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Primer on Obesity and Medical Weight Management Pt V. Strategies for Successful Weight Management

Welcome to the final installment of our blog series on obesity and medical weight management. In this post, we will discuss strategies to mitigate metabolic adaptation we just learned about in part IV and strategies to get the metabolic dance back on beat and restore the balance between all the hunger and appetite hormones and signals.


Remember that when we are exposed to increased stress, disrupted sleep, irregular eating habits, and decreased caloric intake, our neurohormonal signals act instinctively to sense any threat to a lack of energy intake or a loss of energy stores. These conditions lead to increased ghrelin levels, signaling increased hunger and increased energy intake. Diets high in sugar, refined carbohydrates, and unhealthy fats, combined with physical inactivity, contribute to insulin resistance and hyperglycemia. And, counterintuitively, efforts to cause weight loss can prompt increased hunger by decreasing leptin levels and satiety signals.

Also remember that metabolic adaptation also occurs as a survival mechanism. When you lose weight, your body perceives it as a threat to its energy stores and lowers your resting metabolic rate (BMR) to conserve energy. This adaptation can make further weight loss challenging and increase the risk of weight regain.

Strategies that you can take

Regular Physical Activity

Physical activity plays a powerful role in the metabolic dance. Regular exercise not only helps burn calories but also improves insulin sensitivity and enhances the overall efficiency of the dance. Aim for a mix of aerobic and strength-training exercises to keep the body in tune.

Incorporating Strength Training

Strength training is one of the most effective strategies to combat metabolic adaptation. Building muscle mass increases your resting metabolic rate because muscle tissue requires more energy to maintain than fat tissue. Incorporate resistance training exercises, such as weight lifting or bodyweight exercises, at least 2-3 times a week to build and maintain muscle mass.

Incorporating Non-Exercise Activity Thermogenesis (NEAT)

Non-exercise activity thermogenesis (NEAT) refers to the energy expended for everything we do that is not sleeping, eating, or sports-like exercise. Increasing NEAT can help reduce metabolic adaptation. Simple activities like walking, taking the stairs, gardening, or even fidgeting can significantly increase daily calorie expenditure.

Balanced Nutrition: Fueling the Dance

One key step in restoring the metabolic dance is adopting a balanced and nourishing diet. Focus on whole, nutrient-dense foods, including a variety of fruits, vegetables, lean proteins, and whole grains. This provides the essential building blocks for hormones like insulin and incretins to perform their roles effectively.

Increasing Protein Intake

A higher protein intake can help lessen metabolic adaptation by promoting muscle retention and increasing the thermic effect of food (TEF). Protein requires more energy to digest, absorb, and process compared to fats and carbohydrates. Aim to include high-quality protein sources in each meal, such as lean meats, fish, eggs, dairy, legumes, and plant-based proteins.

Avoid Overly Restricting Calories

Levels of ghrelin will increase, and thus your hunger signal, if you are consistently under-eating and drops in weight will decrease your resting metabolic rate; however, you still need an overall energy deficit to achieve weight loss. Calorie cycling involves varying your daily calorie intake to prevent your metabolism from adapting to a consistent calorie deficit. By incorporating higher calorie days (refeeding days) into your plan, you can signal to your body that it is not in a prolonged state of energy deficiency. This can help maintain metabolic rate, prevent elevations in hunger signals, and support continuous weight loss.

Medical Interventions

For some individuals, medical interventions such as medications or bariatric surgery may be necessary to support long-term weight management. FDA-approved anti-obesity medications can help by suppressing appetite, reducing fat absorption, or increasing energy expenditure. Bariatric surgery options, like gastric bypass or sleeve gastrectomy, can be considered for individuals with severe obesity or those who have not responded to other treatments.

FDA-Approved Medications

For some individuals, FDA-approved medications can play a supportive role in weight management. Let's briefly explore how each class of anti-obesity medication functions within the metabolic dance:

  1. Qsymia (phentermine + topiramate): Phentermine suppresses appetite, while topiramate affects neural signals related to food intake, helping regulate weight.

  2. Orlistat (Xenical, Alli): Orlistat blocks the absorption of dietary fats, reducing calorie intake and supporting weight loss.

  3. Contrave (bupropion + naltrexone): a combination medication that works by targeting the brain's hunger and reward pathways to help reduce appetite and control cravings, combining bupropion, an antidepressant, and naltrexone, an opioid antagonist.

  4. Liraglutide (Saxenda): Liraglutide is a GLP-1 receptor agonist that enhances insulin secretion, slows stomach emptying, and reduces appetite.

  5. Semaglutide (Wegovy): A newer GLP-1 receptor agonist like liraglutide, semaglutide, specifically in its higher dose form, has been FDA-approved for obesity treatment.

  6. Tirzepatide (Zepbound): Tirzepatide, a dual GIP and GLP-1 receptor agonist, represents a slight pharmacological difference compared to semaglutide and liraglutide. The dual action enhances its efficacy in weight management.

(GLP-1 receptor agonists are extremely sophisticated medications that deserve an entire blog post to highlight the complex nature in which they work. Stay tuned for this post in the near future.)

Healthy Behaviors: Nurturing the Dance

In addition to the fundamentals of nutrition and fitness, adopting a holistic approach to health can nurture the metabolic dance. Staying hydrated, avoiding excessive alcohol intake, and refraining from smoking are all part of a successful weight management program. These lifestyle choices contribute to an environment where hormones can perform optimally.

Mindful Eating Habits

Practicing mindful eating is like tuning in to the melody of the metabolic dance. Pay attention to hunger and fullness cues, savor each bite, and avoid distractions while eating. This mindful approach fosters a healthier relationship with food, supporting the roles of ghrelin and leptin in appetite regulation.

Managing Stress and Sleep

Chronic stress can negatively impact your metabolism and hormone regulation, leading to metabolic adaptation and weight gain. Implement stress management techniques such as mindfulness, meditation, yoga, or other relaxation methods. Additionally, poor sleep can disrupt hormone balance, elevating ghrelin levels and impacting insulin sensitivity. Prioritize good sleep hygiene with a consistent sleep schedule and a calming bedtime routine.  Aim for 7-9 hours of quality sleep per night to support overall metabolic health.

Regular Monitoring and Adjustments

Regularly monitoring your progress and making necessary adjustments to your diet and exercise plan is crucial for long-term success. Work with your healthcare provider or a weight management specialist to track changes in your weight, body composition, and metabolic rate. Adjust your calorie intake, exercise routine, and lifestyle habits based on your progress and needs.

Achieving metabolic harmony

Restoring balance to the metabolic dance involves having an understanding and an appreciation for the complex nature between our body and its relationship to food and energy. It involves embracing a lifestyle that includes nutrition, exercise, mindfulness, sleep, and stress management. FDA-approved medications, when prescribed under medical supervision, can provide additional support within the limits of this dance. By incorporating these strategies, we empower ourselves to lead a healthier, more harmonious life.

At Cardona Direct Primary Care, we are committed to helping you achieve your weight management goals through personalized, evidence-based strategies. Learn more about our comprehensive weight management program coming soon and start your journey towards improved health.

Thank you for joining me in this blog series on obesity and medical weight management. I hope you found the information valuable and empowering. Stay tuned for more insights and tips on maintaining a healthy lifestyle.

Dr. Cardona is board certified in family medicine and obesity medicine and is the founder and physician owner of Cardona Direct Primary Care and RefineMD Aesthetics. Currently accepting new patients. (904) 551-4625. Visit for information on our obesity management services.

**Disclaimer:** This blog post is for informational purposes only and does not constitute medical advice. Please consult with a healthcare professional before making any changes to your diet, exercise, or medical treatment plan.

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