Difficulty with losing weight is a very common concern of patients. This is rightly so and for good reason, as taking steps to achieve levels closer to an ideal body weight can not only help patients feel better overall but can help prevent the onset of illness as well. The CDC at https://www.cdc.gov/healthyweight/effects/index.html have a list of conditions where people who are obese are at increased risk of certain conditions:
- all-cause mortality
- type 2 diabetes
- coronary heart disease
- stroke
- osteoarthritis
- certain types of cancer
- generalized pain and difficulty with physical functioning
Weight loss is often difficult for many patients, partly because the extra weight gained was quite slow and insidious, over many years. It can be difficult to stay motivated when trying to address a weight gain that has occured over a period of 10 years.
There are many options for patients when they are considering weight loss approaches. It should start with your primary care doctor, often your family doctor, or naturopathic doctor, to rule out some treatable causes, such as hypothyroidism.
There are a plethora of diet programs, supplements, and exercise regimes that are often marketed and it can be confusing for patients.
What options for weight loss have already been investigated or tried
Oftentimes, a patient presenting to a naturopath for weight loss may have already seen their family doctor for investigations on any causes that he or she might investigate. In addition to diet and exercise advice, often conditions such as overt hypothyroidism are ruled out to make sure there is not a hormone deficiency that is causing the difficulty with weight loss.
The patient may have already tried dietary programs, such as weight watchers, or even made an attempt at more rigorous dietary measures such as an Atkin's diet or ketogenic diet. They may have had good results, but have reached a plateau, or they may have regained a lot of the weight when they had finished or stopped a program.
What to expect when speaking to a naturopath for weight loss
Usually, the initial visit with a naturopathic doctor would involve history taking being the primary complaint of difficulty in losing weight. There would be discussions of diet history, activity levels, exercise history, and any past interventions that would were successful or not successful. In my own practice, we would also inquire into the possibilities discussed below, including stress, toxicities, as well as other metabolism affecting factors.
The consultation usually takes around an hour, and a complaint oriented physical exam if indicated is done.
We might at that point suggest and discuss some of the testing below in addition to things such as diabetes, thyroid screening.
Diagnostic work up that may be unique to the naturopathic approach: weight loss specific functional tests
In consulting with a naturopathic doctor for weight loss, most would ensure that the obvious causes for weight gain, depending on the case, are investigated or have been investigated.
This might be investigating for hypothyroidism, or other hormones that may be in excess such as adrenal hormones or cortisol. The work up for such conditions may differ from the usual medical approach, but typically there is a large overlap.
For example, in considering hypothyroidism, the usual testing run from the family doctor would be a TSH or thyroid stimulating hormone, and the naturopathic doctor may elect to run that test but in addition look at the actual hormone levels such as free T3, or any possible hints of thyroid hormone resistance by looking at reverse T3.
These add costs, but many naturopathic doctors find they might be helpful in hinting at factors that might be making weight loss more difficult than it should be.
Another example might be with sugar levels. Most practitioners would want to rule out diabetes as a complication of increased weight, and a fasting glucose or hemoglobin A1c would typically be run. In my own naturopathic practice, we may do the fasting glucose but in addition run a fasting insulin. While often normal, calculating the HOMA ratio from the two is done. If this ratio is elevated for example, the patient may not have diabetes, but they likely have insulin resistance which may guide us to a more specific diet, supplement, or medication that may help as a more targeted intervention.
A naturopathic doctor in investigating factors for difficulty in weight loss might also look at very general factors such as stress hormones. In some cases, we may find elevations in stress hormones such as cortisol that may explain a preponderance of abdominal obesity, for example. In such cases stress management, hormone balancing may play a very important role.
Finally, naturopathic doctors may look into in some cases toxicity factors. For example, in one study in 2018, it was concluded:
If toxicities are found, sometimes the treatment is focused on detoxification and addressing this first.
Naturopathic doctors, depending on the patient history, might also investigate for organic toxins. There is animal data of weight gain following organic chemical exposure, as well as evidence on gut flora disturbances from such toxins that may affect metabolism.
Treatment considerations that may come up with discussing weight loss options with the naturopathic doctor
There are many different approaches to consider, even without the more specific investigations mentioned above. For example. even from a diet perspective, there are discussions about gluten free diets, candida diets, carnivore diets, whole-30 diet, ketogenic diets, and intermittent fasting. In reality, there is no one diet that would suit all patients. Treatment options would be dependent on the status of the patient’s current diet, lab work which might give suggestions about things such as carbohydrate tolerance and insulin resistance, and on any testing results received as part of our investigations.
There may be treatments that are specific to the abnormalities found on investigation. For example, if there was insulin resistance found, we might discuss dietary measures aimed at addressing this, in addition to botanical or prescription options aimed the insulin resistance. If toxins were found to be increased as a body burden, and the patient had a history of already not responding well to other weight loss approaches, we might discuss addressing the issue with some detoxification type approach prior to focusing directly on the weight with diet and activity, for example.
Exercise and lifestyle will always play a role, and while exercise may not be an initial option for all patients, it is one of the goals that we try to incorporate in all patients as time goes on.
If you would like to make an appointment to have the above discussions, please call the office at 604 275 0163 to make an appointment with either Dr Chan, ND or Dr Ward, ND.
References and further reading
Environ Int . 2018 Dec;121(Pt 1):683-694. doi: 10.1016/j.envint.2018.09.035. Epub 2018 Oct 11. Associations of cumulative exposure to heavy metal mixtures with obesity and its comorbidities among U.S. adults in NHANES 2003-2014 Xin Wang 1, Bhramar Mukherjee 2, Sung Kyun Park 3
PLoS One . 2017 Jan 20;12(1):e0169958. doi: 10.1371/journal.pone.0169958. eCollection 2017. Lead Exposure Induces Weight Gain in Adult Rats, Accompanied by DNA Hypermethylation Honglin Sun 1, Ningjian Wang 1, Xiaomin Nie 1, Li Zhao 1, Qin Li 1, Zhen Cang 1, Chi Chen 1, Meng Lu 1, Jing Cheng 1, Hualing Zhai 1, Fangzhen Xia 1, Lin Ye 1, Yingli Lu 1
Hum Exp Toxicol . 2011 Sep;30(9):1119-40. doi: 10.1177/0960327110388959. Epub 2010 Nov 11. Toxic influence of organophosphate, carbamate, and organochlorine pesticides on cellular metabolism of lipids, proteins, and carbohydrates: a systematic review Somayyeh Karami-Mohajeri 1, Mohammad Abdollahi
Nutrition . Nov-Dec 2007;23(11-12):887-94. doi: 10.1016/j.nut.2007.08.008. Epub 2007 Sep 17. Relationship between stress, eating behavior, and obesity Susan J Torres 1, Caryl A Nowson
Annu Rev Psychol . 2019 Jan 4;70:703-718. doi: 10.1146/annurev-psych-010418-102936. Epub 2018 Jun 21. Stress and Obesity A Janet Tomiyama 1
Domest Anim Endocrinol . 2016 Jul;56 Suppl:S112-20. doi: 10.1016/j.domaniend.2016.03.004. Epub 2016 Mar 31. Stress, cortisol, and obesity: a role for cortisol responsiveness in identifying individuals prone to obesity S D Hewagalamulage 1, T K Lee 1, I J Clarke 1, B A Henry 2
Diabetes Care 2002 Jul; 25(7): 1135-1141. HOMA-Estimated Insulin Resistance Is an Independent Predictor of Cardiovascular Disease in Type 2 Diabetic Subjects nzo Bonora, MD, PHD, Gianni Formentini, MD, Francesco Calcaterra, MD, Simonetta Lombardi, MD, Franco Marini, MD, Luciano Zenari, MD, Francesca Saggiani, MD, Maurizio Poli, MD, Sandro Perbellini, MD, Andrea Raffaelli, MD, Vittorio Cacciatori, MD, Lorenza Santi, Giovanni Targher, MD, Riccardo Bonadonna, MD and Michele Muggeo, MD