Well Being: Keeping the Weight OFF for a Long and Healthy Life
The Post-Weight rebound and what to do about it
Executive summary:
This essay explores the link between obesity and metabolically altered fat cells, and how those cells influence behavior over time.
• We discuss how obesity is a significant factor in increased inflammatory processes.
• We explain how obesity leads to chronic diseases and changes in physiological functions.
• We then examine options for weight loss and offer tips to improve the chances of long-term success in weight loss programs to maintain the weight loss.
An image is making its way around Facebook, asserting that when you lose fat, it just gets turned into CO2 and we breathe it out, or it gets excreted through the usual pathways. That all sounds great!
Eat less, move more - and lose fat!
Except that this isn’t exactly what happens.
Just ask anyone who has lost a little or a lot of weight, only to gain it back. Again and again and again. Maybe they (or you) have cycled like that their entire adult lives.
Ask anyone who has gone on a GLP-1 inhibitor, lost a bunch of weight, gone off the inhibitor, and gained it all back…
Or gone on a crash diet plan, only to gain it all back after the diet ended.
What happened to all that “willpower”
The reason is simple and not so simple. The complex answer is as follows:
The number of fat cells in the body generally remains constant throughout adulthood. But when we become fat, the fat cells become metabolically altered.
Obesity fundamentally reprograms fat cells metabolically, endocrinologically, and epigenetically, turning them into drivers of metabolic disease rather than passive energy reservoirs.
Fat cells undergo significant metabolic changes when one loses weight, but do not fully revert to their pre-obesity state.
Fat cells retain an epigenetic "memory" of obesity that persists, even when a person loses the weight. These cells react to weight loss, to losing mass, as if they are starving.
To repeat: Weight loss improves some metabolic functions, such as reducing inflammation and enhancing insulin sensitivity. However, fat cells retain an epigenetic "memory" of obesity that persists even after weight loss.
This memory alters gene expression and cellular function, predisposing individuals to weight regain. This is why it becomes tricky to maintain the weight loss once it has been achieved. But it gets worse.
Fat cells are long-lived and only renewed or replaced every ten years. Adults lose approximately 10% of their fat cells each year, while new ones are formed in a process known as adipocyte renewal. Hence, once obese, theoretically, it takes at least ten years for the body to recover its pre-obesity fat cell memory fully.
Therefore, once the goals of returning to a normal weight are achieved, the need for self-control methods beyond what a thin person needs to maintain that lowered body weight is critical. What we know now is that it takes years to heal from obesity.
So, if you are obese or even overweight, the best thing you can do for your body is to lose the weight. But keeping that weight off will not be an easy task.
Not because you lack willpower, but because your fat cells are hungry.
It is as if “Seymour” from the “Little Shop of Horrors” were riding shotgun in your brain:
So, why bother? What’s a little fat?
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One of the major issues with being obese or even overweight is the increased risk of metabolic disease. Below is the technical description for metabolic disease from the Cleveland Clinic.
Criteria for metabolic syndrome
A person meets the criteria for metabolic syndrome if they have at least three of the following:
Excess abdominal weight: A waist circumference of more than 40 inches in males and 35 inches in females
Hypertriglyceridemia: Triglyceride levels that are 150 milligrams per deciliter of blood (mg/dL) or greater.
Low levels of HDL cholesterol: HDL cholesterol of less than 40 mg/dL in males or less than 50 mg/dL in females.
Elevated blood sugar levels: Fasting blood sugar level of 100 mg/dL or greater. If it’s 100 to 125 mg/dL, you have prediabetes. If it’s over 125 mg/dL, you likely have Type 2 diabetes.
High blood pressure: Blood pressure values of systolic 130 mmHg or higher (the top number) and/or diastolic 85 mmHg or higher (the bottom number).
But what the definition of metabolic disease doesn’t mention is that obesity and being overweight causes inflammation. There is a strong relationship between unhealthy white adipose tissue (fat) and inflammation, which is all linked to insulin resistance, glucose intolerance, type 2 diabetes.
White Adipose Tissue: Overview
White adipose tissue (WAT) is the most prevalent type of fat tissue in adult humans and mammals, making up about 90% of all fat.
WAT is composed mainly of white adipocytes, which is otherwise known as fat or fat cells. In addition to adipocytes, WAT contains other cell types, including immune and vascular cells.
Hormonal and Metabolic Activity
White adipocytes (fat) have receptors for insulin, sex hormones, norepinephrine, and glucocorticoids, allowing them to respond to various hormonal signals. These receptors are involved in the regulation of hunger and satiety through hormone secretion. It also participates in immune responses by producing inflammatory cytokines and interacting with immune cells
leptin resistance, is a condition where the brain fails to respond to leptin's satiety signals despite high circulating levels of the hormone. Obesity-induced inflammation disrupts hypothalamic neurons, exacerbating leptin resistance. We lose the ability to feel full.
Sex drive, increased fat disrupts sex hormone balance through multiple mechanisms, leading to decreased sex drive in both men and women. In men, increased visceral WAT is linked to lower testosterone levels, a condition known as hypogonadism, which is a well-established cause of reduced libido.
Inflammation causes aging.
Chronic inflammation is recognized as a key driver of premature aging. This phenomenon is often referred to as "inflammaging," a state of persistent, low-grade inflammation that accelerates the aging process and increases the risk of age-related diseases.
Gait abnormalities.
Have you even noticed how many middle aged and older adults in the United States use a cane, walk painfully, have an uneven gait or a limp?
In traveling around the country, Jill and I often find ourselves at conferences, in restaurants or in airports and we are people watchers. The number of people who truly struggle with just walking is astounding. And yes, most of these people are suffering from being in a constant inflammatory state and just by observing, it is most likely related to being overweight.
Inflammation can cause gait abnormalities. Both acute and chronic inflammation are associated with measurable changes in walking patterns and mobility. Chronic inflammation can cause arthritic changes.
Much or most of this can be reversed (depending on severity) by simply losing weight and going on a diet low in refined (simple) carbohydrates. Often referred to as an anti-inflammatory diet.
Refined carbohydrates, such as white bread, pastries, and foods with added sugars are consistently linked to increased inflammation. These foods are quickly digested, leading to rapid spikes in blood sugar, which can promote a pro-inflammatory state in the body. Studies indicate that a high intake of refined carbs and added sugars correlates with elevated levels of inflammatory markers, including IL-6 and C-reactive protein . Furthermore, high-carbohydrate diets tend to increase inflammation more than high-fat diets, specifically by raising pro-inflammatory markers in both tissues and blood.
Inflammation-driven gait abnormalities arise from a triad of pain-mediated adaptations, joint/muscle degradation, and CNS dysregulation. These changes create a feedback loop whereby altered movement perpetuates inflammation (e.g., via uneven joint loading). Western medicine treats these chronic symptoms primarily by advocating for early anti-inflammatory treatments to preserve mobility. The list of drugs recommended are NSAIDs, corticosteroids, disease-modifying antirheumatic drugs and various combination therapies.
Shockingly, what is not included in that list to stop inflammation-driven gait abnormalities is prescribing a weight-loss program, long-term nutritional counseling, or even more dramatic measures, such as prescribing a GLP-1 inhibitor. It is as if the healthcare-industrial complex doesn’t want people to get better.
When an over weight person has a check-up, that most important piece of information may be that number on the scale. Yet, physicians hardly consider weight to be of any great importance, unless a person is morbidly obese. This is an indication of how broken our healthcare system is.
What foods are entering into the body should be of utmost importance to a physician, and this of course, includes pediatricians.
What’s a person to do?
Take responsibility for one’s own failing health.
First, recognize that losing weight is just the beginning of a journey to heal the body. Obesity stands out as the most common chronic disease in the U.S.. Being in a pro-inflammatory states drives most of these chronic diseases, including gait abnormalities, hypertension, diabetes, cardiovascular disease, stroke and metabolic disease.
Then make a commitment. That means do what it takes to lose the weight initially. For some, it may be that going on a GLP-1 inhibitor will help. But know, that this is not a quick fix. That the struggle is real and will last for years. Not due to a lack of will power, but due to the physiologic changes that have occurred within the fat cells. That it requires hog-tying that monster which I call “Seymour”, the one that lives within each of us who has been overweight, is a constant battle. This is not a 12-day war, but a ten-year campaign to regain health.
Your commitment must acknowledge that this is not a diet, but it a state of mind. That a person must become obsessed with becoming healthy and recognizing that to be healthy means being within a normal weight range.
These techniques, in no particular order, are what I recommend for both weight loss and keeping the weight off permanently. Know that not all of these will work for everyone, so mix and match or try all of them all at once!
Keep in your heart and mind that this journey towards being healthy is not a diet, but a new way of life.
Keep a journal. For some, a chart or graph with goals can be beneficial as well.
Use a calorie tracker program or just write down calories in a journal. Do this daily.
Fitness trackers and apps can also be helpful.
Weigh yourself daily and write it down in the journal or on a chart or put it into a health app.
Stop making food a reward. Find other rewards. Be creative.
Go outside and take a walk or do something productive when the urge to eat wriggles out of your lizard brain and into your sub-conscious.
Find your triggers and avoid them. Triggers might include watching TV, going out to eat, going to parties, or gaming. Avoidance might include eating before engaging in the activity, creating healthy snacks before beginning, or changing the location of the activity.
Let people know that you are on a diet. Be clear and specific. For instance, one might say before or at a dinner party: “I prefer not to be served desert, do you think I could get a cup of tea instead.”
Make a list of restaurants with healthy dishes and know what those dishes are.
Don’t order deserts at a restaurant. Instead order something like a coffee or tea.
Consider using stevia, instead of sweeteners.
Remove all refined carbs and sugar from the house.
Don’t binge.
Don’t clean your plate. Sorry mom.
Avoid seed oils, transfats, ultra-processed foods (get rid of them from your cupboards too).
Eat organic when possible.
Exercise regularly - keeping muscle mass is important.
Join a gym, or take a exercise class.
Join or start a self-help group.
Take a healthy cooking class or a class on nutrition.
Find a weight loss buddy. Of course, convincing a spouse, partner, family member that you are in constant contact with and share meals with is best. But if not, find a friend who you can go to an exercise class with or take walks with.
Get rid of clothes that are now too large - this will help reduce weight regain by making it harder to adapt to putting on pounds again.
Celebrate your successes.
Using accountability to drive healthy eating behaviors.
Think about the positives in losing weight when the urge to cheat is strong. Such as the loss of chronic pain and inflammation, better health, better sex life, better self-image. Then go find something to do to take your mind off of eating.
Eat protein to feel full. Research consistently shows that protein increases satiety, the sensation of fullness—more than carbohydrates or fat.
Intermittent fasting works well.
The Japanese practice of eating until 80% full, called “hara hachi bu” is a simple, effective way to support healthy weight and longevity, and is a cornerstone of mindful eating.
If you have chronic disease and are overweight, and just can’t lose weight - consider GLP-1 inhibitor. Yes, there are risks, but the risks associated with chronic disease may be much more significant. No judgement.
If you cheat, don’t stop with the lifestyle changes, just commit and work to getting back on track.
Finally, if you have a family or grandchildren, be the example that you wish to be. You are teaching your children and grandchildren how to live a healthy life. Be the person you wish them to grow into.