Obesity

Obesity is a complex disease that requires more than just willpower to solve. Behavior change, dietary change, and exercise combat obesity at its root cause and can treat it for good.

Cases per year

Over 70 million adults in U.S. are obese, plus 99 million are overweight.

General frequency

 42.4% of US adults are obese 1.

Risk

Obesity is a serious risk factor for most chronic diseases including metabolic syndrome, heart disease, diabetes, and certain cancers. It can seriously impact a persons quality of life and stop them from living as they would like to.

Treating obesity the right way, with a plant-based diet and lifestyle changes

All of my patients have seen improvements in health and weight loss can be significant including one patient who has lost 350 pounds!

Dr Laurie Marbas, who has seen the power of lifestyle medicine to treat obesity first-hand.

Podcasts

Here are some top scientific studies that support the results our clinicians have seen first-hand:

Lifestyle interventions with combined diet and exercise components achieve the greatest weight loss of all care methods

Lifestyle interventions for weight loss in adults with severe obesity: a systematic review 

Scientists reviewed studies looking at interventions for weight loss. In every single study lifestyle interventions, combining exercise, diet, and behavioral therapy, resulted in significantly greater weight loss than the control groups or standard care alone. They conclude that interventions containing both diet and exercise components are the most effective methods for weight loss 2.  

Individuals on a plant-based diet have the healthiest BMIs and are least likely to be overweight

Type of vegetarian diet, body weight, and prevalence of type 2 diabetes

A study population of over 60,900 men and women who participated in the Adventist Health Study-2 found those eating plant based diets had the lowest average BMIs of all dietary groups. The more animal products included in the diet, the higher the average BMI of the group. Mean BMI 23.6 kg/m2 in completely plant-based people and incrementally higher in lacto-ovo vegetarians (25.7 kg/m2), pesco-vegetarians (26.3 kg/m2), semi-vegetarians (27.3 kg/m2), and nonvegetarians (28.8 kg/m2) 3

Whole-foods plant-based diet significantly reduces BMI without restricting calorie intake 

The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes

A community-based study provided participants with skills, namely cooking skills, to encourage behavior change and the transition to a plant-based diet. The plant-based diet group had a significantly greater reduction in weight and BMI compared to the control group provided with normal care alone. This study is compelling evidence for the long-term sustainability of a plant-based diet for weight loss, as the participants were able to sustain a plant-based diet at 12 months with very little weight regain, after being given education alone (weight regain is common in almost all diets at 12-48 months) 4.

Plant-based diet results in significant weight loss, better insulin sensitivity, and improved lipid levels in muscle and liver cells 

Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial 

122 people were put on a low-fat plant-based diet for 16 weeks and compared to another 122 people who made no dietary changes. In the plant-based intervention group body weight decreased significantly by 5.9 kg (95% CI, 5.0-6.7 kg; P< .001). They also increased their after-meal metabolism by 18.7% from baseline to 16 weeks, whereas this did not change significantly in the control group 5.

General information about obesity and treatment with lifestyle interventions

What is obesity?

Obesity is a complex disease, defined as excess body fat (adipose tissue) that’s a risk to your health.

What causes obesity? 

Consuming more calories than you burn is the basic, physiological cause of obesity, and our diet is the main determinant of this. The standard American diet is high in processed and animal-derived foods and is implicated in the development of obesity. For example, red meat, poultry, and processed meat are direct causes of weight gain 6

Whilst diet is the main cause of excess weight gain, the contributing factors to becoming obese, including why someone eats the way they do, are complex including genetic, environmental, psychological, social, and economic reasons 7

Obesity isn’t always treated like other diseases by physicians, and people aren’t always given the support they need. Many may have simply been told to ‘eat less’, but this is not how you cure obesity in the long-run.

Lower physical activity levels also contribute to weight gain. We live less active lives than previous generations as behaviors have shifted to be more sedentary. Many of us now drive to work, sit at a desk all day, and watch TV or use the internet in our free time7. Lack of sleep is also associated with a higher BMI 8, and sleep restriction can result in increased hunger hormones and a bigger appetite 9. Stress, medications, and various health conditions also contribute to weight gain.

In order to address these root causes of obesity, a patient should work with a physician that understands these factors, and can support the building of sustainable behavioral and lifestyle changes to lose weight and maintain weight loss in the long run. 

Symptoms 

Common symptoms of obesity include:

  • Excess body fat, particularly around the waist
  • Shortness of breath 
  • Increased sweating 
  • Snoring 
  • Fatigue 
  • Joint and back pain 
  • Low confidence and low self-esteem 
  • Difficulty doing daily tasks or physical activities 

Obesity is also a major risk factor for chronic diseases further down the line. It can increase your risk of cardiovascular disease, several cancer types, type 2 diabetes, chronic kidney disease, dementia, and osteoarthritis. It can also shorten life expectancy and lower your quality of life 10

Diagnosis 

Diagnosis is commonly based on your BMI, which is a measure of your weight (kg) divided by your height squared (m2), and is split into these categories:

BMI isn’t perfect; it doesn't specifically determine excess fat mass, as it can’t distinguish between body fat and muscle mass 11. That means it can overestimate or underestimate fatness due to factors like age, muscle mass, and ethnicity 12

BMI also can’t measure where body fat is carried. Fat carried around our middle can pose a bigger health risk than when carried elsewhere, like our arms or thighs. Some people have a normal BMI but carry too much fat for their size, so may have a false sense of security regarding their health. Conversely, you can have an overweight BMI but be fit and have a healthy metabolic profile 13.

It is useful to combine other measurements that may be a better indicator of body fat and its risk to health such as waist circumference and waist/hip ratio 14

Waist circumference can determine abdominal obesity (and an increased risk of diabetes and heart disease) at the following levels 15:

  • Men, over 102 cm (40 inches)
  • Women, over 88 cm (35 inches) 

Treatment 

Lifestyle medicine and behavioral therapy are the foundation of obesity treatment, as obesity is almost always a result of diet, lifestyle and psychosocial factors. 

Plant-based diets are naturally high in fiber and have a low calorie density, which means most patients can lose weight without restricting their portion sizes or constantly feeling hungry 16. Plant foods are better at regulating our appetite hormones and support gut health which further promotes a healthy weight 17. Equipped with a healthy diet, along with exercise, stress management, and sleep properly planned really sets you up for success treating obesity and overweight. 

Making these sustainable changes to your diet, and lifestyle, to focus on whole plant foods and more movement is, for many, the key to losing weight for good. These changes are more likely to stick if you’re surrounded by a dedicated, supportive medical team that feels like family. 

Useful links

Health and Mora podcast with Dr Laurie Marbas:

If you think you may be struggling with obesity, our physicians are here to help you make real long-lasting change. Book a free appointment with a clinician today. 

References

1. Overweight & Obesity Statistics | NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity.

2. Hassan, Y. et al. Lifestyle interventions for weight loss in adults with severe obesity: a systematic review: Lifestyle interventions in adults with severe obesity. Clin. Obes. 6, 395–403 (2016).

3. Tonstad, S., Butler, T., Yan, R. & Fraser, G. E. Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes. Diabetes Care 32, 791–796 (2009).

4. Wright, N., Wilson, L., Smith, M., Duncan, B. & McHugh, P. The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes. Nutr. Diabetes 7, e256–e256 (2017).

5. Kahleova, H. et al. Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial. JAMA Netw. Open 3, e2025454 (2020).

6. Vergnaud, A.-C. et al. Meat consumption and prospective weight change in participants of the EPIC-PANACEA study. Am. J. Clin. Nutr. 92, 398–407 (2010).

7. Wright, S. M. & Aronne, L. J. Causes of obesity. Abdom. Radiol. 37, 730–732 (2012).

8. Gangwisch, J. E., Malaspina, D., Boden-Albala, B. & Heymsfield, S. B. Inadequate Sleep as a Risk Factor for Obesity: Analyses of the NHANES I. Sleep 28, 1289–1296 (2005).

9. Spiegel, K., Tasali, E., Penev, P. & Cauter, E. V. Brief Communication: Sleep Curtailment in Healthy Young Men Is Associated with Decreased Leptin Levels, Elevated Ghrelin Levels, and Increased Hunger and Appetite. Ann. Intern. Med. 141, 846 (2004).

10. Blüher, M. Obesity: global epidemiology and pathogenesis. Nat. Rev. Endocrinol. 15, 288–298 (2019).

11. Rothman, K. J. BMI-related errors in the measurement of obesity. Int. J. Obes. 32, S56–S59 (2008).

12. Ruban, A., Stoenchev, K., Ashrafian, H. & Teare, J. Current treatments for obesity. Clin. Med. 19, 205–212 (2019).

13. Roberts, C. K. et al. Strength Fitness and Body Weight Status on Markers of Cardiometabolic Health. Med. Sci. Sports Exerc. 47, 1211–1218 (2015).

14. Huxley, R., Mendis, S., Zheleznyakov, E., Reddy, S. & Chan, J. Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk—a review of the literature. Eur. J. Clin. Nutr. 64, 16–22 (2010).

15. National Institutes of Health. Managing Overweight and Obesity in Adults:  Systematic Evidence Review from the Obesity Expert Panel. (2013).

16. Hall, K. D. et al. Effect of a plant-based, low-fat diet versus an animal-based, ketogenic diet on ad libitum energy intake. Nat. Med. 27, 344–353 (2021).

17. Klementova, M. et al. A Plant-Based Meal Increases Gastrointestinal Hormones and Satiety More Than an Energy- and Macronutrient-Matched Processed-Meat Meal in T2D, Obese, and Healthy Men: A Three-Group Randomized Crossover Study. Nutrients 11, 157 (2019).

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