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Blog author, Solai Buchanan is an experienced Registered Dietitian and Certified Diabetes Educator with an MS from Columbia Teachers College. She specializes in treating heart disease, diabetes, hypertension, high cholesterol, polycystic ovarian syndrome,and other chronic diseases. She is a provider at a full-service cardiology practice accepting most insurance and staffed with a primary care MD, pediatrician, and cardiologist. Call: 718.894.7907. NYCC is lead by Interventional Cardiologist Sanjeev Palta, MD, FSCAI, FACC. He trained at Cornell-Columbia Presbyterian Hospital and the State University Hospital of Brooklyn. He currently is an Attending Cardiologist at New York Methodist Hospital and Maimonides Medical Center. He is also an Assistant Clinical Professor in the Department of Medicine at Mount Sinai Medical Center. Having performed over 2000 invasive cardiac procedures Dr. Palta’s patients know they are in trusted hands.

Tuesday, April 10, 2018

WEIGHT LOSS INCREASES HUNGER


Keeping lost weight off is notoriously difficult.  A recent two-year experimental study helps to shed light on just why it's so hard: cutting calories and losing weight causes long-term increases in the hormone ghrelin that increases hunger.  To truly keep the pounds away, people have to deal with feelings of increased hunger for the rest of their lives.  
This study provided a structured highly supportive weight loss program for 35 Norwegians who were morbidly obese. At the outset, all participants underwent a three-week inpatient program in which all meals and snacks were provided.  The inpatient program also provided intensive instruction in how to achieve and maintain healthy behavioral change with nutrition education and psychological counseling.  Participants also participated in daily exercise routines. Over the course of the next two years, four more three-week inpatient sessions were completed.  Throughout the study, all participants were placed on a moderately calorie restricted diet, consuming about 500 calories per day less than otherwise needed to maintain one’s weight. The macronutrient breakdown of the diet was 50% carbohydrates, 30% fat and 20% protein.  Between inpatient stays, participants were advised to continue exercise and maintain a healthy diet similar to that provided at the center.  On average, the participants lost about 11 lbs. (~4% of bodyweight) within the first three weeks of the program, and an average of 24 lbs. (~9% of bodyweight) at the end of the two-year study.
At both the one- and two-year marks all the patients reported feeling increasing hunger following their weight loss.  Why did hunger levels increase? Results indicated that as weight went down, levels of the hormone that drives hunger, ghrelin went up.  Ghrelin levels went up with initial weight loss and these levels stayed up even as patients maintained weight.  
On top of the increase in hunger, people's bodies become more efficient in using energy after weight loss.  For example, on average, a person who has weighed 176 lbs. their whole adult life can maintain their weight consuming about 400 more calories daily than a person who has come down to 176 lbs. after previously weighing more.
What to do:  The take home message here is that weight loss maintenance requires deliberate lifelong dietary and lifestyle changes.  To minimize ghrelin increases during weight loss, it helps to lose weight gradually over time without drastic decreases in calories consumed.  To cope with increased hunger it helps to increase intake of low calorie fluids and non-starchy vegetables.  It also helps to adopt a healthy balanced diet that does not profoundly differ from one’s usual intake.  For example, diets that radically switch up your intake such as very low carbohydrate diets are unlikely to be maintained and are especially associated with weight regain. It is also recommended that in order to keep weight off, individuals need to engage in 60 minutes or more of physical activity most days.  Odds of maintaining activity are best when exercise is social and when one does activities one enjoys.  Recording intake and portions also is positively associated with weight loss maintenance.  The likelihood of morbidly obese individuals keeping weight off over the long term is much better with bariatric surgery, partially because the surgery significantly reduces hunger.  Even though it is hard to keep lost weight off, remember maintaining even modest weight loss of 5-10% of bodyweight can meaningfully improve your health.  And, regular activity and better food choices have many health benefits even if they do not result in weight loss.

Source
Coutinho SR, Rehfeld JF, Holst JJ et al.  Impact of weight loss achieved through a multidisciplinary intervention on appetite in patients with severe obesity. American Journal of Physiology Endocrinology and Metabolism, 2018; DOI: 10.1152/ajpendo.00322.2017

Information adapted from articles available at:
www.sciencedaily.com/releases/2018/02/180201123318.htm