and happiness. This is an often-overlooked element of weight management and can be critical in supporting patients to achieve successful outcomes simply because when you feel better about yourself, it is much easier to achieve goals and stick to a plan. 

 

The cornerstone of our weight management service is the strength of the multidisciplinary services we partner with.

 

Weight management is a complex problem which requires a multi-modal solution.

 

Psychological issues related to weight management can be massively important. As an example, we need to consider complex issues like the patient who has been sexually abused as a child and, although they may not be aware of it, is using their heavier weight as a way to fend off any further unwanted sexual attention. There are some very deep and complex issues along these lines to be addressed, and it would be absolutely wrong of us to expose these issues without having the ability to safety-net our patients with other appropriate professional support, e.g. clinical psychologists or counsellors; they are a crucial part of our extended team. 

 

Effective patient management and support might involve a whole range of multidisciplinary team members, including but not limited to a weight management doctor or nurse to oversee overall progress, a personal trainer, yoga therapist, relaxation specialist, hypnotherapist, counsellor or clinical psychologist. 

 

Far from being a simple and easy metabolic issue to address, weight management is highly complex both on a physical and psychological level. We need to support our patients to ensure that they have the right support and accountability frameworks in place, alongside the right education in relation to their dietary intake, exercise regime, mindset and overall approach to health.

 

Medication as a treatment option can have a place when the patient feels they have exhausted all other options or need a short-term boost to start their weight loss journey. However, I would very much caution against using weight loss medication as a long-term management plan. 

 

Typically weight loss medication helps to reduce the appetite, slow gastric emptying and moderate the presence of Ghrelin (the hunger hormone) to help the patient achieve a reduced dietary intake. 

 

This can be an effective short-term management plan alongside other strategies however, as a solo intervention, it is unlikely to have long-term efficacy, and the evidence would suggest that once discontinued, there is a high probability of the patient regaining their excess weight. 

 

So, where is the elusive silver bullet? I’m sure it’s absolutely no surprise that there really isn’t one. However, by taking a multi-modal approach to weight management and overall health and wellbeing, we stand the best chance of supporting our patients to take control of their weight and long-term health.