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WEIGHT MANAGEMENT & LOSS 

Weight loss, tone body, hormonal weight loss, diet plans

Weight Management & Loss

Have you heard of the expression that WEIGHT LOSS is Ninety Percent (90%) DIET and Ten Percent (10%) EXERCISE? Sure! I believe in working out and a good diet plan, but I do not want to SUCK OUT the JOYS of FOOD and LIVING.

We are not looking at weight loss over a short time, but as a long-term plan so you can continue managing your weight as a lifestyle.

 

I guarantee that you can still LOSE WEIGHT with a REASONABLE DIET PLAN and EXERCISE PLAN. All YOU need is some help. 

Weight gain may be a HORMONAL ISSUE, POOR METABOLISM, BUILD UP OF BODILY TOXINS, WATER RETENTION, POOR EATING HABITS and Many More! So we will treat these issues and get YOU results FAST!

 

Your may be on a DIET or with a PERSONAL TRAINER but YOU just do not see the results! All you need is the right Doctor to help YOU know where is the PROBLEM! 

START THE CHANGE! CALL NOW or WALK IN and SAY YES TO A NEW YOU!

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What is obesity?
Obesity is currently at a crossroads of being called a disease rather than a lifestyle problem.

Obesity can be considered a disease if you look at it from a different perspective. People who are type 2 diabetic are already prone to become obese. So is it possible to look at it from this point of view, that obesity can be a complication of being diabetic? 

Another example, people with depression have been known to binge eat or eat excessively and they gain weight. Then this results in obesity which technically means is it a disease. 

There are many people, doctors, and even insurance providers who still consider obesity as a lifestyle problem, therefore obesity is not covered under any insurance medical card in Malaysia. 

We are trying to change the perspective of obesity but it will be a hard and tedious journey.

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Does obesity affect people differently?

There are studies that showcase the brain function in people who never been obese versus people who were obese. They divided into two groups of people: Group A (never had obesity) and Group B (had or is still living with obesity). Both groups were show food and each of the participants was hooked up to an MRI to see the brain activity.

 

People in Group A who have never been obese have lower stimulation or brain activity to the parts of the brain which evokes desire, pleasure, and reward centers. Whereas, people in Group B who lived with obesity have high brain activity due to food stimuli to the parts of the brain which evokes desire, pleasure, and reward centers. 




















 

In the diagram, you can see the brain function on MRI of both group A (thin, never been obese) and B (lost weight, was obese) participants. The yellow and red flares on the MRI of the brain show the intensity of stimuli in each part of the brain and there are gross differences between Group A (thin, never been obese) and B (lost weight, was obese).

Group B (lost weight, was obese) participants have higher intensity stimuli in different parts of the brain like:

  1. Posterior Hippocampus (memory). This part of the brain forms long-term memories. These memories if in relation to food will evoke either pleasure or disgust. For example, a person who has eaten a slice of delicious, crispy, and scrumptious pizza will remember the taste, pleasure, sensation smell, appearance, and texture of the pizza. This information is then stored in the Hippocampus of the brain and can be readily assessed anytime to remember the process of eating that pizza. 
     

  2. Insula (desire, reward, pleasure, joy),  This part of the brain has a correlation to the Posterior Hippocampus because the process of eating the pizza evokes stimuli to the insula of the brain to feel good, desire, and joy. The feeling of pleasure of eating the pizza is generated by the insula, which heightens and affirms the memory generated by the posterior hippocampus. Therefore feelings and memory go hand in hand to form a  strong permanent memory.
     

  3. Parietal (Visual). Have you watched Masterchef? The saying goes "Eat with your eyes first." We determine fresh products from sight. A red apple looks more appetizing as compared to green apples. Food that has a beautiful appearance is more enticing to eat. When people see the food they like to eat, it stimulates the body to desire it.

People who are living with obesity or have been obese previously, they are already playing a losing game. They have it in their blueprint to succumb more to the temptation of food. So if you present food to those who have been obese or are still living with obesity, their brain responds much more aggressively as compared to those who have not experienced obesity.

Therefore solutions to treating obesity must not be a one-sided attack against the patient. Doctors or even slimming therapists often blame the patient for not adhering to the diet plans. It is not the patient's fault that they are unable to overcome the temptation of eating because their brains are already wired differently as compared to people without obesity.

We should be more empathic towards people with obesity. We must construct a cohesive and holistic plan to cater to the person as an individual with different needs, financial background, co-morbidities, and psychological threshold.  

brain response to food.PNG

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How to classify obesity?
In the new guidelines, obesity is classified differently in Asians as compared with Caucasians.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What is Body Mass Index (BMI)?

Asian's body frame and height are different as compared to Caucasians therefore there are discrepancies in the range of their Body Mass Index.  Body Mass Index or BMI is similar to the ratio of proportions. A person who is well-proportional has an ideal weight to height ratio.

How to calculate my Body Mass Index (BMI)?







 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Who can use Body Mass Index (BMI)?
BMI can only be used in the general population in people above the age of 20 years old. The population from age of 0 to 19 years old use growth charts called percentile charts. The percentile chart plots a mean average of children's weight and height based on the population in a particular country or region. Each country has its own percentile chart and the range of underweight, normal weight, and overweight is different based on different regions.

 

Why do Percentile charts differ from one country to another?
Percentile charts differ from one country to another because each country or region has a different population constitution in terms of height and weight. Take for example Asian are short, to begin with before the 1990s and the height of Asians are increasing. In a study of 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively.

Percentile chart normalcy ranges may change after 5 to 10 years, therefore due to the changes in population constitution, percentile charts are constantly updated.  Percentile charts are useful tools to plot the growth of a child to adulthood during the most rapid growth period of the child.

 

BMI is not suitable in children 0-19 years old with growth spurts as their height constantly changes during the growth spurts.
 



How to interpret Body Mass Index (BMI)?
Normal BMI means that the amount of fat and muscle mass is proportional to body weight.

High BMI (>27.5) means that the amount of fat exceeds the muscle mass relative to body weight.

Low BMI (<18.5) means that the amount of fat is relatively lower than muscle mass to body weight.

BMI is not applicable in bodybuilders as their muscle weight relatively exceeds the weight of fat in their body. 

How does the Body Mass Index (BMI) correlate with health?

BMI provides a simple numeric measure of a person's thickness or thinness. BMI is a simple method to address the medical condition of the general public by making it possible to quantify the approximate amount of body fat composition in a person. 
 

People from different ethnic groups, populations, and descent have different associations between BMI, percentage of body fat, and health risks, hypothyroidism, with a higher risk of type 2 diabetes mellitus, atherosclerotic cardiovascular disease, and strokes.

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When to use waist to hip ratio?

Bodybuilders tend to use the waist to hip ratio formula because their body weight does not correspond to the weight of fats but to the weight of muscle mass. We cannot use BMI in this case because BMI will indicate that most bodybuilders are overweight with muscles but not fat.

I will explain to you the logic when to use BMI and when to use Waist to Hip Ratio. Let us imagine there are two men (Man A) and (Man B) who are of equal weight 80kg and height 170cm. By using BMI, both men will have the same BMI right?

So who is healthier, if both men have the same BMI? Man (A) is considered overweight because he is fat heavy and Man (B) is muscle mass heavy. Therefore BMI has this limitation and can be used for the normal activity or sedentary population whereas BMI cannot be used in bodybuilders as they are heavy due to their lean muscle mass. 

It makes more sense that the Waist to Hip Ratio is better suited for both fat heavy and muscle heavy individuals. Even with the Waist to Hip Ratio, there will be some problems in its calculation. Taking the circumference of the waist and hip has a higher probability of getting wrong readings


To calculate your waist-to-hip ratio, measure both your waist and hip circumferences, then divide the waist measurement by the hip measurement. 

  • In women, the ratio should be 0.8 or less

  • In men, it should be 1.0 or less.

Muscle and fat man.jpg

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What causes obesity?
There is a myriad of multiple factors influencing the progression towards obesity:

  1. Life-style

    • Sedentary​ lifestyle and exercise

      • Your body will constantly burn calories ​despite being sedentary. In order for your body to maintain normal bodily processes, there is a required minimum daily energy expenditure. If you do nothing the whole day your body will still use up minimum calories as energy and that is called basal metabolic rate or the minimum daily calorie requirement. By exercising you will be utilizing more calories as fuel, leading to a calorie deficit that causes excess fat to be taken up as energy.
         

    • Diet

      • Atkin's diet or ketogenic diet which comprises of high fats and low carbohydrate diet causes a depletion of sugars in the body. The body then starts using fats as a replacement of sugars to acquire energy and burns the fat as a source of calorie. This diet may not be the best option and there are many studies that have debunked the safety and health benefits of the ketogenic diet.

      • Your diet should comprise of all nutrients but in Atkin's diet, there is a disproportionate amount of fat to protein and carbohydrate percentage which may be less healthy.

      • The Malaysian ministry of health has advocated for the diet plan called "suku-suku-separuh". In our language, it means a "quarter-quarter-half". This indicates the ratio of an entire plate comprising of a quarter of protein, a quarter of carbohydrates, and half of fiber. This is a simple way to quantify the ideal ratio of the nutrients but it is not necessarily effective for everyone. This plan lacks specificity to each individual with different problems


         


















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  2. Psychological diseases

    • Stress​ or depression
      ​With the changes in the current busy and taxing world, stress higher than it has ever been. Humans are creatures of habit and we are more comfortable in conditions where we are doing something repetitively while reaping their rewards immediately. For example scrolling through Twitter, Instagram, or watching Youtube videos. The reason scrolling through these social media platforms is so addictive is because of the repetitive motion of scrolling and get immediate satisfaction. Immediate satisfaction nullifies the feeling of depression or stress.

      People manage stress by overeating because the act of picking up food and putting it into the mouth is considered a repetitive action that can be therapeutic. Eating causes people to feel good about themselves because eating activates the immediate reward system of the brain therefore reduces stress. 


       

  3. Metabolic syndrome

    • Diabetes​
      Diabetes is a chronic disease. In diabetes, the body is unable to utilize sugar in the body well. The sugar floats in the bloodstream and the cells cannot capture the sugar to be used by the cells to function well. This tricks the cells of the body to tell itself that it is lacking sugar but in reality, the body has excess sugar in the bloodstream.
       
      Therefore the body hungers for more sugar because it because and results in the person having more to eat. The excess sugar accumulates more and more until the body uses sugar and becomes fats. This process of changing excess sugar into fats is called lipogenesis.

      Lipogenesis is mostly derived from carbohydrates and is a relatively minor contributor to whole-body lipid stores, contributing 1–3% of the total fat balance in humans consuming a typical diet. Lipogenesis increases considerably when individuals are fed a hypercaloric high-carbohydrate diet and are stored as adipose tissue or in the liver.


       

    • Dyslipidemia
      Some people are at higher risk of having poor fat metabolism and more in obese children. Obese is translated as high cholesterol or/and triglycerides. Genetically some population of people stores fats easily as compared to other people. Situations like Primary or Familial dyslipidemia is an inherited disease caused by a single genetic mutation in one of several genes. Genetic abnormalities that lead to abnormal blood lipids are most often found in genes involved in the transportation and cellular uptake of lipids. 


       

    • Gout
      Studies have shown that being overweight causes insulin resistance which hampers the kidneys in carrying out their duties. This then reduces uric acid excretion which, in turn, leads to high blood uric acid. Not only that, fat cells themselves contain proteins called leptins which can also affect the kidneys’ ability to excrete uric acid.
      Obesity is closely linked to gout; as the country’s obesity rate has gone up, so has its rate of gout. 






















       

  4. Hormonal status​

    • Menopause
      The hormonal changes of menopause might make you more likely to gain weight around your abdomen than around your hips and thighs. Obesity is a multifactorial issue which means that hormonal changes alone don't necessarily cause menopause weight gain. Instead, weight gain is also related to aging, as well as lifestyle and genetic factors.

       

    • Andropause
      Andropause is a condition similar to women having menopause but it affects the male hormones in the male body. We know testosterone has multiple functions to regulate muscle mass, boost energy, concentration, libido, and psychological well-being.
      Low testosterone does not mean that the testosterone is below the normal value, rather the testosterone is close to the lower limit of the normal range.

      Low testosterone causes muscle mass loss, tiredness, poor libido, loss of concentration, and andropause depression.
      Overtly high testosterone causes muscle mass gain, good libido, hyperactivity of mental function and aggression,
      Therefore, it is important to hit a sweet point for the testosterone to be normal but on the high normal levels.

       

    • Cushing's Disease
      This is a chronic situation where is excessive cortisol and this causes weight gain.  The excess cortisol in the body does not increase protein and carbohydrate metabolism. It slows or nearly disables metabolism function, which can cause weight gain (fat accumulation) in the buttocks, abdomen, cheeks, neck, or upper back. This rare disease also causes loss of muscle mass.

       

    • Hypothyroidism
      Low thyroid hormone causes weight gain because the person's metabolism drops significantly with low thyroid hormones. People tend to gain weight with low thyroid and it can be a factor causing obesity.

       

  5. Drug-induced

    • Antidepressants ​

    • Sulfonylurea 

    • Insulin

    • Anti-histamine

    • Steroid

    • Contraception pills

      These medications may increase appetite and change certain processes in fat and sugar metabolism. Weight gain can surely be linked with certain medications but you will have to explore these situations with your doctor.

       

  6. Socio-economical

    • Many studies have been conducted in multiple countries, showing that socio-economical circumstances affect the rates of obesity. Each country has many inconsistent findings related to socio-economical status causing obesity. It has also been proven that there is some correlation between socio-economical status leading to obesity and diabetes.

       

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What are the types of fats?
There are two types of fats:

  1. Subcutaneous fats

    • Subcutaneous fats are fats under the skin.
       

  2. Visceral fats

    • Visceral fats are fats around the organs. It is a combination of fats surrounding the stomach (omental fats), fats around the heart (pericardial fats), fats​ around the kidney (renal fats), or even around the intestines.
       

    • Notice the huge amount of visceral fat that’s putting the individual on the right at a much higher risk of those serious health complications.
       

    • Based on abdominal obesity, physicians can suspect some dyslipidemia or metabolic syndromes in their patients:

      • Men waist size: 40 inches or over (US); 37 inches (94 cm) or over (Europe).

      • Women waist size: 35 inches or over (US); 32 inches (80 cm) or over (Europe).​
         

    • The following MRI image compares visceral fat (colored pink) in two individuals as in the image on the right.

visceral_fat_compare.png

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What is BMR (Basal Metabolic Rate)?
BMR is directly proportionate to the muscle mass rate of burning calories. If a lean person is at 60kg versus a fatty person also at 60kg, who will burn more calories in a day if both are resting? 

The lean person will burn more calories because he has more muscle mass as compared to a fatty person who is at the same weight but has less muscle mass.

This means that a person with higher muscle mass will use up more calories, therefore causing the leaner person easier to lose or maintain their weight.

Basal-Metabolic-Rate.jpg

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What is the treatment available for obesity?

Treatment of obesity is a holistic approach and can range from hypnosis, oral medication, injectable medication, surgery and aesthetic treatments.

  1. Hypnosis
    Hypnosis may be effective for some people but not necessarily for everyone. According to multiple studies, hypnosis is considered a reinforcement of good dietary habits. However, hypnosis is not effective on its own and requires other modalities to be highly effective. Exercise and appetite suppressors can help in the process of weight loss. 

     

  2. Exercise
    Exercise is to increase calorie utilization from the existing BMR (Basal Metabolic Rate). As you know BMR (Basal Metabolic Rate) is the minimum calorie requirement in a day and exercise utilizes more calories on top of the BMR (Basal Metabolic Rate). Exercise is to ensure that the person goes into a calorie deficit so more fats are burned to replace the calorie deficit. 

     

  3. Oral Medication

    • Appetite Suppressor​

      • Phenteramine is a weight loss medication that can be prescribed by physicians when they think they are dealing with a difficult case of obesity. It is known to be a powerful appetite suppressant that can trick the brain into thinking the body is not hungry.
         

      • Orlistat
        Orlistat inhibits pancreatic and gastric lipases and thus reduces the absorption of dietary fat. It is the only approved weight-loss medication that does not work primarily by suppressing appetite and has a relatively good long-term safety record. 

         

    • Diabetic Medication

      • Empagliflozin is a sodium-glucose co-transporter 2 (SGLT-2) inhibitor that increases sugar excretion via urine. This process causes the regulation of sugar and reduces the conversion of excess sugar into fats therefore decreasing weight. 
         

      • Metformin​ is an age-old drug that is used to increases the body's sensitivity to sugar utilization which is used in type 2 diabetes. Sugar in diabetic patients tends to stay in the bloodstream and difficult to be taken into the cells of the body to generate energy. Metformin is like a Delivery boy that delivers sugar to the cells of the body. This draws out the sugar from the bloodstream and effectively shunts it to the cells to be used as energy.
         

  4. Injectable medication

    • Liraglutide
      Liraglutide is a glucagon-like peptide-1 (GLP-1) agonist initially used to treat T2DM and controls hyperglycemia without causing hypoglycemia or weight gain. Its side effect profile of decreased appetite reduced energy intake, and subsequent weight loss has led to its more recent approval as a weight management drug.
      Liraglutide was recently approved in Malaysia for weight management as an adjunct to diet and physical activity. 

       

  5. Bariatric surgery
    Usually, bariatric surgery is regarded as an advanced option for weight loss. Physicians often put more emphasis on exercise,  diet, and lifestyle changes, treating ongoing diseases like diabetes, hormonal diseases (hypothyroid, andropause) and stress,

    Bariatric surgery is done when diet and exercise haven't worked or when you have serious health problems because of your weight. Some procedures limit how much you can eat. 

    There are a few types of bariatric surgery and each has its own pros and cons:

    • Sleeve gastrectomy
      With sleeve gastrectomy, about 80% of the stomach is removed, leaving a long, tube-like pouch. This smaller stomach can't hold as much food. It also produces less of the appetite-regulating hormone ghrelin, which may lessen your desire to eat.

      Advantages to this procedure include significant weight loss and no rerouting of the intestines. Sleeve gastrectomy also requires a shorter hospital stay than most other procedures.

       

    • Biliopancreatic diversion with duodenal switch
      This is a two-part surgery in which the first step involves performing a procedure similar to a sleeve gastrectomy. The second surgery involves connecting the end portion of the intestine to the duodenum near the stomach (duodenal switch and biliopancreatic diversion), bypassing the majority of the intestine.

      This surgery limits how much you can eat and reduces the absorption of nutrients. While it is extremely effective, it has a greater risk, including malnutrition and vitamin deficiencies.

       

    • Roux-en-Y (roo-en-wy) gastric bypass
      This procedure is the most common method of gastric bypass. This surgery is typically not reversible. It works by decreasing the amount of food you can eat in one sitting and reducing the absorption of nutrients.

      The surgeon cuts across the top of your stomach, sealing it off from the rest of your stomach. The resulting pouch is about the size of a walnut and can hold only about an ounce of food. Normally, your stomach can hold about 3 pints of food.

      Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch. Food then goes into this small pouch of the stomach and then directly into the small intestine sewn to it. Food bypasses most of your stomach and the first section of your small intestine, and instead enters directly into the middle part of your small intestine