"Dr G., do you have any ideas on the best way to lose weight?"
"What do you think about (name the supplement) for losing weight?"
Diet and nutrition questions are some of the most common that I get on Fox. My response always begins with the calorie speech: "In order to lose weight, calories consumed must be less than calories expended." I consistently take a hard stance on the physics of weight loss which makes some people bristle, especially those who believe that their weight issues are hormonal, genetic, or “their metabolism.” I emphasized this very black and white perspective in my February blog, "Weight Loss 101: Count Your Calories", where I explained, mathematically, how my own 2-1/2 pound weight loss was fully explained by the energy expenditure of some increased physical activity.
After seven months, I've lost a total of seven pounds and the thermogenic reality is a 24,500 calorie deficit. The bigger achievement, however, is the insight into my personal relationship with food.
1) Hunger does not necessarily mean that my body needs to eat. Emotional-eating has been a way of life for me. I just accepted this behavior as one of my (many) flaws until I learned about the physiologic effects of two hormones that have a powerful influence on the urge to eat—or not. Ghrelin is produced mainly by the stomach and pancreas. Levels are normally high before meals and make us feel hungry. Leptin, its counterpart, is produced by fat cells and causes feelings of satiety and reduces sugar cravings. When leptin levels increase after meals, the brain signals us to stop eating. Here’s the problem: these appetite-controlling hormones are not simply regulated by the body’s nutritional status. Ghrelin (or should I say, gremlin!) levels increase with sleep deprivation. (Maybe this is why I was at my heaviest during my residency?) And leptin levels, or the body’s sensitivity to it, may diminish in the presence of emotional stress. Just educating myself was enough to give me the willpower to pause before reaching for an extra helping or sneaking a second dessert. If I can objectively convince myself that I am calorie-deficient, fine. Open mouth, insert food.