A Broader Approach to Obesity

:dropcap_open:O:dropcap_close:verwhelmingly, research studies are delivering staggering statistics: approximately two-thirds of the American population is overweight, and nearly half of those folks are obese.
hfcsThe causes of obesity are assumed to be well known: too much food and too little exercise. As healthcare professionals, we have an obligation to help our patients by educating them on the right course of action to reverse the trend. We also have an opportunity to move past the generic recommendation of “exercise and eat right.” We must challenge ourselves to explain what constitutes good nutrition and effective exercise for this population.
We recommend a three-pronged approach for our obese patients. It tackles the key areas that often combine to produce failure. Our goal as healthcare professionals is to enable our patients to be successful in their weight loss goals. The three components include:
  1. Identify what constitutes good/proper nutrition.  
  2. Incorporate a realistic strength training program that doesn’t overwhelm or over-complicate. 
  3. Educate patients on up-to-date research that sheds the truth on salt, sugar (especially fructose), and saturated fats.
While lack of exercise is constantly cited as a major cause of obesity, the facts do not support this sweeping generalization. We have come to realize that the majority of people who rely on exercise to lose weight are extremely frustrated with the results. 
Numerous studies over the last three decades show that exercise, in general, is not particularly effective at reducing fat stores. We know people who spend a lot of time in the gym, on the treadmill or stair stepper, who never see any lasting benefits. We also all know people who have lost weight on an effective eating plan without exercise.
The healthcare system’s bland and undocumented recommendation to be “active” is a simplistic and ineffective approach to obesity. So, what can we offer our patients as a realistic “single-pronged” approach to better health and fitness?
We need to tell our patients that the most essential part of a weight loss program is maintaining glycemic control or maintaining normal blood sugar and brain sugar levels. We need to explain that clearly by impressing the fact that reducing the consumption of refined starches and sugars—especially fructose—will result in weight loss and lower blood pressure, both of which will reduce the likelihood of diabetes.

The fructose phenomenon
There is compelling new evidence linking fructose consumption to increased uric acid levels, which is intricately linked to obesity and associated health problems such as diabetes and hypertension. Fructose is the most pernicious type of sugar. It contributes to glycation, a pathological aging process, more than any other sugar. The oxidative damage caused by glycation, and its cascading effect on the tissues of the vascular system, renal capillaries (kidneys), joints, retinal capillaries, and the skin (wrinkles), will surely grab our patients’ attention.
Dr. Mehmet Oz and others proclaim that Americans should add more fruit to their diets. The blanket statement that fruit is always an acceptable part of the diet does not hold true for those with a problem regulating blood sugars. Fructose content is particularly high in some fruits, such as raisins, grapes, prunes, plums, figs, dates, cherries, pears, bananas, berries, apples, and watermelon, as well as honey, ordinary sugar, and corn syrup. Is that to say no one should eat fruit? Of course not. Everyone has an individual tolerance for fruit.
For those who proudly claim they are juicers, the concentration of fructose is even higher than in whole fruit. There is nothing natural about consuming large quantities of juice. You may have heard or know someone who has lost weight juicing. More than likely, the weight loss was a result of a dramatic reduction in the total amount of sugars and carbohydrates they were consuming before juicing.
The skinny on fat
At the other end of the nutritional spectrum, educating patients on the importance of fats, especially saturated fats, is often more challenging.

Fats are one of the body’s most important nutrients. Scientific research clearly shows that saturated fat does not cause degenerative diseases; it actually protects against them. Fats are essential for hormone production and for slowing down the aging process. 
For more than forty years, Americans have been duped into believing that fats are the culprits in their weight loss failures. However, groundbreaking studies show that a high fat intake upregulates key enzymes (lipase), which break down dietary fat and body fat. It seems counterintuitive to most Americans, but a high fat intake can actually lower body fat! 
The body is an amazing organism: highly regulated and fine-tuned. Making changes across the board is important because switching to a high fat diet without limiting or removing carbohydrates will result in body fat accumulation. If we emphasize how foods affect hormones and fat storage, we de-emphasize the requirement to compensate for bad dietary choices with excessive exercise.
Working out the time to work out
Time is a very relative factor for most people when trying to work exercise into a hectic lifestyle. The recommendation to exercise for at least 30 minutes a day for five, six, or seven days usually has a negative effect on compliance for obese and overweight patients. 
The goal is to set your client up for success. Don’t overwhelm and stress out the non-athletic, overweight, and obese population with formulas for failure. A successful exercise program must show immediate, incremental accomplishment and be as stress-free as possible.
Our expertise with the obese/overweight population clearly demonstrates that a new approach to fitness is necessary. First, it’s important to make a realistic assessment of immediate needs. It is critical to understand the extremely different exercise protocols available to this group, and the relative effectiveness each has on influencing weight loss. Making an exercise protocol accessible and doable is an important part of the equation.
Based on the tremendous clinical improvement we have witnessed with the obese market, we firmly are convinced that the healthcare system has overcomplicated exercise for the population interested in only health and fitness. Trainers are overemphasizing endurance training, such as running and aerobics, for the obese and overweight population, which is not prudent or appropriate. This kind of training does little to promote muscle, and provides little metabolic stimulus post-workout.
:dropcap_open:Because muscle is where fats and sugars are metabolized, it should be a priority for this group to maintain and build muscle as it helps normalize blood sugars seven days a week. :quoteleft_close:
With years of experience under his belt, Rick Bramos believes the average overweight person does not need the endurance of an athlete, but instead needs to engage in strength training to wake up dormant muscle fiber and even add a few pounds of this metabolically active tissue. Because muscle is where fats and sugars are metabolized, it should be a priority for this group to maintain and build muscle as it helps normalize blood sugars seven days a week. 
Resistance training is inherently safe for all fitness levels regardless of age or gender. It packs a potent post-workout punch when executed properly.
Putting it all together
We believe that once your patients understand that losing weight (fat) is primarily impacted by what you eat, not necessarily how much, then all you need is two strategically planned workouts a week to stay fit and healthy for the rest of your life. Research has shown that someone can achieve and maintain sufficient gains in muscle and strength with only two workouts a week. 
Two workouts a week are doable and that dramatically improves compliance, which leads to more positive clinical outcomes. 
The following is a simple guide to present to patients who have issues with their weight:
  • Keeping insulin levels low is the key to losing weight. With low insulin levels, exercise will accelerate weight (fat) loss because the body has access to the fatty acids that are stored in the fat cell. This is accomplished by limiting sugars and refined carbohydrates.
  • Managing stress has a profound effect on weight gain because cortisol has an upregulating effect on the LPL receptors of the fat cells.
  • Sleeping soundly is necessary for adequate growth hormone production. 
  • Matching the training approach with the patient’s goals and available time will improve long-term compliance, which supports normalized blood sugar levels.
  • Addressing the biochemical glitches such as thyroid, environmental toxins that disrupt fat metabolism, and nutrient deficiencies.
Addressing obesity requires a multifaceted approach that meets the patient’s needs. A simple solution to our country’s chronic obesity problem is to pay greater attention to the root of the problem: the food that we eat.
As healthcare professionals, we can educate our patients by presenting them with the facts and solutions that truly work.

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  2. Brooks D, Effective Strength Training: Analysis and Technique for Upper-Body, Lower-Body, and Trunk Exercises, Human Kinetics; 1 edition (June 29, 2001)
  3. Faigenbaum AD, Milliken LA, Loud RL, Burak BT, Doherty CL, Westcott WL.Comparison of 1 and 2 days per week of strength training in children., Res Q Exerc Sport. 2002 Dec;73(4):416-24.
  4. Buchheit M, Laursen PB.High-Intensity Interval Training, Solutions to the Programming Puzzle, Sports Med. 2013 Mar 29.
  5. Westcott WL, Annesi JJ, Skaggs JM, Gibson JR, Reynolds RD, O’Dell JP., Comparison of two exercise protocols on fitness score improvement in poorly conditioned Air Force personnel., Percept Mot Skills. 2007 Apr;104(2):629-36.
  6. Reiser & Hallfrisch. “Metabolic Effects Of Dietary Fructose,” CRC Press, 1987
  7. Ravinskov, Journal of American Physicians and Surgeons 8, No 3 (2003), 94-95. The retreat of the diet heart hypothesis. Journal of American Physicians and Surgeons 8, No 3 (2003), 94-95. 
  8. Ling, P., et al. “Evaluation Of Protein Quality Of Diets Containing Medium and Long Chain Tryglicerides In Healthy Rats,” Journal Of Nutrition 116, 343-9, 1986.
  9. Laitinen, M., et al., “Effects of Dietary Cholesterol Feeding On The Membranes Of Liver Cells And On The Cholesterol Metabolism In The Rat,” International Journal Of Biochemistry 14 (3) 239-41, 1982
  10. Gary Taubes, Good Calories Bad Calories, Anchor Books,  2007
  11. Gary Taubes, Why We Get Fat, Alfred A. Knopf,  2011
  12. Michael Aziz, The Perfect 10 Diet, Cumberland House 2010
Ronald Grisanti D.C., D.A.B.C.O., M.S., is medical director of Functional Medicine University. If interested in improving your diagnostic skills and increasing your community reputation and recognition, we strongly recommend subscribing to our Free Clinical Rounds Series. These challenging case studies will give you the unique opportunity to test your clinical skills and, at the same time, improve your ability to handle many of the most difficult cases. Go to the following link to get your free access: www.ClinicalRounds.com.
Rick Bramos is a 35 year fitness veteran. He has successfully trained thousands of obese individuals using the latest scientific research on losing fat and getting fit. He is the author of the breakthrough book, 2 Days to Fitness (www.2DaystoFitness.com). He has had the privilege of sharing his experience and knowledge with a growing number of chiropractors. In turn, his fitness and training philosophy is making a significant impact on thousands of patients in the US and abroad.

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