By: Krista W., Lagniappe Wellness Dietetic Intern

With the continuous rise of obesity rates over the past three decades, it’s no secret that we are in the midst of an obesity epidemic. It is predicted that more than half of the world’s population will be living with overweight or obesity by the year 2035 if no significant action is taken (1). 
The root causes of obesity are complex and go beyond the conventional paradigm of “eat less and move more”. Like any chronic disease, nutrition and exercise are crucial components of a successful treatment plan. However, there are several less-well known factors that can cause unwanted weight gain that also need to be taken into consideration.
Integrative and functional nutrition offers a unique, whole-body approach in identifying and treating the root causes of chronic diseases like obesity and its comorbidities. Because humans are so complex, the idea of a one-size-fits-all solution doesn’t exist, making a whole-body approach critical in modern treatment of obesity and weight management.  

What causes obesity?

Obesity is a multifactorial disease, meaning there are many factors that can have powerful effects on weight management, some of which are outside of a person’s control. While obesity may be the result of chronic energy imbalance caused by excessive calorie intake and physical inactivity, it is not always that simple. 

Genetics and obesity

For the past two decades it has been speculated that obesity is closely related to genetics. In recent years, genome-wide association studies (GWAS) have revealed more than 300 different genes that are linked to body mass index (BMI), waist-to-hip ratio, and other adiposity traits (2). 
For example, obesity is associated with the leptin gene (LEP) and its receptor (LEP-R), both key regulators of adipose tissue and energy balance. Normally, leptin binds to its receptor which triggers a series of chemical signals that help produce a feeling of fullness (satiety). The altered expression (mutation) of these two genes causes a condition known as leptin resistance. With leptin resistance, the brain misses these signals which leads to reduced satiety, over-consumption of nutrients and ultimately weight gain (3). 

Gut health and obesity

The gastrointestinal (GI) tract is home to trillions of bacteria that play a vital role in day-to-day functions including digestion and metabolism of nutrients, immune function and protection against pathogens (4). In order for the body to function optimally, there needs to be a balance between the good and bad bacteria in the gut. 
The composition of the gut microbiome can be affected by several things including genetics, medications, travel, stress, exercise and dietary habits. Evidence shows that those with obesity have an altered gut microbiome, or gut dysbiosis, an imbalance of good and bad bacteria. It has been reported that gut composition differs in obese and lean individuals, further suggesting that gut dysbiosis can affect body weight (5). 
Additionally, gut dysbiosis has been shown to dramatically influence eating behaviors and food preferences. Studies confirm that consumption of highly palatable and ultra-processed food is closely related to gut dysbiosis. This creates a frustrating cycle involving the consumption of the Western diet with poor gut health and “addictive” eating behaviors (6). 

Poor sleep and obesity 

There is extensive evidence linking insufficient sleep to weight gain and obesity. Both poor length and quality of sleep is associated with increased appetite and cravings, and decreased motivation for physical activity. More specifically, sleep deprivation impacts weight maintenance by causing a dysregulation of hunger hormones (leptin and ghrelin) causing an increased sense of hunger, leading to a higher caloric intake (7). Furthermore, a troubling concern for those with obesity is that not only does poor sleep lead to weight gain, but obesity can cause complications like obstructive sleep apnea which affects sleep quality (8).

Stress and obesity

Although it is evident that stress is one of the main factors involved in weight gain and obesity, combating stress is hardly ever part of the conversation for obesity prevention and treatments. Research shows that stress-induced elevated cortisol levels are associated with an increase in appetite and enhanced cravings for highly palatable foods, leading to overconsumption of calories (9). Aside from overeating, stress can also lead to sleep problems, decreased motivation to exercise, increased alcohol consumption and gut dysbiosis, all factors that increase the likelihood of weight gain.

Environmental toxins and obesity 

Scientific evidence shows that certain chemicals that are found in our environment, called obesogens, are linked to weight gain. Obesogens are toxic endocrine-disrupting chemicals (EDCs) that interfere with hormones and disrupt the body’s ability to regulate metabolism and weight (10). The endocrine system is complex and plays a role in many bodily functions by producing, releasing, and regulating various hormones as needed. Hormones that are involved in the control of metabolism and weight include insulin, glucagon and estradiol. 
For example, bisphenol A (BPA), a well-known obesogen commonly found in plastic bottles and food containers, has been shown to interfere with insulin production and sensitivity, and can cause an increase in fat cell production, ultimately increasing the risk of obesity (11). 

Creating a personalized plan for obesity and weight management 

As you can see, there are numerous risk factors that can contribute to unwanted weight gain. This is why it is important to take a personalized, whole-body approach that takes all aspects of an individual into consideration. Along with individualized nutritional recommendations, optimize treatment plans by implementing other lifestyle changes such as:   

Optimize gut health

One way to help restore balance in the gut is by consuming probiotic and prebiotic-rich foods. Probiotics have been shown to improve body composition and reduce body weight, BMI, and abdominal visceral adipose tissue (12). Food sources of probiotics include fermented products like greek yogurt, miso, kimchi and sauerkraut. In order for probiotics to do their job, they need prebiotics to feed off of. Increase dietary prebiotics by consuming more fruits, vegetables, whole grains, beans, lentils and nuts.   
Along with this, limiting stress, alcohol and eating a diet with less ultra-processed foods and added sugars have also been shown to have a positive effect on gut health.  

Get moving  

Exercise has the potential to alleviate many health consequences related to obesity, even in the absence of weight loss. Exercise can not only help increase energy expenditure and reduce excess adipose tissue, but it can also aid in appetite regulation and restore insulin sensitivity (13). 
The most appropriate exercise plan is one that is customized to an individual and includes all aspects of physical fitness including strength training, cardiovascular and flexibility exercises. As a general goal, aim for 150 minutes of moderate-intensity exercise per week.  

Stress management

Reducing stress will not only have a positive effect on body composition, but also on one’s overall well-being (14). Stress-relieving activities are infinite and may include gentle exercise, journaling, meditating, listening to music, bubble baths, reading a book or spending time in nature. 
Another way to reduce stress is through connecting with others. Having a community to rely on helps create a sense of belonging, protecting against stress, depression and anxiety. Bonds can be built with existing family or friends, or with new groups of people through volunteering or book clubs. 

Get better sleep  

In efforts to optimize health and metabolism, getting enough quality sleep is crucial. Ways to get better sleep include implementing a sleep schedule of no less than 8 hours per night, following a bedtime routine to help wind down, creating a comfortable sleeping environment and engaging in healthy habits like exercise during the day. 
Additionally, try not to consume food within three hours of bedtime as sleep quality may be affected (15). 

Reduce toxin exposure  

Unfortunately, a consequence of living in an industrialized society is the abundance of  obesogens in the environment. Some ways to minimize exposure of obesogens linked to weight gain include (16): 

• Replace non-stick cookware with stainless steel or glass
• Heat and store foods in glass containers instead of plastic 
• Swap harsh cleaning products for natural ones such as vinegar and baking soda
• Invest in a home air purifier  
• Filter tap water 
• Choose fragrance-free beauty products and detergents

ConclusionObesity is a worldwide health concern that is continuing to rise rapidly. Integrative and functional nutrition recognizes that weight gain and obesity have deep-rooted causes that simply cannot be corrected by calorie restriction and exercise alone. It’s crucial that treatment plans consider all factors that contribute to weight gain including energy imbalance, genetic alterations, gut dysbiosis, poor sleep and stress management, and environmental impacts. A functional approach that includes the conventional wisdom of diet and exercise, but goes a step further to individualize a custom plan based on these risk factors is key to reversing the current obesity trend.by Krista Wale, LWDI Intern 

References 

1. World Obesity Federation, World Obesity Atlas 2023. https://data.worldobesity.org/publications/?cat=19
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3. Obradovic, M., Sudar-Milovanovic, E., Soskic, S., Essack, M., Arya, S., Stewart, A. J., Gojobori, T., & Isenovic, E. R. (2021). Leptin and Obesity: Role and Clinical Implication. Frontiers in endocrinology, 12, 585887. https://doi.org/10.3389/fendo.2021.585887
4. Rinninella, E., Raoul, P., Cintoni, M., Franceschi, F., Miggiano, G. A. D., Gasbarrini, A., & Mele, M. C. (2019). What is the Healthy Gut Microbiota Composition? A Changing Ecosystem across Age, Environment, Diet, and Diseases. Microorganisms, 7(1), 14. https://doi.org/10.3390/microorganisms7010014 
5. Cuevas-Sierra, A., Ramos-Lopez, O., Riezu-Boj, J. I., Milagro, F. I., & Martinez, J. A. (2019). Diet, Gut Microbiota, and Obesity: Links with Host Genetics and Epigenetics and Potential Applications. Advances in nutrition (Bethesda, Md.), 10(suppl_1), S17–S30. https://doi.org/10.1093/advances/nmy078
6. Novelle M. G. (2021). Decoding the Role of Gut-Microbiome in the Food Addiction Paradigm. International journal of environmental research and public health, 18(13), 6825. https://doi.org/10.3390/ijerph18136825
7. Papatriantafyllou, E., Efthymiou, D., Zoumbaneas, E., Popescu, C. A., & Vassilopoulou, E. (2022). Sleep Deprivation: Effects on Weight Loss and Weight Loss Maintenance. Nutrients, 14(8), 1549. https://doi.org/10.3390/nu14081549
8. Seo, S. H., & Shim, Y. S. (2019). Association of Sleep Duration with Obesity and Cardiometabolic Risk Factors in Children and Adolescents: A Population-Based Study. Scientific reports, 9(1), 9463. https://doi.org/10.1038/s41598-019-45951-0
9. Hewagalamulage, S. D., Lee, T. K., Clarke, I. J., & Henry, B. A. (2016). Stress, cortisol, and obesity: a role for cortisol responsiveness in identifying individuals prone to obesity. Domestic animal endocrinology, 56 Suppl, S112–S120. https://doi.org/10.1016/j.domaniend.2016.03.004
10. Jackson, E., Shoemaker, R., Larian, N., & Cassis, L. (2017). Adipose Tissue as a Site of Toxin Accumulation. Comprehensive Physiology, 7(4), 1085–1135. https://doi.org/10.1002/cphy.c160038
11. Naomi, R., Yazid, M. D., Bahari, H., Keong, Y. Y., Rajandram, R., Embong, H., Teoh, S. H., Halim, S., & Othman, F. (2022). Bisphenol A (BPA) Leading to Obesity and Cardiovascular Complications: A Compilation of Current In Vivo Study. International journal of molecular sciences, 23(6), 2969. https://doi.org/10.3390/ijms23062969 
12. Cerdó, T., García-Santos, J. A., G Bermúdez, M., & Campoy, C. (2019). The Role of Probiotics and Prebiotics in the Prevention and Treatment of Obesity. Nutrients, 11(3), 635. https://doi.org/10.3390/nu11030635
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