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Weight loss can feel like a complex problem to solve. Whether it’s the latest diet, exercise fad,  or nutritional guru, patients struggling to find health and vitality while dealing with obesity can be at a loss for a real solution.  For some, the pure math of calories in, calories out feels like a simple truth, and it can be effective, but is it enough to create the significant and sustainable change necessary for decreased BMI and improvements on overall bodily health?

Unpredictability: Why We Can’t Accurately Measure Calorie Intake or Output

Many Americans prefer convenience – grabbing snacks at a corner store or sitting down to eat at a restaurant instead of cooking at home. These will certainly satisfy hunger, but it may be impossible to truly calculate the number of calories in prepacked food or a meal that was cooked by a restaurant. Unseen additives, such as salt, fats, and oils are present in these food items, which add calories and contribute to the cycle of obesity. Per the American Society for Metabolic and Bariatric Surgery, “[c]onsumption of foods that, independent of caloric content, cause metabolic/hormonal changes that may increase body fat. These include foods high in sugar or high fructose corn syrup, processed grains, fat, and processed meats.” (“Disease of Obesity,” n.d)

Portion sizes in the US are also notoriously large, making it hard to determine how much is enough. If you are attempting a routine of exercise to track calories expended throughout the day, the predictability of electronic devices varies; no watch or app can tell you exactly how your body has performed.  These factors make it difficult to determine how much you have consumed throughout the day and how much energy has been used during exercise.

Your Emotions and Hormones Don’t have a Calorie Calculator

As much as weight loss patients may not want to admit it, complex emotional and behavioral factors are at play in weight loss, such as food cravings and how your body works to process the food you’ve taken in. Patients who are obese can face overeating challenges created by emotional influences; after a bad day, it can be easy to use the gratification of eating as a way to cope. Patients who frequently diet and restrict their calorie intake also face emotional challenges; foods that you should typically avoid, such as sweets and salty snacks, become the desirable and untouchable, making struggling weight loss patients want and value them even more. The ASMBS reiterates this point, adding “[w]eight gain may also cause psychological or emotional distress which, in turn, produces hormonal changes that may cause further weight gain by stimulating appetite and by increasing fat uptake into fat storage depots. “ (“Disease of Obesity,” n.d).

What’s more, the simple state of being obese changes the way your body behaves. In their article on “The Disease of Obesity,” ASMBS states the following:

“Weight gain causes a number of hormonal, metabolic and molecular changes in the body that increase the risk for even greater fat accumulation. Such obesity-associated biological changes reduce the body’s ability to oxidize (burn) fat for energy, increase the conversion of glucose (carbohydrate) to fat, and increase the body’s capacity to store fat in fat storage depots (adipose tissue).” (“Disease of Obesity,” n.d).

Durability: Do You Expect to Count Calories Indefinitely?

The cycle of weight loss can start to feel particularly restricting to consider in the long run. Full health benefits of weight loss are best achieved when patients can maintain their new weight. This improves blood pressure and reduces the risk for diabetes, heart disease, hernias, and hypertension.  Calorie counting can be a good way to jumpstart your health journey, but for many patients, it is not sustainable in the long term.  Calorie counting and the traditional dieting route can also prove to be less effective than you might have thought.

“[D]ieting is also a contributor to obesity progression. Dietary weight-loss causes biological responses that persist long-term and contribute to weight regain. One of these responses affects energy balance. When a person loses weight, the body ‘thinks’ it is starving and energy expenditure is reduced in order to conserve calories.” (“Disease of Obesity,” n.d).

Health Concerns – Conditions and Medications

The cycle of obesity becomes an even bigger obstacle when you consider how medical conditions play into your weight. Not only can obesity cause problems like sleep apnea, depression, and joint pain, but experiencing any of these makes it that much harder to find the motivation and energy to increase movement and make better choices about the foods you eat.

All of the above health problems can make it hard to gain quality, restful sleep, which is a factor in weight gain. ASMBS explains as follows:

“Sleep duration is reduced by weight gain due to a number of conditions that impair sleep quality such as pain, sleep apnea and other breathing problems, a need to urinate more frequently, use of certain medications, and altered regulation of body temperature. Shortened sleep duration, in turn, produces certain hormones that both stimulate appetite and increase the uptake of fat into fat storage depots.” (“Disease of Obesity,” n.d).

Why Weight Loss Surgery Makes all the Difference

Surgical intervention takes calorie counting and hormonal imbalance out of the equation; with the help of a weight loss surgeon, you can effectively break the loop of obesity. Patients who undergo surgery, such as the laparoscopic sleeve gastrectomy or gastric bypass, benefit from hormonal changes caused by removing part of the stomach (in the case of the sleeve) or bypassing that part (in the case of the bypass). Aside from limiting the storage capacity, removing or bypassing part of the stomach positively impacts hormonal levels and reduces production of the chemicals that make patients feel consistently hungry (known as hunger hormone). In addition to hormonal change, in the case of the bypass, re-routing the intestine limits the absorption of consumed calories optimizing further the weight loss.

Unlike calorie counting, bariatric surgery is a weight loss method that is sustainable and durable; because of the changes to the way your body processes food and responds to food, it’s easier to maintain your healthy new weight over time. According to the ASMBS, “Patients may lose as much as 60% of excess weight six months after surgery, and 77% of excess weight as early as 12 months after surgery.^. On average, five years after surgery, patients maintain 50% of their excess weight loss²⁴” (“Metabolic and Bariatric Surgery,”  2013).

With a lighter frame, bariatric patients find it easier to go about their everyday lives and engage in healthy physical activity, which further promotes an improvement in BMI.

If you have been counting calories to lose weight and aren’t having much success, it may be time to consider surgical methods. Contact Dr. Lutfi to learn more about how he can help.

The Disease of Obesity. (n.d) Retrieved from https://asmbs.org/patients/disease-of-obesity

Metabolic and Bariatric Surgery. (2013, November) Retrieved from https://asmbs.org/resources/metabolic-and-bariatric-surgery