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5/04/20

One Perspective on Weight loss

The deposition and storage of fat tissue is a normal metabolic process that is adaptive for an individual's lifestyle. However, given the current environment, with calorically dense, readily available food and a concomitant increase in sedentary behavior, the human system has a high proclivity to become maladaptive and metabolically deranged. This leads to increased adiposity, which may or may not be reflected in outright obesity. Genetics have a large say in where excess fat tissue proliferates - some prefer to coat their viscera (internal organs) with it, and others deposit it in the subcutaneous layer. It is unclear which pattern is preferable metabolically, as each carries increased risks for cardiovascular disease, cerebrovascular disease, musculoskeletal dysfunction and pain, as well as for endocrine and hormonal abnormalities. It is on the basis of these metabolic derangements that we seek to address excess weight and adiposity. While vanity and other ego-drive reasons for weight loss may be motivationally appropriate, we do not conflate the value of an individual with their aesthetic appeal and thus do not advocate for weight loss as a means of boosting self-esteem, although we acknowledge that to be a healthy side-effect.

One of our approaches to metabolic health starts in the brain. The neurophysiology behind body metabolism is very complex, and while we do focus on the top-down (brain-body) influence, we understand that the brain depends heavily on the peripheral body signals in order to issue the correct executive orders. The hypothalamus is the major integration hub for comparing energy inputs to outputs. The hypothalamus samples signaling molecules, hormones, and peptides in the blood to assess fuel availability and resources. Additionally, the enteric (gut) nervous system communicates to the brain via the vague and splanchnic nerves, which provide a different level of analysis and resolution for the brain to integrate. In response to these inputs, the hypothalamus issues orders to different organ systems to increase or decrease activity. Some of these organs are the adrenal glands, thyroid gland, liver, pancreas, adipose, and muscle tissue. Changes in behavior and energy metabolism then follow.

Weight loss Caleb drawing.png

So while dietary changes, restricted eating patterns, and other lifestyle changes promote metabolic well-being, if the central nervous system is not addressed, then weight loss will be much more difficult to attain. We have seen this in many of our patients who, by diet, lifestyle, and bloodwork look cardio-metabolically well, but are still obese - a testament to the brain's ownership over each person's basal metabolic rate (BMR), or the amount of energy expended simply by being alive, moving, and breathing. If you are someone, or know of someone, who is doing everything they can with diet and exercise but are still struggling to lose weight, reach out and talk with us!

- Caleb Greer

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