Written by Dr. George Papanicolaou, DO
A Functional Medicine Approach to Obesity: 10 Ways to Lose Weight & Keep It Off

A Functional Medicine Approach to Obesity: 10 Ways to Lose Weight & Keep It Off

You don’t need experts to tell you we have a big fat problem, but obesity statistics are more staggering than you might imagine. The latest information from the National Health and Nutrition Examination Survey (NHANES) shows 39.6 percent of Americans are obese. Overall, there are over 100 million obese people in this country. As these numbers continue to climb, they estimate almost half of the world’s adult population will be overweight or obese by 2030. Obesity doesn’t discriminate among demographics: Studies show we have a global epidemic of obesity in all age groups for both developed and developing countries. In 2017, The Guardian reported that there are now 124 million obese children worldwide.

Researchers define obesity as a condition where fat accumulates in the body to become a risk factor or marker for many chronic diseases including diabetes, cardiovascular diseases (CVDs), and cancer, as well as adversely impacting overall health.

While practitioners use other measures to determine whether someone is overweight or obese, body mass index (BMI) is one of the most common. Researchers define a BMI of 25 to <30 as overweight and BMI ≥ 30 as obese.

The Problem

Obesity isn’t aesthetically pleasing, but it also paves the way for many physical and psychological problems including type 2 diabetes, cardiovascular disease, and nearly every other disease on the planet. Research shows obesity is often a major risk factor for development of disease, significant disability, and premature death.

Obesity also comes at a financial cost. Researchers find American health care for obesity-related problems costs about $147 billion annually.In 2014, the global economic impact of obesity was estimated to be an astonishing two trillion dollars.

Healthcare costs aside, obesity also creates lost productivity and missed economic growth because of things like lost work days, lower work productivity, mortality, and permanent disability.

The Conventional Approach to Weight Loss

Obesity presents a real problem, but experts are unsure exactly how to handle this condition. Every year new diet books appear, fad diets or “superfoods” get positioned as “miracle cures” to melt away fat, the government tells us to not eat dietary fat, and gyms become packed with people determined to lose weight once and for all.

And yet, obesity rates continue to skyrocket.

Healthcare practitioners recognize obesity as a chronic illness with vast and potentially deadly consequences, but they seem at a loss about how to treat this condition. A conventional doctor might offer dietary advice including reducing calories, reducing dietary fat, or eating specific foods. He or she might also suggest increasing physical activity.

Many conventional doctors lack the time and knowledge to effectively treat obesity. Seeing a patient for only 10 minutes doesn’t allow much opportunity to educate someone about how to eat healthy. And some doctors are themselves overweight or obese.

Instead, conventional practitioners often outsource patients to dietitians or other healthcare professionals. They might also suggest a number of over-the-counter or pharmaceutical drugs that address various aspects of weight loss, including suppressing appetite or blocking fat absorption.

As obesity rates continue to climb, pharmaceutical companies will likely develop new drugs that address this epidemic. What these drug companies and conventional healthcare practitioners often neglect to ask is why someone becomes obese to begin with.

The body is a wonderfully complex mechanism, and taking a one-size-fits-all approach focused on calories-in-calories-out, reducing dietary fat, using a drug to address the problem— whatever—overlooks the underlying condition. Overeating might be the reason a patient is obese, but I find something deeper and more complex often creates this condition.

A Functional Medicine Approach to Weight Loss

Why do obesity statistics continue to increase? I have some ideas: We eat fewer whole foods and more processed foods, more inflammatory foods, and we’re taking in more environmental toxins. Many of us work sedentary jobs and don’t get enough exercise. We’re not eating enough foods rich in probiotics and prebiotics that support gut health.

At the same time, these are simple answers to a complicated problem. Like many diseases, obesity is multifactorial. Addressing it with mainstream medicine’s approach—take a drug, move more, cut down on your food intake—dramatically oversimplifies the solution.

Using functional medicine I take  a dramatically different approach to obesity.  I look at the whole person to determine the underlying reasons you might be overweight. Even if it “runs in your family,” genetics are far from the whole story when it comes to obesity.

Instead, I look at metabolic, hormonal, environmental, and other factors that might be keeping you from losing weight. While that sounds complex, the underlying approach for weight loss is really simple: Take out the bad and add in the good.

The Solution

Research shows what I’ve long seen in my practice: Weight loss provides significant health and economic benefits. You look better, feel more confident, reduce your risk for nearly every disease including type 2 diabetes, and increase longevity. As long as you do it intelligently and healthily, there is no downside to becoming your ideal weight.

Every patient is different. I take the time to really get to know them, understand why obesity became a problem, and create a customized protocol based on their budget, preferences, and particular needs. That takes time and effort, but this comprehensive approach not only helps you reach your goal weight but maintain it and great health for your life time.

Here are some of the underlying principles I have used with 100’s of patients to lose thousands of pounds and keep them off! Losing weight starts with your diet, but lifestyle modifications are also crucial to lose weight and keep it off. From that perspective, I’ve found these 10 strategies work for nearly everyone:

  1. Focus on whole, real, unprocessed foods. These are the foods your great-grandmother would recognize and eat regularly. They will always be the foundation of a high-quality, nutrient-dense diet. Most of your plate should ideally be plant-based foods including non-starchy vegetables, low-sugar fruits like berries and avocado, legumes, nuts, and seeds. The rest should be wild-caught seafood, grass-fed beef, or another high-quality animal protein. If you’re vegan or vegetarian, focus on plant-based proteins including legumes and quinoa.
  2. Reduce or eliminate sugar and other food sensitivities. Researchers note that we consume up to 152 pounds of sugar each year, and that doesn’t include the starchy foods that convert to sugar in our bodies. Even so-called healthy foods like almond milk can contain hidden sugars, so scrutinize labels very carefully. Food sensitivities including dairy and gluten, which trigger an immune system in overdrive and inflammation, can also keep you overweight or obese. One study found what I commonly see in my practice: A gluten-free diet with plenty of real, whole foods (not gluten-free junk foods) reduces inflammation, excess weight, and insulin resistance.
  3.  Eat plenty of gut-supporting foods. Animal and human studies show when your gut microbiome—which consists of trillions of bacteria—becomes imbalanced, all sorts of problems including obesity and metabolic syndrome can occur. Many of my patients aren’t eating enough high-fiber foods, and they eat few, if any, fermented and cultured foods like kimchi and unpasteurized sauerkraut. A high-quality probiotic supplement containing billions of microorganisms can really help here.
  4. Manage inflammation. Overall, we eat too many inflammatory omega-6 fatty acids (in foods like vegetable oils and grain-fed beef) and too few anti-inflammatory omega-3 fatty acids. Chronic, low-grade inflammation contributes to obesity and other metabolic disease. A vicious cycle ensues as inflammation makes your body cling to fat, which makes you more inflamed. To shift that omega ratio more favorably, dial down the inflammatory fats and increase your intake of anti-inflammatory foods including wild-caught fish, freshly ground flaxseed, and walnuts.
  5. Keep good sleep hygiene. “Lose Sleep, Gain Weight: Another Piece of the Obesity Puzzle,” Angela Spivey titles one review. She notes that in epidemiologic studies, shorter sleep correlates with increased obesity, hypertension, and other metabolic disorders./ In our technology-heavy, work-into-late-hours society, sleep sometimes gets the short end of the stick. Weight loss becomes easier when I have patients prioritize sleep. Turn off electronics a few hours before bedtime, find a sleep ritual that helps you unwind, and aim for 8 – 9 hours of quality, uninterrupted sleep every night.
  6. Manage stress levels. Research shows chronic stress can contribute to obesity for several reasons: You’re more likely to assuage that stress with comfort foods, for one. And you keep levels of your stress hormone cortisol ramped up when they should taper, which stores belly fat. You can’t eliminate stress, but you can learn to manage it with strategies including deep breathing, meditation, walking, and yoga.
  7. Set yourself up for success. In my practice, I’ve learned people who think ahead—things like prepping ingredients, planning what they take to work for lunch, and stocking up on grocery essentials—are more likely to succeed at losing weight and keeping it off.

Here are four success strategies I use with my patients:

  • Make eating a priority. Block out time in your schedule to fully enjoy your meal. Don’t work and eat. You will be far more productive after a healthy, restful meal.
  • Plan what you are going to eat. If it’s  a busy day away from home, then take a “lunch box” filled with good nutritious foods from you diet menu. If you leave the house with no food and just a credit card, you will find yourself in that dark place where diets go to fail.
  • Identify your food triggers and avoid them. Make a list of people, places, circumstances, and things that trigger your hunger and make a list of different options you can choose instead.
  • Avoid all spontaneous compulsive eating. Don’t walk by the leftover pizza on the counter and grab a slice on your way out the door. Always ask yourself these three questions before eating anything: Is it the right time time to eat? Is it a healthy food to eat? If so, how much can I eat? If the answers are all yes, make the time, space ,and place to eat and enjoy. Take control of the food, don’t let it control you.

Taking guesswork out of the equation makes things so much easier when you, for instance, come home from a long day at work and feel tempted to order take-out. You’re far less likely to succumb to temptation when you have a meal pre-prepped in the fridge.

  1. Determine the type of diet that works for you. Biochemical individuality underlies Functional Medicine. That means everyone is different, and you’re more likely to adhere to a diet plan that you enjoy and can maintain long-term. Some people feel better eating a mostly plant-based diet, whereas others thrive on a high-fat ketogenic diet that includes plenty of non-starchy vegetables. Finding out what works for you might take some trial and error, but you’re more likely to succeed once you’ve found it.
  2. Avoid food fights. Put a Paleo advocate and a vegan in the same room and civil war may break out. Interestingly, most plans aren’t that different when you consider a foundation of whole, unprocessed foods. Diehard devotees of a particular plan can get locked into rigidity and a holier-than-thou attitude about anyone who doesn’t agree.   Instead of trying to adhere 100 percent to one plan, consider a hybrid diet. Dr. Mark Hyman recommends what he calls a Pegan Diet, which combines the best principles of Paleo and vegan plans. What ever you choose, stick with it.
  3. Diet first; exercise second. Research shows you can’t out-exercise a bad diet. That doesn’t mean you shouldn’t exercise. In my practice, I’ve found patients who find a workout plan that works for them lose weight and maintain that loss more easily than those who don’t exercise. Figure out a routine that works for you and commit. That might mean weight resistance, high-intensity interval training (HIIT), brisk walking, or a vigorously paced yoga class.

If you’ve struggled with obesity and attained (or maintained) weight loss, I’d love to hear what strategies you would add to this list. Please share yours below.

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