Monthly Archives: January 2018

Don’t Avoid Exercise Because It Makes You Hungry

Among the many kinds of advice given to those who are trying to lose weight, exercise usually ranks just below diet. But just as weight-loss advice can be contradictory and confusing, so too are the recommendations for exercise. No one disputes the benefits of physical activity on everything from improved digestion to better cognition. The adverse effects of ignoring the prescription to move ones body are just as compelling: no exercise equates to bad sleep, bad bones, and bad mood, among other unpleasant symptoms.

But many dieters and weight maintainers are reluctant to exercise because they fear the effect on their hunger. Exercise seems like an ineffective, and indeed unworkable, way of losing weight when post-exercise appetite may lead to eating many more calories than those worked off. Anecdotal reports by dieters of feeling ravenous after a stint on the treadmill or weekly Zumba class supports the erroneous belief that exercise while dieting should be avoided to prevent overeating.

Curiously, highly-trained athletes (who, of course, don’t have to worry about their weight) are the least likely to want to eat after their highly intense exercise routines are completed. In a study published a few years ago on appetite among female athletes, the scientists found that intense exercise actually decreased subjective hunger. Moreover, ghrelin, the hormone in the gut and blood that regulates hunger, was decreased and another hormone that shuts off appetite, increased. (“No Effect of Exercise Intensity on Appetite in Highly-Trained Endurance Women,” Howe, S., Hand, T., Larson-Meyer, D., Austin, K. et al Nutrients, 2016; 8 ) The same effect had been found earlier in studies carried out with male endurance athletes.

Since most of us are not likely to devote a good portion of our lives to training for competitive athletic events, we cannot rely on this for suppressing appetite after exercise. However, it seems that even unfit obese men may also experience a decrease in hunger after intense exercise, at least for 30 minutes after the exercise session completed. Whether they overate several hours later was not reported. (“The Effects of Concurrent Resistance and Endurance Exercise on Hunger Feelings and PYY in Obese Men,” Asrami, A., Faraji, H., Jalali, S., International Journal of Sport Studies, 2014 4; 729-)

But one may ask: what is wrong with being hungry after physical activity? Isn’t hunger a natural and inevitable response of the body after calories are used up? A Food Network show featuring life on a ranch in some unnamed cattle-raising part of the country often features recipes for the “hungry” family and ranch hands after a day of especially hard work. It would be absurd for the workers to avoid physical labor just because they are very hungry when they return home to eat a substantial meal.

But most of us have traveled far from the natural progression of physical activity to hunger to eating to a return of energy, and thus being able to work again. The “I am so hungry that I could eat a horse” (or whatever animal comes to mind) statement after hours of manual labor or recreational physical activity seems to many like a prescription for weight gain, rather than the way nature intended us to feel.

But it is not. Hunger is natural. The hormones causing us to want to eat are there to make sure we do so in order to live. If hunger disappears, as is the case for some with late stage Alzheimer’s disease, the individual will not survive unless others make sure to feed the patient.
In short, we should stop being afraid of being hungry. Hunger means our bodies need food the way being thirsty means our bodies need water. How we satisfy our hunger is what we have to improve if we want to stop gaining weight and begin to lose it. Just as we could, but should not, satisfy our thirst by drinking gallons of champagne or sugary sodas; we should satisfy our hunger not by consuming junk food, but by eating foods that not only supply calories (to replace those used up in exercise) but also needed nutrients into our bodies.

Dieters are told to try to eat fewer calories than needed so the calories in their stored fat will be mobilized to make up the difference. But unless the dieter goes on a drastically low-calorie diet, or a diet that eliminates certain categories of foods, it is possible to eat less, satisfy hunger, and still lose weight. We often eat beyond feeling full, that is, beyond the cessation of hunger; this is why we eat dessert. If eating stops when hunger disappears—even if all the food has not—weight can be lost.
Should you eat before or after exercise? It depends on your body. Some cannot exercise after eating and will eat breakfast after, rather than before, working out in the morning. Others find that they don’t have the energy to play tennis or go hiking unless they have eaten. Therefore, they will eat enough to give their muscles fuel for their workout, but not so much that they feel too stuffed to move.

Sometimes during long bouts of exercise, such as a long bike ride or hike, the first sign that the body needs food is not hunger but fatigue. I remember once when I was cross-country skiing all day, I become too exhausted to move my skis up a hill to get back to the lodge. As I stepped outside the track to let a woman behind me pass, she handed me an energy bar. “You need food,” she said. “Eat this.“ She was right. Within a few minutes I felt my fatigue lift, and I was able to continue moving.

We are told to be in touch with our bodies. Exercising, being hungry, and eating healthfully are excellent ways of communicating with ourselves.

 

 

 

Is the US Becoming More Obese Because of Medication?

Despite a blizzard of weight-loss programs, touting novel fat-reducing foods, and innovative exercise devices, the country is getting fatter and fatter. The Centers for Disease Control and Prevention reports that nearly 4 in 10 U.S adults, according to their body mass index, can be classified as obese. Obesity is not evenly distributed among the states. The losers; i.e. the thinnest states, are Colorado, Hawaii, Massachusetts, and D.C. The gainer is West Virginia where almost 40% of adults are obese.

We have been becoming heavier for so many decades that we forget how thin we were as a country 80 or more years ago. It is only when viewing newsreels of the first half of the 20th century in which most adults look extremely thin that you realize what we now consider thin was considered normal weight back then.

The same old reasons are brought out yearly to explain why we, and indeed the rest of the world, is getting fatter: junk food, sugary drinks, dependence on motorized transport rather than our two feet, humongous restaurant portions, intestinal flora that make our bodies store fat, too much time on electronic devices, and too little time in the gym.

Might our growing obesity be related to the weight gain after smoking withdrawal? Weight gain is common among ex-smokers, and studies as reported by the National Bureau of Economic Research (Sharon Begley, “Gut Check”) suggest that it may be 11-12 pounds on average. But a close examination of who gains the most weight indicates that smokers with the lowest BMI are most likely to gain the most, and 11 or 12 pounds is not enough weight gain to make them obese.

Could medications used to treat mental disorders be another, mostly overlooked cause of national weight gain? That psychotropic drugs—the medications used to treat depression, anxiety, bipolar disorderschizophrenia and other mental diseases—cause weight gain is established. Sometimes the weight gain is only a few pounds, stops after a month or two, and is lost as soon as the treatment ends. But many drugs cause substantial weight gain because the patient experiences a relentless urge to eat. Moreover, to the chagrin, indeed horror of some patients, stopping the medications does not always cause weight loss even with dieting and exercise.

Data on the use of psychotropic drugs comes from a 2013 Medical Expenditure Panel Survey discussed in a Scientific American article by Sara Miller.  One in six Americans is taking a psychotropic drug, although not all are being prescribed for mental illness. There have also been many studies showing that depression itself is linked to future obesity. A common depression, Seasonal Affective Disorder, is diagnosed in part by the overeating and weight gain of patients during the increased darkness of winter. Often the depression of PMS and pre-menopause is accompanied by overeating and weight gain as well.

Yet in the list of causes for our increasing girth, reasons such as genes, inflammation, bad gut bacteria and bread are more likely to be found than the weight-gaining potential of depression and the drugs that treat it.

Where are the weight-loss programs specifically designed to help those whose overeating is caused by lack of sunlight, or hormones affecting appetite control centers in the brain, or drugs that hijack control over satiety? Where are the support services for those who are embarrassed to go to the gym because their medications have turned their formerly fit and slim body into a much heavier one?  Recently someone who has been struggling to lose the weight gained on her medication for obsessive-compulsive disorder told me that her dietician put her on a low- carbohydrate diet. “I was craving carbohydrates all the time,” she told me, “so the dietician figured the easiest way to take care of that problem was to remove them from my diet. She did not realize that my medication had caused the cravings even though I told her. And since I couldn’t stop my drugs, I just craved bread and pasta so much on her diet that I began to binge.”

 

This story is typical in that this patient was not seen as needing specialized weight-loss help because her weight gain was the result of a drug, and not related to emotional issuesor an inability to make healthy food choices. Moreover, the dietician’s advice to remove carbohydrates showed lack of knowledge on the effect of eating carbohydrates on serotonin synthesis. Serotonin levels drop when carbohydrates are not consumed and often lead to a worsening of the obsessive-compulsive disorder, depression, or other mental disorders.

How long is it going to be before weight-loss professionals acknowledge that many of the obese in the United States are that way because of their medications? How long will it be before thought, labor, and money are put into programs to address their special needs?

Will 2018 bring about needed innovations in weight-loss therapy for these individuals, or will we just become fatter?