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Diet Heart Health Metabolic

Approaching Weight Loss

The topic of weight loss is both a medical topic and one that is emotionally charged. Many of my health coaching clients blame themselves for their weight problems and believe that more willpower will lead to better outcomes.

Being overweight or the diagnosis of obesity is a medical condition the same way pneumonia or back pain is a diagnosis. If gaining weight is done simply by eating more then eating less should result in weight loss. And this discrepancy is precisely why weight loss is more complex.

My approach to weight loss is unique as I’ll highlight below. For those whose weight negatively affects their cardiovascular health, we create an individualized plan and tackle obstacles to obtaining an ideal weight.

Reductionist Thinking

In western medicine reductionist thinking is abundant. If you have a urinary tract infection you must take an oral antibiotic. If anyone has diabetes they must be started on medications.

Reducing any concept down to one easily explainable idea is a pitfall. It prevents more insightful thinking.

I don’t reduce obesity down to a calorie issue. This makes sense on paper in a calorimeter but the human body is agnostic to our mental models.

Weight Loss Drivers

There are several factors that affect weight loss. I see this in my clinical practice when a patient unintentionally loses weight. Below are examples.

56-year-old Mary

Mary is a 56-year-old woman who always carried an extra 50 lbs, as she put it. Her kids had grown up and she got laid off which was the perfect excuse to move to a remote city in Mexico where her husband found a job with an electrical company.

The type of food she had access to was very different there. Busy with getting settled in she didn’t pay any attention to her weight until her clothes started being too big. Without pizza, pasta, ice cream, or bagels her weight was coming down rapidly.

The activity levels she always wanted to engage in like riding a bike or hiking suddenly were much easier. It was her lower weight that made it easier for her to be more active. This, in turn, made her lose even more weight.

44-Year-Old Jesus

Jesus got diagnosed with an inflammatory bowel condition which caused him severe diarrhea and bloody stools. He was about to lose his health insurance so he decided to not start on any new medications but he met with a nutritionist who suggested a diet to help prevent further flare-ups.

Jesus was petrified of the blood in his stool and was committed to never seeing that again. Though stressed about work he bought those college-style bound notebooks and kept a food journal and meal planned as instructed by this nutritionist.

He was told to eat fish, olive oil, fruits, nuts, seeds, oats, and legumes as much as he wanted. The items to avoid were bread, white rice, alcohol, pasta, desserts, and anything fried.

Jesus was never worried about his weight and felt that for his height he had a normal physique. At 5’10” and 205 lbs he described himself as stocky but not fat or skinny/scrawny, which was what kids teased him about when he was in grade school.

9 months later when he found a new job and could afford health insurance again, he saw me for the first time and was quite concerned about his weight loss. He had lost around 27 lbs and believed it was due to the inflammatory bowel disease.

Foods that Help with Weight Loss

It’s clear from the examples above that changes in what we eat impact weight loss. For some individuals certain foods are obesogenic – they cause a high spike in blood sugars which results in fat deposition and more hunger.

But there is no one diet that helps every person lose weight – human physiology is simply not the same from person to person.

I, for example, can eat a lot of fruit without gaining weight. Trying the same diet for some of my patients results in rapid weight gain. Therefore, it has to be individualized. But some generalizations can be made.

1. Slow Carbs

Slow carbs are whole grains and seeds such as 100% whole wheat or brown rice, quinoa, barley, oats, etc. These tend to not cause a sudden spike in blood sugars which helps curb hunger later in the day but also signals decreased weight retention.

Slow carbs versus higher glycemic load or glycemic index carbs seem to also help lower high blood pressure. Something Jesus also noticed from the example above.

2. Fiber

Fiber is filling and helps many maintain healthy gut flora. Though some believe that fiber is not needed many of my patients do well with it, anecdotally.

Avoiding it is generally a bad idea. But it’s easy to overdo it. Beans, generally quite high-fiber, can be well tolerated by some but someone else can only handle 1/4 cup without getting a lot of GI symptoms.

3. Healthy Fats

Certain fats are more obesogenic. Milk and fatty meats seem to not be ideal food choices for weight loss.

Olive oil, fish, avocados, nuts, and seeds are better fat/oil choices for someone trying to lose weight.

Some physicians recommend avoiding fats altogether and eating more starches. Perhaps you have the kind of physiology which would respond well to this. Experiment and find out.

4. Plant Proteins

Animal foods tend to be a bit more calorie-heavy but less nutrient dense. As in, they satisfy your macronutrient needs but may not have enough micronutrients.

Obtaining proteins from plants is a good option for many of my Heart Health coaching clients. Does this work for everyone? Absolutely not. We are all unique and our response to certain foods must be taken into consideration.

5. Nuts

Without brown rice or something oily, it’s hard for me to feel satiated. Nuts and seeds are ideal for me after a lighter meal. It’s my dessert and helps me feel full.

I could also feel full with a fatty whip cream or ice cream dessert but the weight and health consequences from that aren’t worth it.

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Heart Health Metabolic

Obesity and Cardiovascular Health

In my practice, I focus on obesity and cardiovascular health only when weight clinically affects heart health. Obesity, in isolation, if all else is optimized, offers only slight improvement if corrected.

Obesity has become a sociopolitical topic rather than a medical one. In my practice, I don’t focus too much on obesity unless it is a unique contributor to my client’s heart health.

Obesity in Healthcare

In western medicine, the patient is considered sick if their BMI is over 25. The patient will always have an ICD-10 code stuck somewhere in their medical chart.

It’s hard to know why conventional medicine manages patient health in such a way. Perhaps it expedites care and makes insurance billing simpler.

It is true that carrying extra weight puts most people at increased risk of insulin resistance, joint problems, sleep apnea, certain cancers, and other metabolic issues. But not everyone.

A person can be obese (BMI > 25) and relatively healthy. They manage their stress well, they are active, and their diet is optimized for their individual needs.

Vice versa, a person can have a normal BMI and not have an ideal metabolic profile. They can still have sleep apnea, hypertension, insulin resistance, and increased cancer risk.

Personal Perspective on Weight and Heart Health

I have clients who carry extra weight but live a good life. They have a diet that fits their individual needs, and they aren’t suffering in any significant way due to their weight.

For such individuals discussing obesity is clinically unnecessary. The minor percentage points of health advantages may not be worth the effort needed to change their weight.

If weight is an important topic, however, affecting their heart health, then we make that a priority. Think of sleep apnea or insulin resistance.

Obesity And Heart Health

I’ve worked with many heart health coaching clients and many of heart risk factors due to their lifestyles. Much more so than due to their body mass index.

We work together to improve their diet, stress, exercise, breathing, chemical exposures, and relationships that change their heart disease risk and improve their heart health.

If my client has the ideal diet, lifestyle, clean environment, sleep, and social support but remains overweight or obese, then we perform calculations to assess their ongoing risk.

This final risk score is how we determine if a weight reduction would add meaningful results; if it would improve this person’s heart health.

The Current Obesity Research

Look, all else equal, it’s potentially better to have a lower BMI – up to a point, of course.

However, we’re talking about an individual and not the population. The current research, just like most research, uses statistics to draw general conclusions. And it generally states a strong correlation between obesity and cardiovascular health.

General conclusions don’t define you and must be carefully applied to individuals. Otherwise, it’s easy to do a lot and not get results.

Most individuals who suffer from obesity also tend to have poor diets. They tend to be sedentary and, therefore, strongly correlate their weight and heart health.