Beyond the Conventional Weight Loss Approach

Understanding the Power of Pranayama for Wellbeing

Entering just two words “how to” into your Google search bar, reveals “how to lose weight fast” as one of the top searched questions.

In a nation where weight loss industry services are worth close to $500 million in 2023, and two in three adults are overweight or obese, it asks a different question – why are conventional weight loss efforts failing?

Being one of the greatest public health issues to date, excessive unhealthy weight gain has markedly increased in many parts of the world and has been attributed to the explosion and availability of ultraprocessed, inexpensive, and energy-dense foods, alongside a lack of daily physical activity1. We might simply correlate this with the age-old ‘calories-in-vscalories-out’ equation when it comes to weight loss.

The abundance of competitors that make up the weight loss sector, including dietary meal provision companies, diet shakes and meal replacements and online weight loss programs, have created an overwhelming landscape of solutions to essentially the same problem across the last few decades.

Whilst there is no question that the environment that informs the energy in vs energy out equation for an individual is a critical factor in their weight loss and weight maintenance journey, there are many other factors influencing body weight that must be considered.

These include infection, epigenetics, endocrine disruptors, sleep debt, pharmaceutical iatrogenesis2 as well as other key biological factors including resting energy expenditure (REE), body composition, meal-induced thermogenesis, appetite control and satiety, adipocyte metabolism, nutrient partitioning, gastrointestinal signalling and emotional state and stress1.

From a clinical perspective, other presenting factors that may also influence weight gain include gut dysbiosis, insulin resistance, endocrine hormone dysfunction, chronic inflammation, loss of muscle/ sarcopenia and genetic predisposition.

A simple model highlighting the factors determining body weight and composition (as shown in Figure 1), include key metabolic and physiological factors such as NEAT (Non-Exercise Activity Thermogenesis) and behavioural factors such as macronutrient composition and eating frequency1. In essence, it is the complexity and interaction of an array of factors that more closely explain daily energy expenditure and intake, which can be highly variable from one person to the next.

Conventional weight loss efforts are also failing because they do not more closely consider the physiological adaptations that occur within the body to counteract a reduction in energy intake. Dietinduced weight loss may trigger mechanisms such as a decrease in energy expenditure, increases in appetite, craving and orexigenic hormone (such as, ghrelin) levels, decreases in fat oxidation and anorexigenic hormone (such as, leptin) levels, and potentially promote weight regain2. Furthermore, many weight loss approaches do not consider maintenance of weight loss, which is considerably the most important step of all.

Research has shown that at the end of prolonged continuous (12-14 week) energy restriction, as little as 60% of the expected change in body weight and fat mass is elicited through an intentional energy deficit1 In contrast, the MATADOR (Minimising Adaptive Thermogenesis And Deactivating Obesity Rebound) study successfully demonstrates that intermittent energy restriction, in comparison to continuous energy restriction, produced greater weight and fat loss in a controlled cohort. The prescribed intermittent energy restriction was delivered as alternating two-week blocks of energy restriction and energy balance, for a 16-week period. This approach resulted in greater fat loss without greater loss of fat-free mass, a lessening in the reduction of resting energy expenditure, and superior weight loss retention after six months, compared with an equivalent

‘dose’ of continuous energy restriction across the same period3. This study is just one example of an approach that goes beyond traditional weight-loss diets and provides a strategy that may support better compliance and metabolic outcomes across the long term.

Once we have addressed some of the key foundations to optimal metabolic health, such as eating for stable blood sugar, daily exercise, optimising sleep and circadian rhythm and minimising stress, if weight loss is to be achieved it must be founded on addressing core behavioural and biological factors, adapting to inevitable metabolic changes, ensuring dietary and lifestyle flexibility, and of course adopting an individualised approach. This approach is the antithesis of the quick fix of conventional diets: however, as holistic-focused clinicians it is one that empowers and educates clients to see weight loss beyond the number on a scale, and as a critical step in achieving optimal health and wellbeing.

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