With more than half of society considered obese and roughly 20% in a weight range that would qualify them for weight loss surgery, much attention has been focused on treating obesity more as a medical problem and less of a social concern. Obesity has become one of the most significant public health risks and affects almost every part of our body, resulting in the onset of chronic illnesses (diabetes, hypertension, arthritis, etc.). With diabetes resulting in kidney failure and hypertension causing heart attacks and strokes, complications from these illnesses can result in a shortened life expectancy and a decreased quality of life due to chronic fatigue, immobility, and pain. 

The Hormonal Nature of Obesity

We have all heard people say that if an obese individual ate less and exercised more, then you would not have any weight concerns. However, this is not accurate. Metabolic research has revealed that ultimately our weight is controlled by a complex array of hormones. 

The problem in managing the disease of obesity is understanding which hormones are most impactful when it comes to our weight, and understanding how to correct them. The answer to this question has yet to be discovered. Physicians and researchers agree that there is not one specific hormone to target to aid in weight control. Instead, many hormones affect our weight. When combined with the environmental, emotional, and psychological factors that contribute to a person's weight, the study of obesity becomes more challenging to understand.

Environmental Factors

Many environmental factors contribute to weight gain, particularly how our body's hormones interact and respond to the food we eat. 

Americans, and now many other parts of the world, consume many highly processed foods, resulting in a diet much higher in carbohydrates. Think about what a prehistoric human might have eaten and contrast that with what you most recently ate. 

Research tells us that ultimately the best way to lose weight is to eat fewer carbohydrates. Yet although this sounds simple, some people are genetically and hormonally more sensitive to carbohydrates than others. We all know someone that can eat anything they want and not gain weight. So, what's the difference? 

As physicians, we believe that this lean individual, who may not eat what we would call a "healthy" diet, has a faster metabolism which speeds up to burn off all the extra carbs that their body doesn't need. Our patients who suffer from obesity do not get this same metabolic response when consuming the same types and quantities of food. 

Other environmental factors that make it hard to lose weight are the medications individuals take today and the activity level of most individuals. 

The advancement in medical science has resulted in many lifesaving and improving drugs that did not exist even a decade ago. Many of these medications have negative weight consequences, such as steroids, antidepressants, and birth control pills, just to name a few. 

Similarly, there has been a relative decline in activity for many individuals. In decades past, most individuals worked in industrial or agricultural fields where more physical activity was required; however, most of our society works in the service industry, sitting on telephones and computers all day. As a result, our day-to-day lives are much more sedentary. This sedentary work environment is further compounded by the luxuries that make our lives easier yet lazier, such as television, computers, and smartphones.

Psychologic and Emotional Factors

Complicating the difficulty in losing and maintaining a healthy weight are many psychological aspects. We cannot underestimate the powerful impact of food on how we feel. We have all heard the term "comfort foods," or foods that make us feel good. Unfortunately, in many cases, these foods are loaded with carbohydrates.

Some individuals truly have an addictive craving for carbohydrates and sugar. Radiologic scans of the brain that localize activity (PET Scans) show that when an individual consumes foods high in carbohydrates/sugar, the same area of the brain leads to intensified activity to the same degree that a drug addict achieves when exposed to cocaine.

When we consume foods high in carbohydrates, we release neurotransmitters known as dopamine and serotonin. These neurotransmitters are the same ones deficient in individuals who suffer from depression. Therefore, most antidepressant medications are designed to elevate serotonin and dopamine levels in the brain, resulting in feeling better.

By understanding this, we can now appreciate how the term "comfort foods" came about and how it is so difficult to turn away from these foods long-term, from a psychological standpoint.

How to Improve Your Health

In summary, eating less and exercising more doesn't work for everybody. What ultimately helps patients lose weight is changing the hormonal environment that regulates our metabolism. Unfortunately, the only proven long-term way to do this is with weight loss surgery, and that is not always perfect. 

A good bariatric surgery program needs to combine other management strategies such as a well-balanced meal plan or nutrition counseling program, an exercise program, and long-term behavioral follow-up to ensure that the post-surgery patient remains on track. 

Ultimately, in the end, bariatric surgery helps alter this hormonal environment to assist with losing a lot of weight. However, each individual needs to do their part in the "eating right, being physically active, and regular follow-up/accountability" department. 

This article was originally published on the Bariatric Centers of America blog.