The numerous dietary failures, which characterize many patients suffering from obesity and the name of “yo-yo syndrome, “can imply the establishment of beliefs that become increasingly ingrained as the unsuccessful attempts to lose weight increase. These dysfunctional ideas lead to thinking of having a slow metabolism or of being unable to comply with a prescribed meal plan as they are weak and unable to control themselves, thus ignoring the disease or the set of symptoms, which causes and perpetuates the tendency to change body composition in favor of fat mass.
The genetic component in primis intensely conditions and causes alterations in eating behavior which are prerequisites for the onset of obesity. Add to this the fact that for the patient suffering from obesity, the need to feed is no longer regulated by the physiological mechanisms of hunger and satiety but by individual and social environmental situations that lead to the intake of food that is vastly different in quantity and modality from that which characterizes normal-weight subjects.
Without the awareness of these mechanisms, the person suffering from obesity – blamed by society and often by certain health professionals who invite them to lose weight by relying only on individual skills – is convinced that the solution to their problem is not to be found in the medical profession but in their own will or, even worse, falls into the trap of the weight loss industry. Medical therapy, first of all, clinical and educational – informative consultancy, finds its particular place in treating obesity. The laboratory diagnosis, with the search for any hormonal alterations (actually infrequent) or dysmetabolism, and the instrumental diagnosis, with indirect calorimetry, bioimpedance, and anthropometric evaluation, are the basis of the diet program.
False Ideas That Stabilize Obesity:
- “I have a slow metabolism.”
- “Even if I lose weight, then I will regain all the weight lost anyway.”
- “Others have greater willpower than mine.”
- “To lose weight, you have to fast.”
- “I hope to find a doctor or medicine capable of healing me.”
- “I have a hormonal dysfunction.”
- “I hope to find a diet that will make me lose weight forever.”
Before starting a diet program, it is necessary to have a clear idea of the starting situation both from a metabolic and psychological point of view. The body composition analysis quantifies the percentages of the various parts of the organism (fat mass, cell mass, extra and intracellular water). It allows for the evaluation of the nutritional status of the subject. The bivector analysis (vector parameter obtained from the BIA, i.e., bio-impedance meter) also positions the issue in the nutritional quadrants of belonging: muscular, obese, skeletal, and cachectic, and provides information on the state of hydration.
The nutritional intervention is not limited to weight loss but to the modification of the body composition that can and must be monitored over time. In this way, the myth of the scales and the ideal weight falls, and the focus shifts to body composition. The dietary intervention will therefore be periodically supported by instrumental tests that disregard the idea of the operator and the person affected by obesity. An aseptic and objective means of assessment can be helpful in the presence of dysfunctional ideas about weight and body image.
It happens pretty frequently to abandon a diet program because the balance needle does not move as we would like: it is necessary to clarify that the balance needle weighs and moves according to body mass. And not just fat. Therefore, situations that modify water (the menstrual cycle in women) or muscle mass (in those who practice physical activity) can mask fat mass loss. The bioimpedance allows for evaluating the nutritional status of the subject, who may have the same weight but a different state of health. In the body weight loss goal, we must add to the concept of quantity (the loss of 10% of the initial body weight ) that of the quality of what you are losing.
It is also necessary to consider the so-called “set-point,” a balance point between lean mass and fat mass determined by our body at birth, which tends to keep the weight constant. It is easy to eliminate the extra weight accumulated beyond the set point. At the same time, it is undoubtedly more challenging to counter the body’s natural and biological tendency to return to the pre-established balance, trying to lose weight further. A genetic factor can be pretty discouraging if expected “miraculous” weight loss. Therefore, body composition analysis can help set a realistic and achievable goal without particular frustration.
What Do I Lose When I Lose Weight?
Another critical point to clarify is that weight loss must correspond to the loss of fat mass alone, an essential condition for maintaining the weight achieved. The loss of non-fat substances (cell mass, water, and muscle mass) threatens the organism’s nutritional state, which defends itself with an immediate weight recovery. Metabolic adaptation or resistance to weight loss is nothing more than a defense mechanism for the species’ survival. The essential condition for obtaining a healthy weight loss is the controlled reduction of the prescribed calories, which must not possibly fall below the measured energy expenditure.
Losses of body weight of more than 0.5-1 kg per week can hardly guarantee this result. Time is the essential condition for changing body composition. In the first weeks – with standard diets – a loss of body weight affects the fat mass in a meager percentage (50%) while it can be optimized with a targeted prescription. Educational or cognitive-behavioral therapy cannot and must not ignore energy expenditure, body composition, and dietary prescription data. The general advice to cut calories should be avoided to eat less because there is a risk of depriving the educational therapy of meaning and putting the individual in a position to develop negative thoughts about weight loss when he does not reach the desired goal, often unrealistic and therefore unattainable.
The Person Suffering From Obesity Needs Certainties
Being followed during the diet program does not mean having a doctor who strictly controls the weight, but a professional able to evaluate the effectiveness of the educational and behavioral program, study therapeutic strategies, and modify them in progress based on the results obtained. The certainty of losing weight if you follow the prescribed schedule is absolute and allows us to get the best results.
Thanks to calorimetry, it can be seen that the subject suffering from obesity consumes calories faster than the average weight subject to counterbalance their accumulation. This data dispels the myth of “slow metabolism” and allows the patient to take in a moderate amount of calories. Sometimes this belief is enough to lose weight without undergoing drastic regimes that always end up with losing control and regaining the lost weight.