Obesity: A Holistic Approach

There’s no secret trick for 

losing weight

. Truth is, many things work together to help you shed unwanted pounds. 

In the WebMD webinar,
“Holistic Obesity Therapy,”
Octavia Pickett-Blakely, MD, MHS, explained the holistic approach to weight management, why lifestyle choices are key, and when anti-obesity meds (AOMs) and medical procedures might come into play.

She is director of the GI Nutrition, Celiac Sprue, and Obesity Program at Penn Medicine. 

“To reach your weight loss goals, there’s no magic,” says Pickett-Blakely. “The key to managing obesity and weight loss lies in the development of healthy habits and lifestyle practices that you’ll carry throughout the course of your life.”

Poll Questions

Lifestyle habits like exercise, weight training, diet, sleep, and stress management are the foundation for successful weight loss, said Pickett-Blakely.

A poll of more than 1,100 webinar attendees found that 48% want to work on getting more 

exercise or more strength training

. That’s followed by 28% who want to focus on eating healthier.

Question: I want to work on:

• 
  Getting more exercise or strength training: 48%
• 
  Eating healthier foods: 28%
• 
  Improving my sleep: 16%
• 
  Lowering my stress: 8%

Another poll asked about sleep. Pickett-Blakely explained that good sleep habits are necessary for weight management. That’s because good sleep translates into more energy to exercise and the ability to choose healthy eating options. If you combine good sleep with other healthy habits, you’re more likely to see your weight come down.

Around half of respondents said they keep a regular bedtime, while 20% said that they create a relaxing space without distractions.

Question: When it comes to sleep, I make it a habit to:

• 
  Keep a regular bedtime: 49%
• 
  Create a relaxing space without distractions: 20%
• 
  Avoid daytime naps: 19%
• 
  Stop using technology near bedtime: 12%

What’s the Holistic Approach to Weight Management?

It combines different areas of weight loss, focusing on lifestyle first, and then other tools that can help you lose weight. For example, it involves how you and your doctor might combine your healthy habits with AOMs and endoscopic procedures. 

“Medications and surgeries for weight loss get a lot of attention,” says Pickett-Blakely. “But the foundational aspects for weight loss are absolutely critical to your success, before those things.”

Viewer Questions

Why do people snack late at night when they’re not hungry?

How healthy is intermittent fasting when you have diabetes?

How important is sleep in weight management?

Late-night snacking often doesn’t come from hunger. When you get the sensation that you want to eat, typically it’s related to your blood sugar being low. Sometimes you can also have a sensation of hunger when you’re thirsty. It can be difficult to separate these.

Late-night eating often comes as a behavior. When you’re younger, you go to the movies, you eat popcorn, you drink a beverage. I encourage my patients to stop before they eat something and ask, “Am I really hungry, or thirsty?”

Another option is to avoid staying up late if you don’t need to. If you have to stay up late because your work shift is late, for example, you’re not necessarily eating, because you’re doing your job. It’s when you stay up late, at home, and you have the ability and freedom to late-night snack.

With
intermittent fasting
, it’s important to talk to your doctor or health care provider who’s managing your diabetes. Because not every person with diabetes is created equal.

Individuals have different levels of management, and different levels of severity, of diabetes. That plays a role in whether or not intermittent fasting is appropriate for you.

In terms of sleep, I don’t think people realize how important it is when it comes to weight loss. It’s a part of the weight loss recipe that many people neglect.

When you don’t get enough sleep, studies show you have increased hunger and more cravings. Being sleep-deprived is also linked to weight gain. There are changes in how your brain responds to certain things around you. For example, if you’re sleep-deprived and see commercials for food, the way you react to those is different when you’re tired, compared to when you’re rested.

If you’re having difficulty sleeping, talk to your doctor or health care provider about how you can be tested or treated for sleep issues.

Is it harder to lose weight after menopause?

Are yoga and tai chi types of exercise or stress relief?

How overweight does someone need to be before they get help from weight loss medications or procedures?

It’s true that it’s harder to lose weight after menopause. Our basal metabolic rate, or metabolism, has a set point with which we burn energy. That set point starts to decline as early as in your second decade. So, after your 20s, your energy burn speed declines. That gets slower after you hit menopause – and further declines after menopause.

Other things are happening with menopause, too. Your hormones shift a lot. These play a role in cravings and hunger. Hormones also create a shift in your body’s muscle-to-fat ratio. So, you may see changes in the distribution of your weight, especially in your stomach fat. That can affect how easy or hard it is to lose or achieve a certain goal. This is why strength training and keeping a good amount of muscle is very important.

Yoga and tai chi are both exercise and stress relief. They’re good for resistance training as well. You hold poses, use muscle control, and engage your core strength. In certain cases, yoga and tai chi may be your only options for what you’re physically able to do.

It’s important to realize that everyone’s weight loss journey is different. Some people have been overweight for years, while others have more recently had to focus on it. Weight and body size differ around the world – and by culture, too. 

I think healthy lifestyle modifications, like being active, are incredibly helpful, regardless of your 

body mass index

. Typically, we recommend starting with lifestyle modifications when you’re in the overweight category, or if you have most of your extra weight in your belly.

If you’re in the overweight category but have other conditions like diabetes or high blood pressure, you should talk with your doctor about additional therapies. At the end of the day, it’s important to talk to them about your body’s specific needs, to find the best approach for your goals.