The Government’s ominous statistics and ‘complex and challenging’ issues regarding obesity (1) are enough to make anyone reach for the chocolate!  Telling people to eat less and exercise more does not often work because it assumes that we have a conscious control over appetite and weight regulation (2).  Weight involves the body as well as the mind because one influences the other and visa versa. Weight loss may be achieved via a nutritional therapy strategy which works with the individual person, their body functions as well as their mindset, lifestyle and personality. 

Assessment and Immune function
Assessing a person’s health and diet history helps to identify various influences on their weight, body function and nutrient status. Obesity is characterised by inflammation, (3, 4).  Increased immune function may lead to low serotonin, a brain chemical involved in mood, sleep and appetite. Low serotonin may increase food cravings and decrease mood and the body’s ability to feel full and satisfied (5, 6, 7, 8).  Preventing inflammation and supporting serotonin production are therefore important in any weight loss strategy.  Identifying and removing the causes of inflammation are ideal. A range of tests may be used to pinpoint inflammatory causes, nutrient deficiencies or functional imbalances while the consultation process is used to find out how the body is feeling and what the mind is thinking.

Anti-inflammatory Mediterranean style diets rich in essential fatty acid and antioxidant fruits and vegetables have been found to reduce inflammation (9) and may help to positively influence weight loss. Comprehensive, individually tailored supplement recommendations consider a person’s health and diet history, nutrient status and nutritional requirements. Supplement recommendations may include multi-vitamins and minerals, antioxidants and essential fatty acids which aim to reduce inflammation and improve nutrient status, carbohydrate cravings and satiety (10, 11, 12, 13).

Behaviour, emotions and stress
Stress is the most commonly reported trigger of binge eating and high stress levels are positively related to both food intake and central body fat (15). A person’s stressors, emotional triggers, motivators and aspirations are fully explored during a consultation.  This information is invaluable as it allows for the development of a truly individual nutritional strategy that includes diet, exercise and lifestyle changes which fit with a person’s beliefs, personality and long-term goals as well as nutritional needs.

Lifestyle recommendations aim to take the focus away from dieting and place it on other positive, obtainable goals.  This helps to distract thinking away from food and  promotes achievement of a gain instead of a loss (weight loss) which may build self-esteem. Instead of weight-watchers we should have happy-watchers!  Reducing dietary stressors such as caffeine, alcohol and sugar and improving food and nutrient intake may also improve stress response and positively influence mood, behaviour and impulsivity.

Diet, exercise and Insulin sensitivity
A typical western diet, high in saturated fat and carbohydrate is considered to be a major factor in the development of obesity via insulin resistance.  Blood sugar balance contributes to balanced weight, mood and appetite. When blood sugar is high we store the sugar as fat and when blood sugar is low our appetite and cravings for carbohydrate may increase.  Lifestyle and dietary factors which affect blood sugar balance, such as: stress, smoking, exercise, alcohol, caffeine and carbohydrate intake, all affect our ability to lose weight. 

Aerobic exercise is one of the best ways to improve blood sugar control, insulin sensitivity and mood (17). Dietary recommendations consider how food structure and chemical composition affect blood sugar levels. Low glycemic index (GI) diets are  popular because they support blood sugar balance.  Protein intake is considered key to sustained reductions in appetite (18).  Although the mechanisms are not clearly understood, increased satiety may be, at least in part, responsible for the weight loss effects of increasing dietary protein relative to carbohydrate and fat (19). Blood sugar balance should be supported by limiting intake of refined foods, alcohol and sugars and promoting high fibre, low GI  foods. 

Research demonstrates the potential benefits of supplementing chromium, omega-3 fatty acids, l-tryptophan and alpha-lipoic acid for improving insulin sensitivity, weight control and blood sugar balance (20, 21). Their effectiveness depends on individual nutrient requirements.  Multivitamins and minerals may help to support metabolism and increase nutrients available in the blood stream which has also been hypothesised to influence food intake.

Liver function and Detoxification
Supporting liver function and detoxification with diet and appropriate supplementation is also considered important for promoting weight loss.  Many toxic chemicals are stored in fatty tissues and proper liver function is required to remove them. Chemical calories from plastics, pesticides and additives are associated with the disruption of weight-control mechanisms and cause weight gain (22). Recommendations which limit processed foods, alcohol and chemicals and promote organic foods and adequate hydration may help to reduce toxic load.  Exercise also aids detoxification (22) and exercise motivation may be achieved by a positive mindset and clear, specific and attainable goals.

Nutritional Therapists Approach
A Nutritional Therapists strategy therefore works on multiple levels. Lifestyle, diet, functions of the body, mood and mindset are assessed with a detailed health history.  A range of diagnostic tools may be used to gain a comprehensive understanding of the body’s function at a biochemical level.  To help implement lasting change, key beliefs, objectives and motivational factors are identified and used to support long-term dietary and life-style changes.  A targeted, individual nutritional strategy is developed, including exercise, foods, cooking and nutritional supplements, which fit with lifestyle as well as social, ethical and cultural needs of the individual. Recommendations are not about eating less and exercising more, they focus on what can be eaten, enjoyed and achieved with clear, specific and obtainable targets set to build self-esteem and meet personal goals.


References:
(1) House of Commons Health Committee (2004). Obesity – Third report of Session 2003-2004. London: The Stationary Office.

(2) LaValle, J. B. (2001). Stress: the hidden factor for weight gain. Nutrition Science News. Retrieved on 21st May 2006 from http://www.newhope.com/nutritionsciencenews/NSN_backs/Apr_01/cortisol.cfm?path=ex

(3) Trayhurn, P., Wood, I, S., (2004). Adipokines: inflammation and the pleiotropic role of white adipose tissue. British Journal of Nutrition. 92, 347-355.

(4) Lehrke, M., Muredach, P. Reilly, S. C. Millington, N. I., Rader, D. J., (2004). Resistin Integral Part of the Inflammatory response.  Retrieved on 31st may 2006 from: http://www.upenn.edu/researchatpenn/article.php?876&hlt

(5) Brandacher, G., Winkler, C.; Aigner, F., Schwelberger, H., Schroecksnadel, K., Margreiter, R., Fuchs, D., Weiss, H. G., (2006).Bariatric surgery cannot prevent tryptophan depletion due to chronic immune activation in morbidly obese patients Obes Surg. 16(5):541-8.

(6) Pizzorno, L. U., Pizzorno, J. E., Murria, M. T., (2002). Natural Medicine instructions for patients. London: Churchill Livingstone.

(7) Murray, M., T., Pizzorno, J., E., (1998). Encyclopaedia of Natural Medicine. London: Time Warner Books.

(8) Wurtman, R. J., Wurtman, J. J.,(1995). Brain serotonin, carbohydrate-craving, obesity and depression. Obes Res. 3(4):477S-480S.

(9) Espisito, K., Marfells, R., Ciotola, M., Do Palo, C., Giugliano, F., Giugliano, G., D’Armiento, M., D’Andrea, F., Giugliano D. (2004). Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 292(12)1490-2.

(10) Church, T. S., Earnest, C. P., Wood, K. A., Kampert J. B., (2003). Reduction of C-Reative Protein levels through use of a Multivitamin. The American Journal of Medicine. 115(9).

(11) Sanchez-Moreno, C., Dashe, J. F., Scott, T., Thaler, D., Folstein, M. F., Martin, A. (2004)., Decreased levels of Plasma Vitamin C and Increased Concentrations of inflammatory and oxidaive stress markers after stroke. Stroke. 35:163.

(12) Walston, J., Xue, Q., Semba, R. D., Ferrucci, L., Cappola, A. R., Ricks, M., Guralnik, J., Fried, L. P. (2005). Serum Antioxidants, inflammation, and Total Mortality in Older Women. American Journal of Epidemiology. 163(1):18-26.

(13) Jho, D. H. Cole, S. M., Lee, E M., Espat, N. J. (2004). Role of Omega-3 fatty Acid supplementation in Inflammation and Malignancy. Integrative cancer Therapies. 3(2):98-111.

(14) Cangiano C, Ceci F, Cairella M, et al. (1991). Effects of 5-hydroxytryptophan on eating behavior and adherence to dietary prescriptions in obese adult subjects. Adv Exp Med Biol. 294:591-593.

(15) Gluck, M. E., Geliebter, A., Lorence M., (2004). Cortisol stress response is positively correlated with central obesity in obese women with binge eating disorder (BED) before and after cognitive-behavioural treatment. Ann NY Acad Sci. 1032:202-7.

(16) Bratman, S., Girman, A. M. (2003). Handbook of Herbs and Supplements and their therapeutic uses.  Missouri: Mosby.

(17) Bland, J., (2000). Nutritional Management of the Underlying Causes of Chronic Disease. Washington: Institute of Functional Medicine.

(18) Weigle, D. S., Breen P. A., Matthys, C. C., Callahan, H. S., Meeuws, K. E., Burden, V, R., Purnell, J, Q,. (2005). A High-protein diet induces sustained reductions in appetite, ad libitum coloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations. American Journal of Clinical Nutrition. 82(1):41-48.

(19) Moran, l. J., Luscombe- marsh, N. D., Noakes, M., Wittert G. A., Keogh, J. B., Clifton P. M. (2005). The satiating effect of dietary protein is unrelated to postprandial ghrelin secretion. Clin Endocrinol Metab. 90(9):5205-11.

(20) Murray, M. T., (1996). Encyclopaedia of Nutritional Supplements. New York: Prima Publishing.

(21) Braverman, E. R., (2003). The healing nutrients within. New Jersey: Basic Health Publications.

(22) Ballie- Hamilton, P. (2006). Environmental Toxins and Weight Gain: the link. Positive Health Magazine. 120:32-35.