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Transform Your Body Composition

Why is it important to maintain an ideal body composition? Obesity and Overweight is not a cosmetic issue. Being overweight or obese leads to severe impairment at the molecular level. We know that both of these conditions result in an increase in the inflammatory state, worsening insulin sensitivity, worse lipid panels, accelerated cardiovascular disease and an increase in cancer rates. Obesity is probably worse than cigarette smoking for your health. This is not a problem with how you look on the outside, this is a problem with how you look on the inside, and we’ve got to correct this for long-term Health and Wellness.

In our practice the initial attempts will be made through teaching a person to rethink how they manage their lifestyle prescription. It is important to understand how food affects appetite, how the timing of food ingestion affects appetite, and ultimately energy consumption. What a person eats determines to some extent how your intestine is colonized, the composition of the Microbiome. The Microbiome in turn helps control how much energy you consume and how much energy you spend. The bacteria in our intestines must be fed. And the source of that energy is the foods we consume. So some of the calories that we ingest go to feeding Our Microbiome. A healthy Microbiome consumes a lot of energy.

Strategies to improve energy out are also shared in great detail. This will be some combination of exercise and modifications to activities of daily living.

There are genetic variations in our appetites. Some people have Obesity genes. Despite these genes, many can learn to control Energy in to match Energy out. Most people do this regularly, but unfortunately at a higher set point than is ideal. In order to correct the excessive energy stored, Energy in will have to be maintained below Energy out for an extended period of time, until energy stored (fat), is reduced to the optimum storage level. With proper adherence to the Lifestyle prescription, most people can reach this balance without experiencing a tremendous amount of hunger or feeling deprived of food or calories. It is not accomplished by living in the gym, though exercise and alterations in our daily activity levels can be helpful.

So weight is very complex.

Not everybody will accomplish what they need to do through the Lifestyle prescription. Medical interventions can be helpful. One common pathway is to return hormones to Youthful levels. In particular, the Sex Hormones, Testosterone in both men and women, and Estrogen in Women, restored to Youthful levels, have many beneficial effects in this domain.

Testosterone improves Insulin sensitivity, shifts fat storage away from the visceral (gut fat-the dangerous stuff) and into a more healthy pattern. It’s ability to Enhance the Exercise prescription, and thereby effect Energy out has a big impact.

Estrogen also has similar effects on Metabolic Health and Fat storage patterns.

Supplementation can be important. Enhancing the Microbiome through supplementation of bacteria can result in a colony that can consume more energy because they have to divide and grow and they utilize some of the food energy that we take in. They also provide important signaling molecules that affect appetite. We do need to target our Microbiome for a healthy outcome.

There are a handful of other Supplements that can help with energy regulation. See the section on “Supplements” for some “no Brainers”.

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There are other interventions that are very effective for weight loss and we’re very fortunate in that we now have access to a class of medications (actually peptides) called GLP-1 agonists. These peptides act through three mechanisms in helping us gain control. One mechanism is at the endocrine level. They actually lower blood sugar. They were originally developed as diabetes medications. They have an added benefit of improving most of the other metabolic and cardiovascular risk biomarkers that we follow, when patients are treated with these agents for weight loss, even if they don’t have diabetes. When we put people on these GLP-1 agonists, not only do they lose weight, they also have a decrease in the inflammatory state, their insulin sensitivity improves and their lipid panels get better. It is a real blessing to have this tool in our tool bag, to help people who can’t succeed with just a lifestyle prescription or perhaps some simple supplementation, or hormone replacement therapy.
They have additional weight loss mechanisms. These medicines also act to delay gastric emptying, so people tend to feel full and not have that experience of hunger. The most amazing thing about these interventions is that they cause people to have a different relationship with food, resulting in a loss of cravings for foods that typically are thought of as not very helpful to our long-term Health and Wellness.

I cannot stress how important it is to get yourself down to ideal body weight. Through one or a combination of all of these strategies, everyone should be successful.

We have a very sophisticated way to evaluate your current weight and body composition. It’s called DEXA scan, (dual energy X-ray absorptiometry), and that is the gold standard for determining body composition. It allows us to determine lean muscle mass, body fat percentage, visceral fat (the fat that’s associated with all of the metabolic diseases), and it also allows for assessment of Bone density, which is a whole other problem, when we’re addressing frailty. Using this test, we can calculate the weight or the amount of fat loss necessary to reach the general targets for a male and a female body fat percentage. A generally accepted healthy target for a male is 20% or less and for a female 25% or less. We can accurately calculate the weight we would achieve those goals, so at least we have a known target goal weight. DEXA then becomes a great aid in weight surveillance, so we can sort out whether weight loss is indeed from the “Fat” we are targeting, or from the “Lean” compartment (muscle). At times, proper application of the lifestyle prescription will result in gains in lean mass and loss of fat mass, such that weight may not change appreciably, even though body fat percentage is improving. Retesting at regular intervals can help dissuade a patient who is actually successful from becoming discouraged because they’re not seeing changes in scale weight.

Weight loss is important if you’re not already close to, or below these important body composition targets. If you decide to engage, whether it’s with just learning about how to eat and possibly considering adding some supplementation (a fair amount of people can benefit just from that knowledge and simple intervention), or you seek treatment at the full medical level with hormone therapy and actual prescriptions, there is a strategy that will succeed. Hope can be on the way!

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