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Part 3 - (New Year's Eve And) Why It Is So Hard To Prevent Weight Regain

>> Wednesday, December 30, 2015

In the last few weeks, we have talked about two of the main drivers of weight regain: the hormone changes that happen with weight loss which drive hunger; and the marked reduction in energy expenditure that occurs.

Today, let’s talk about the third player in this battle: hedonic mechanisms.

Hedonic barriers to maintaining weight loss refer to emotional factors that play into the weight struggle.  There are several parts of the brain, together called the limbic system, that have an important influence on if, what, when, where, and how we eat.   These include the ventral tegmental area and nucleus accumbens as our main reward centers; the amgydala as our emotional centre; the hippocampus, which is involved in memory; the dorsolateral prefrontal cortex which is involved in impulse control...and many others.  These centres in our brain talk to each other without us even knowing it, to drive us to eat.

So picture this:  It’s New Year's Eve, and you are absolutely stuffed after a delicious meal.  You couldn’t possibly eat another bite.  Then a chocolate fondue for dessert, warm melty deliciousness, is placed on the table… the delicious aroma, the reassuring coziness and happy memories with which you associate this dessert and the holiday season… and suddenly you have room for just a few more bites.   That is your hedonic system kicking in and driving food intake, even though your hormone systems have told you that you are full.    

So, after successful weight loss, in addition to the lower energy burn and changes in hunger/fullness hormones that drive us to eat, we also have a powerful subconscious hedonic system driving us to regain weight.   

The hedonic system is an important consideration in anyone with a weight struggle, whether or not they have previously lost weight.  Most of us have a psychological relationship with food of some kind – some of us eat when we feel sad, others when stressed, others when happy.  Some people find themselves eating to manage physical pain from another medical condition – food releases endorphins in our brains, which is why eating can ease pain for these individuals. 

The first step to managing hedonic mechanisms behind food intake is to recognize them – and they will be different for each individual.  The next step is to figure out how to best manage these hedonic inputs without food intake as the response.  For example, avoiding the hallway with Tim Hortons on the way through your work complex to your office can avoid those triggering smells from reaching your nose.  If pain is the issue, then your health care professionals need to help you find better ways to manage your pain.  Stress – well, we probably could all do with less of that in our lives!  And the list goes on.  

As hedonic mechanisms are so very powerful such as to overwhelm physiology in anyone who struggles with weight, it can’t be stressed enough how important it is to understand any hedonic contributors in each individual’s weight struggle, then work together as a team of patient and health care providers to manage them in the most effective way possible.

Wishing everyone a happy, healthy, and fulfilling 2016!!

Follow me on twitter! @drsuepedersen © 2015 


Whole Wheat Ginger Snaps!

>> Friday, December 18, 2015

Every year, I look for a healthier slant on a yuletide treat to enjoy during the holiday season.  This recipe caught my interest as its focus (in the title) was on the whole wheat ingredient.  It’s interesting, because although whole wheat does contain more fiber and has a lower glycemic index than white flour, it makes very little difference in the actual calories (58 calories less for the entire recipe, or just over 1 calorie difference per cookie!).  Just a note not to be wooed by the seemingly healthy titles of recipes. 

This brings me to the reason why I actually chose this recipe, which is the small size of the cookies.  Portion control is key when our senses are assailed by so much temptation during the holidays!  Eating only 1 cookie (for 43 calories) or 2 cookies (for 86 calories) from this recipe is not a damaging onslaught of calories; rather, a delicious and flavorful treat to include in your daily calorie intake total.   

The recipe comes from Lively Table, but I have switched up the ingredients a little – particularly the coconut oil for the healthier canola.


½ cup canola oil
¼ cup granulated sugar
¼ cup brown sugar
¼ cup molasses
1 large egg white
1 tsp vanilla
2 tsp grated ginger

1 ¼ cups whole wheat flour
1 tsp baking soda
pinch of salt
1 tsp cinnamon
½ tsp ground cardamom
pinch of ground white pepper

1.     In the bowl of a stand mixer, beat canola oil and sugars until fluffy, about 2 minutes. Add molasses, egg, vanilla and ginger. Beat until combined.
2.     Sift flour, baking soda, salt, and spices into bowl with wet ingredients. Beat until well combined. 
3.     Cover mixture and refrigerate 2 hours. 
4.     Preheat oven to 350° F. Remove dough from refrigerator.
5.     Scoop into small balls (about 1 tsp). Roll to shape and place at least 1 inch apart on a cookie sheet lined with parchment or a silicone baking mat. Flatten balls slightly.
6.     Bake cookies 6-8 minutes until golden. Remove from oven and let cool a couple of minutes before transferring to cooling rack. 

Makes 48 cookies.  Per cookie:

Calories: 43

Fat: 2.3g

Carbs: 5.4g

Protein: 0.5g

Happy Holidays, everyone!   

Follow me on twitter! @drsuepedersen © 2015 


Part 2 - Why It Is So Hard To Avoid Weight Regain

>> Friday, December 11, 2015

In last week's post, I talked about the decrease in energy burn that happens with weight loss.  Today, let's focus on the other major driver of weight regain - the powerful changes in hormones that happen with weight loss, which drive us to eat more and regain the weight we worked so hard to lose.

In humans, there is only one hormone that is known to increase hunger, called ghrelin.  Interestingly, there are many hormones that signal satiety, telling us that we feel full.  Several hormones tell us we feel full in the short term (release 10-15 minutes into a meal), including hormones called GLP-1, cholecystokinin (CCK), PYY, oxyntomodulin, and others.  There are also hormones circulating that are long terms signals of fat and energy storage, which are also fullness hormones: leptin, which is made by fat cells, and insulin, which is made by the pancreas.  These hormones act in the hypothalamus in our brain to regulate when and how much we eat.  (there are also many emotional and social drivers of eating, called 'hedonic' mechanisms... stay tuned for more on this important factor another day :).

When we lose weight, leptin and insulin both drop precipitously, which result in a powerful drive to eat and regain the lost weight.  The short terms regulators of hunger and fullness are affected as well, including a decrease in GLP-1, PYY, and CCK, and an increase in ghrelin, all of which work in concert to beg our brains to eat more, eat more!  Studies have shown that even a year after weight loss, these hormone changes persist - an unrelenting drive to regain the lost weight.

So what can we do to combat these hormonal changes?  It's not easy - evolution has made it so to drive us HARD to look for food and eat during times of food scarcity.  Keeping the energy burn up with activity helps to offset the powerful hormonal drive to increase energy intake, but a whole lotta exercise can be 'cancelled out' by what we can eat in just a minute or two.  Fortunately, medications are now available or in development to combat these hormonal changes, which can help to maintain weight after weight loss.  The only medication along these lines available in Canada is called liraglutide or Saxenda, and it has been shown not only to help people to maintain an average 6% weight lost from diet and exercise, but actually helped people lose an additional 6% weight loss over a year on top of that (with the ever critical lifestyle changes continued throughout).

Disclaimer: I was involved in the research trials of liraglutide as an obesity treatment.  I receive honoraria as a continuing medical education speaker and consultant from the makers of liraglutide (Novo Nordisk). I am involved in research of medications similar to liraglutide for the treatment of obesity and type 2 diabetes.

Follow me on twitter! @drsuepedersen © 2015 


Why Is It So Hard To Avoid Weight Regain?

>> Saturday, December 5, 2015

One of the biggest challenges in successful weight management is prevention of weight regain after weight loss.   Studies show that most often, people regain weight after intentional weight loss, with many people regaining most or all of their lost weight over time (and then some, in some cases).

There are two major drivers of weight regain:

1.  Many powerful changes in hunger and fullness hormones happen with weight loss, which drive us to eat and regain weight.

2.  Our energy burn (called 'energy expenditure') drops - more than we might expect.

Today, we are going to focus on #2 above. (stay tuned for much more on #1 another day!)

So, just how much does our energy burn drop with weight loss?

Well, it turns out that we are geared towards retaining energy and downregulating metabolism in the face of weight loss, as a strong defence mechanism genetically engineered to protect our weight to survive times of famine.  This happens thanks to a decrease in thyroid hormone levels, decrease in sympathetic nervous system tone, an increase in skeletal muscle efficiency, and other changes as well.  While we do expect a proportional decrease in energy burn simply due to the weight loss itself, the decrease in energy burn is actually much more than that, thanks to these changes.

Here's an example: When a person loses 10% of their body weight, one might think that their daily energy burn (called Total Energy Expenditure or TEE) would also drop by 10%, reflecting 10% less body mass that needs daily care and energy, and 10% less body mass for the person to physically carry around in a day.  In fact, studies show that the total energy burn of this person will actually drop by 20-25%, - in other words - to 10-15% less than what would be predicted.

Said another way, it will take 300-400 fewer calories per day to maintain the 10% loss in body weight, compared to a person of the same body shape, size, and weight, who hasn't lost 10% of their weight.

This decrease in total energy expenditure may not persist forever - the POUNDS LOST study suggested that the TEE comes back up to expected baseline after 2 years (though others have suggested that the reduced energy burn lasts as long as 7 years or more).   Some research has also suggested that the drop in energy expenditure may be less with a low carb diet, higher with a low glycemic index diet, and the highest on a low fat diet (my speculation on this is that this may be related to higher protein intake in the low carb diet - it takes more calories to burn and digest protein compared to carbs compared to fat).

Because of this reduction in energy burn with weight loss, as well as the powerful hormone changes that happen to drive hunger, it is very difficult to maintain weight loss.  Fortunately, the American National Weight Control Registry has provided some useful information regarding habits that help keep the weight off (though these are not easy either) - check it out!

Follow me on twitter! @drsuepedersen © 2015 



I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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