Multidimensional weight loss: More than calories in, calories out


The average woman spends the equivalent of between six to 13 years during her lifetime dieting, according to multiple studies, but are women – and men – who want to lose weight looking for answers in the right places?

Both internal and external factors may be standing in the way of achieving weight loss goals.

It’s really not just calories in, calories out.

Dr. Kenneth Tieu, one of the leaders of NewFit, a nationally accredited surgical weight loss program connected to Health First, which operates four hospitals in Brevard County, including Viera Hospital, where NewFit procedures are performed, says your gut health (microbiome) may be interfering with weight loss. “People don’t think about it on a daily basis, but more and more, data indicates it plays a big role in obesity.”

The microbiome is the community of microorganisms, including fungi, bacteria and viruses, that exists in a particular environment. In humans, the term is often used to describe the microorganisms that live in the gastrointestinal tract. These groups of microorganisms are dynamic and change in response to a host of environmental factors, such as exercise, diet, emotional state and medication.

Dr. Tieu says that although there’s no pill you can take to change your GI tract, you can elicit positive results by eating a diverse diet. Zoe, a health science company that runs the world’s largest in-depth nutrition study, says that consuming a gut-friendly diet that contains plenty of fiber, prebiotics and fermented foods rich in probiotics can help the beneficial bacteria in your gut to thrive. Their data shows that eating for your unique microbiome and metabolism can lead to weight loss without counting calories or restricting how much you eat.

Although no one likes to hear it, genetics is a part of the weight loss puzzle that you can’t control, according to Harvard Medical School’s newsletter. Genes contribute to the causes of obesity in many ways, by affecting appetite, satiety (the sense of fullness), metabolism, food cravings, body-fat distribution, and the tendency to use eating as a way of coping with stress.

Dr. Tieu says that the Human Genome Project (which took place between 1990-2003) identified some 500 genes that affect weight gain.

Changes that come with aging are inevitable, too, and women’s loss of estrogen when they hit menopause can have a major impact.

Getting older brings physiological changes that can affect weight. Chief among them is muscle loss. Starting in middle age, we lose about 1 percent of muscle mass per year, which affects strength and metabolism (how fast we burn calories). Smaller muscles use fewer calories.

“If your diet doesn’t change, you’ll consume more calories than you need. The excess is stored as fat,” says Dr. Caroline Apovian, an obesity medicine specialist and co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital.

Wendy Fiumano, APRN, FNP-C, is a board-certified Family Nurse Practitioner working at Health First Medical Group. She says it’s important to incorporate strength training into your cardio workouts to help replace vanishing muscle mass.

“Get up and move. Being sedentary helps you pack on the pounds,” she advises.

Underestimating portion sizes is a culprit whether you’re eating out or at home. Packages often have misleading and unrealistically small portion sizes listed, making it difficult to estimate the number of calories you’re consuming.

Dr. Tieu says serving sizes at fast-food restaurants have ballooned. “People eat what’s put in front of them, whether they’re hungry or not. And although burgers, fries and soda came in one size when most chains started, now everything is much bigger and easily available.”

Fiumano suggests you stop partway through your meal or snack and see if you’re full; if you are, stop eating.

Could your medicine cabinet be to blame? The University of Rochester Medical Center in New York says that insulin to treat diabetes, certain antipsychotics or antidepressants, some epilepsy therapies, steroids, and blood-pressure-lowering meds like beta blockers may cause weight gain because they affect your metabolism or increase your appetite while treating your health issue.

Dr. Tieu cautions against going off needed medications, but suggests you check with your healthcare provider to see if there’s a substitute medication available or if a smaller dose may work for you.

Snacking while you’re in a daze watching TV or on your phone can become almost automatic, causing you to lose track of what you’ve eaten. If you aren’t mindful of what’s going into your mouth, chances are you don’t process that information, which means it won’t be stored in your memory bank and you are more likely to eat again sooner.

Mindful eating includes noticing the colors, flavors, smells and textures of your food. It also means getting rid of distractions and concentrating on what’s going into your mouth.

If your dieting strategy includes skipping meals to save calories, you’re setting yourself up to fail. If you restrict yourself all day, your body’s protective mechanisms will kick in – the ones that drive you to get food. As a result, you’re likely to binge on a bag of cookies or bowl of ice cream to fight the feeling of deprivation.

Fiumano has developed several other strategies during her experience working with cardiac patients.

“Unhealthy lifestyles encourage you to have unhealthy eating habits. Eating too much and drinking too much are offshoots of too much stress, too little sleep and not enough self-care.

People tend to overlook their beverage intake while counting calories. Coffee with sugar and cream, cocktails, sugary juices … those calories add up, too,” Fiumano says.

“Get a good app, like MYFITNESSPAL, to help you track your daily calorie intake.”

It is important, too, to keep a sense of proportion and relax in some sense even as you pursue a weight-loss goal.

“Don’t get mad at yourself if you want to indulge for a day. It’s important to have balance in your life,” Fiumano says.

Kenneth Tieu, MD, FACS, FASMBS, is a leader of NewFit, Brevard County’s only nationally accredited surgical weight loss program. Dr. Tieu specializes in robotic-assisted general surgery and bariatric surgery. He received his M.D. degree at Pennsylvania State University and completed his residency in surgery and fellowship in minimally invasive surgery at the University of Texas Medical School at Houston. He is board-certified in surgery by American Board of Surgery. His office is located at Health First Medical Group-Viera Medical Plaza, 8725 North Wickham Road, Suite 200, Melbourne. Phone: 321-434-9230.

Wendy Fiumano, APRN, FNP-C, is a Family Nurse Practitioner. She got her degree at Northern Arizona University and is board-certified by the American Academy of Nurse Practitioners. She works as an Interventional Cardiology NP at Health First Medical Group, 699 West Cocoa Beach Causeway, Suite 503, Cocoa Beach. Phone: 321-434-6650.

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