Introduction

Overview of the topics covered

This guide provides a comprehensive overview of the importance of achieving and maintaining a healthy weight, emphasizing personalized approaches tailored to individual genetic, metabolic, and lifestyle factors. We discuss a root cause approach to weight management, focusing on the underlying imbalances that contribute to weight gain, such as chronic inflammation, insulin resistance, and hormonal disruptions. By adopting a personalized, whole-person approach that includes balanced nutrition, regular physical activity, stress management, and mindful eating practices, readers can make informed, lasting changes to their health and lifestyle. It also highlights the significance of understanding and overcoming common misconceptions about weight loss, as well as the impact of emotional and psychological factors on successful weight management.

This guide is intended for the management of excess weight for individuals who are overweight or living with obesity. While it provides comprehensive strategies for those seeking to lose weight and improve metabolic health, particularly the visceral fat (fat that surrounds the internal organs in the abdomen) that is associated with a heightened risk of chronic conditions,¹ it does not cover issues related to being underweight.

Being underweight predisposes individuals to various health risks, including nutrient deficiencies, immune system weakness, increased susceptibility to infections, decreased muscle strength, osteoporosis, and higher risk of fractures, among others.² Additionally, individuals who are underweight may have underlying medical issues, such as hyperthyroidism or malabsorption conditions, impairing their ability to absorb nutrients, calories, and fats.³ Those who are underweight should seek personalized guidance and support tailored to their specific needs. For more information, visit Nutrition 101, a science-based overview of foundational nutritional principles that support health.

The importance of achieving and maintaining an optimal weight

Achieving and maintaining a healthy weight is fundamental to health,  playing a key role in preventing chronic diseases, boosting physical and mental performance, and enhancing quality of life.⁴ Managing weight can be challenging, and many people face difficulties for a variety of reasons. Understanding the reasons for achieving a healthy weight can provide valuable insights into how it affects key biomarkers and, ultimately, overall health.

Personalized weight management

Personalized weight management involves specifically tailoring strategies to an individual’s unique genetic makeup, metabolism, lifestyle, culture, and access to foods. A customized approach like this can significantly enhance the likelihood of long-term success in achieving and maintaining a healthy weight.⁵ It can also help to address specific needs and challenges, making a plan more sustainable and effective. By considering the whole person, this approach can empower informed choices that align with the body’s natural tendencies and personal circumstances, hopefully leading to more lasting and meaningful results. When we consider current underlying conditions, we can tailor food choices to better support and manage those specific health needs. When factoring in someone's culture, we can ensure that the dietary recommendations are respectful, relevant, and enjoyable, making it easier to incorporate healthy habits into everyday life while honoring personal and cultural traditions.

For instance, when we align dietary interventions with a person’s genetic predispositions—such as how they respond to different macronutrients, like carbohydrates and fats—we can significantly improve weight loss outcomes.⁶ This personalized approach to nutrition is not only very effective for weight management but also plays a role in supporting metabolic health.

Optimizing weight for a longer, healthier life

Maintaining an optimal weight extends healthspan by reducing the risk of chronic diseases like heart disease and diabetes, which are leading causes of death in the United States.⁷ Supporting metabolic and cardiovascular health can improve biomarkers that can support or undermine the functions of the body, and that can improve quality of life when in proper balance.⁸

Obesity, defined as a BMI of 30 or higher, is a known risk factor for neurodegenerative diseases like Alzheimer’s disease.⁹ Weight loss for those with excess weight or who are living with obesity can improve cognitive functions like memory and attention, reduce systemic inflammation and oxidative stress, and enhance brain health.^10,11

Balancing diet with regular physical activity improves metabolism and contributes to a greater sense of vibrancy and energy.¹² Maintaining an optimal weight boosts athletic performance by enhancing endurance, strength, and agility, while regular exercise sharpens mental focus and energy, benefiting both athletic and professional success.¹³

Root cause approach to weight management

Weight is more than a number on the scale. Rather, it is an indicator of underlying imbalances in the body. Excess weight, particularly visceral fat (fat that surrounds the internal organs in the abdomen), is often a sign of chronic inflammation, insulin resistance, and hormonal imbalances, which are at the root of many modern diseases, including type 2 diabetes, cardiovascular disease, and even certain cancers.^14,15

Understanding weight in this context allows us to delve deeper into the metabolic, hormonal, and environmental factors that contribute to these chronic conditions, rather than simply treating the symptoms. For example, addressing insulin resistance through dietary changes, such as reducing consumption of refined carbohydrates, can lead to weight loss and significant improvements in metabolic health.¹⁶

A root cause approach focuses on tailored interventions.¹⁷ For instance, if weight gain is linked to stress and elevated cortisol levels, a root cause approach incorporates stress reduction techniques like mindfulness and adaptogenic herbs to balance cortisol levels and support weight loss.

Similarly, optimizing gut health through probiotic and prebiotic supplementation can reduce inflammation and improve weight management, as gut dysbiosis is closely linked to obesity and metabolic disorders.¹⁸ By viewing weight through the lens of root cause medicine, we can create tailored strategies that address the underlying causes of disease, leading to more effective and sustainable outcomes.

Understanding Weight Management

What is weight management?

Definition and importance

Weight management is about making lasting, mindful lifestyle changes to reach and maintain a healthy body weight. It’s not just about diet or exercise alone—it’s a balanced approach that includes healthy, delicious eating, regular physical activity, and thoughtful behavioral shifts that support long-term success.¹⁹ Effective weight management is essential for preventing obesity and lowering the risk of chronic diseases, all while boosting mental well-being, increasing energy levels, and improving sleep quality.^20,21 Weight management is also essential for individuals who are underweight, ensuring they receive adequate nutrition, prioritize strength training to build muscle mass, and establish healthy eating habits that support their bodies’ optimal function.

Misconceptions about weight loss

Many misconceptions about weight loss can lead to confusion and ineffective strategies. Let’s clear up some of the most common ones:²²

• Rapid weight loss is sustainable: While it might be tempting to shed pounds quickly, rapid weight loss is often unsustainable and can backfire. It can lead to muscle loss, nutritional deficiencies, and a slower metabolism, which can ultimately cause rebound weight gain.²³

• Calorie counting is key: Of course, the energy we obtain from our diet matters, but it’s not just about the number of calories consumed. The quality of those calories matters most.²⁴ Nutrient-dense foods like proteins, healthy fats, fruits and vegetables, nuts, seeds, and high-fiber foods can enhance satiety, boost metabolism, and improve overall health.²⁵ In contrast, calories from ultra-processed foods can lead to weight gain, inflammation, and metabolic dysfunction.²⁶

• Carbohydrates are the enemy: Carbohydrates have gotten a bad rap, but they are a primary source of energy for the body. The key is choosing the right kind of carbohydrates from whole fruits, vegetables, whole grains, and legumes, which are essential for a balanced diet. The real culprits are refined carbohydrates, sugars, and ultra-processed foods^25,26

Fat causes weight gain: Dietary fat is essential for the body, and it’s not the enemy in weight management. Healthy fats, like those found in avocados, nuts, and olive oil, support weight management and contribute to healthspan.²⁵

• Skipping meals causes weight loss: Skipping meals might seem like a quick fix, but it often backfires by leading to overeating later and slowing down the metabolism. Regular, balanced meals help maintain stable blood sugar levels and controlling appetite. ²⁷ Consider aiming for a 12- to 14-hour window between dinner and breakfast. This space between meals can help regulate insulin sensitivity, improve metabolism, and support weight management by allowing the body time to efficiently process nutrients and switch to fat-burning mode during the overnight fasting period.^28,29

• Exercise can counteract a poor diet: Without attention to dietary habits, exercise is often insufficient for managing weight or improving metabolic health. Poor dietary choices can lead to excessive caloric intake, nutrient deficiencies, and chronic systemic inflammation, all of which can undermine the benefits of physical activity.^30,31 For instance, running can’t help the digestive system turn candy into proper nutrients.

• Obesity is solely a result of poor willpower: Obesity is a complex, chronic condition influenced by genetics, environment, hormones, microbiome, immune system, neurochemistry, and more. It’s not just about willpower or personal choice; there are many factors at play.^22,32 For instance, dysregulation of hormones such as leptin and ghrelin contributes to persistent hunger and overeating, disrupting normal appetite control.³³ The brain’s dopamine-driven reward system can be hijacked by highly processed foods, leading to overeating and addictive eating behaviors.³⁴

• Weight loss supplements: Beware of supplements that promise quick fixes. They’re often ineffective and can even be harmful. Real, sustainable weight loss comes from lifestyle choices like a balanced diet and regular physical activity.³⁵

Understanding these misconceptions can help with setting realistic expectations and adopting healthier, more effective weight loss strategies. Sustainable weight management requires a comprehensive approach that includes balanced nutrition, consistent exercise, and positive behavioral changes.

The Science of Metabolism

Why does metabolic rate matter when it comes to weight management?

Metabolic rate is the amount of energy, measured in calories, that the body requires to maintain basic physiological functions like respiration (breathing), blood circulation, and body temperature regulation.³⁶ This energy expenditure occurs even when at rest, so it’s often referred to as basal metabolic rate (BMR) or resting metabolic rate (RMR). Simply put, metabolic rate determines how many calories the body needs to function daily, regardless of physical activity levels.

Metabolic rate is a key factor in determining whether someone gains, loses, or maintains weight. Consuming more calories than the body burns causes those extra calories to be stored as fat, leading to weight gain. On the flip side, consuming fewer calories than the body needs causes it to tap into fat stores for energy, resulting in weight loss.³⁷

Several factors influence metabolic rate, including genetics, age, sex, muscle mass, and overall body size. For example, individuals with more muscle mass tend to have a higher metabolic rate because muscle tissue burns more calories than fat tissue.³⁸ This is one reason why resistance training is often recommended for weight management—because it helps build muscle, it can boost metabolic rate.

Another critical factor is thyroid function. The thyroid gland produces hormones that regulate metabolic rate. When thyroid function is optimal, it helps keep the metabolism running smoothly.³⁹ However, an under active thyroid (hypothyroidism) can slow metabolic rate, making it harder to lose weight and easier to gain it.

Understanding metabolic rates makes it possible to tailor weight management strategies more effectively. For instance, foods rich in protein can increase metabolic rate due to the energy required to digest and process them—this phenomenon is known as the thermic effect of food.^25,40

However, drastic calorie restriction can lower metabolic rate.⁴¹ When the body senses that it’s not getting enough calories, it can go into “starvation mode,” slowing down metabolism to conserve energy. This is why sustainable weight management strategies should focus on a balanced diet and regular physical activity rather than extreme calorie cutting.

Metabolic rate is a key player in the complex system of weight management. Understanding and supporting metabolism through healthy lifestyle choices—like eating a nutrient-rich diet, engaging in regular exercise, and managing stress— makes it possible to create an environment that supports long-term weight management and health.

The carbohydrate-insulin model

The carbohydrate-insulin model suggests that the type and quantity of carbohydrates we consume significantly impact body weight and metabolism through their effect on insulin levels, particularly when eating high-glycemic index foods.¹⁶

The role of insulin

• When we eat carbohydrates, they break down into glucose, causing blood sugar levels to rise. In response, the pancreas releases insulin to help cells absorb glucose for energy and storage.

• Diets rich in refined carbohydrates and sugars trigger frequent spikes in insulin.
• Elevated insulin levels encourage fat storage by driving glucose into fat cells and inhibiting fat breakdown, leading to increased fat accumulation.

Impact on metabolism

• High insulin levels can reduce energy availability to other tissues, increasing hunger and decreasing energy expenditure, which can lead to a cycle of overeating and weight gain.
• Diets high in refined carbohydrates can cause insulin resistance and reduce metabolic rate, making weight loss more challenging.

The benefits

• Lower insulin levels: Reducing high-glycemic index carbohydrates, such as refined carbohydrates and sugars, lowers insulin levels, promoting fat breakdown and better appetite control.
• Increased satiety: Higher intake of protein and healthy fats enhances satiety, reduces overall calorie intake, and improves adherence to a weight loss plan.
• Improved metabolic health: Lowering carbohydrate intake improves insulin sensitivity, reducing the risk of metabolic diseases like type 2 diabetes.

The carbohydrate-insulin model provides insight into how carbohydrate intake and insulin levels may influence weight gain and loss, highlighting the importance of diet composition in weight management and metabolic health.

The carbohydrate-insulin model versus the energy balance model

Carbohydrate-insulin model (CIM)

Pros:

• The CIM emphasizes the role of insulin in fat storage and hunger, highlighting how high-carbohydrate diets can lead to elevated insulin levels, increased fat storage, and weight gain.¹⁶
• A low-carbohydrate diet lowers insulin levels and can lead to reduced hunger, facilitating calorie restriction.
• Reduced carbohydrate intake can improve insulin sensitivity and glycemic control and reduce the risk of type 2 diabetes.

Cons:

• Focuses only on carbohydrate intake versus macronutrient balance.⁴²
• Excessive emphasis on insulin and with insufficient attention to other significant factors, like genetics, physical activity, and diet quality.⁴²
• May not account for individual differences in metabolism and may not be as effective for everyone, particularly those who tolerate carbohydrates well.⁴²

Energy balance model (EBM)

Pros:

• Balance between calories consumed and calories expended, offering a straightforward framework for understanding weight management.⁴³
• Total calorie intake relative to expenditure is a key factor in weight gain, loss, and maintenance.
• Allows for a variety of dietary patterns to achieve energy balance, accommodating different preferences and lifestyles.

Cons:

• Does not adequately consider the role of hormones like insulin in regulating hunger, fat storage, and energy expenditure.⁴²
• Focusing solely on calories can lead to neglect of diet quality, where individuals might consume high-calorie, nutrient-poor foods that contribute to poor metabolic health.
• Monitoring and maintaining an exact energy balance can be difficult for individuals, leading to frustration and potential non-compliance.

Understanding Key Metrics in Weight Management: BMI, Body Fat Percentage, Visceral Fat, and Waist-to-Hip Ratio

When it comes to weight management, understanding the body’s composition is also essential. Let’s break down four key metrics—body mass index (BMI), body fat percentage, visceral fat, and waist-to-hip ratio—and explore their roles in overall health and well-being.

• Body mass index (BMI): BMI is a simple height-to-weight calculation used to categorize individuals as underweight, normal weight, overweight, or obese. While it is useful as a quick screening tool, BMI doesn’t account for muscle mass, misclassifying muscular individuals as overweight or obese. Despite its simplicity, BMI is valuable for identifying potential health risks, but should not be the sole metric for assessing overall health.⁴⁴

• Body fat percentage: Body fat percentage measures the proportion of weight that comes from fat, offering a more precise view of body composition than BMI. This metric is critical because excess body fat, particularly around vital organs, increases the risk of chronic diseases like heart disease and diabetes.⁴⁵

• Visceral fat: Visceral fat, the fat stored deep within the abdomen around organs like the liver and pancreas, is far more dangerous than subcutaneous fat (the fat just under the skin). High levels of visceral fat are linked to serious health risks, including insulin resistance, type 2 diabetes, and heart disease.¹ Reducing visceral fat is key to improving metabolic health and should be a primary focus of any weight management strategy.

• Waist-to-hip ratio: Waist-to-hip ratio compares waist size to hip size, offering a simple yet effective measure of fat distribution. A higher ratio, indicating more fat around the waist, signals excess visceral fat and a greater risk of metabolic syndrome and cardiovascular disease.⁴⁶ For men, a ratio above 0.9, and for women, above 0.85 indicates a higher risk of these conditions. Waist-to-hip ratio is not a one-size-fits-all metric and varies across all demographics such as age, sex, ethnicity, and body composition.⁴⁷ An emphasis on demographic-specific values is needed to accurately assess the risk of cardiovascular disease and type 2 diabetes.

Understanding and tracking these metrics permits more strategic weight management decisions, leading to better overall health.

Measuring key metrics in weight management

Bioimpedance analysis (BIA)

Bioimpedance analysis (BIA) measures body fat percentage by sending a small electrical current through the body. The resistance (impedance) to the current is measured, as fat tissue conducts electricity differently than lean tissue (muscle and water).⁴⁸ BIA devices can also estimate waist-to-hip ratio by analyzing the distribution of body fat in different areas, although this is less common and less accurate than direct measurements.

Dual-energy X-ray absorptiometry (DEXA)

DEXA uses low-dose X-rays at two different energy levels to differentiate between bone, lean tissue, and fat tissue. It provides a highly accurate assessment of body fat percentage, including the distribution of fat in specific areas of the body. It can distinguish between visceral fat (around organs) and subcutaneous fat (under the skin).⁴⁹ By analyzing fat distribution in the abdominal and hip regions, DEXA can indirectly provide information on waist-to-hip ratio, offering precise insights into regional fat accumulation.

Magnetic resonance imaging (MRI)

MRI uses strong magnetic fields and radio waves to create detailed images of the body’s internal structures. MRI can accurately measure body fat percentage by creating detailed cross-sectional images of the body, allowing for the precise quantification of fat, muscle, and other tissues.⁵⁰ MRI can provide highly accurate measurements of the waist-to-hip ratio by directly imaging the abdominal and hip regions. It can quantify the exact amount and distribution of fat in these areas, making it the most precise method for assessing body fat distribution.

Personalized Nutrition for Weight Management

Creating an optimal diet

Nutrition plays a key role in health and weight management. For more information, visit Nutrition 101, a science-based overview of foundational nutritional principles to support optimal health.

Macronutrients: proteins, carbohydrates, and healthy fats

A balanced diet is foundational to good health, and it starts with consuming the right mix of macronutrients—proteins, carbohydrates, and healthy fats.²⁴ Each of these macronutrients plays a unique and essential role in the body.

Proteins are essential building blocks that are critical for repairing and building muscle. Beyond muscle, protein is vital for producing enzymes, hormones, and other key molecules that keep the body functioning.⁵¹

• Aim to get about 25-30% of daily calories from protein, which translates to roughly 0.7 to 1 gram of protein per pound of ideal body weight. Protein intake should be increased with physical activity to support muscle repair, recovery, and growth.⁵²
• Incorporate high-quality protein sources like lean meats, cold-water fish (e.g., salmon, mackerel, anchovies, sardines, and herring), eggs, legumes, nuts, tofu, and tempeh into meals.

Carbohydrates are the body’s main energy source, fueling everything from brain function to physical activity. However, not all carbohydrates are the same.¹⁶

• Prioritize unprocessed whole food carbohydrates from fresh fruits and vegetables, whole grains, and legumes, which provide steady energy and are rich in fiber, polyphenols, vitamins, and minerals.
• Limit refined carbohydrates from sugar, refined flour, and ultra-processed foods, as they can spike blood sugar and contribute to weight gain.²⁶

Fats are often misunderstood, but they are essential for health. Healthy fats from sources like avocados, nuts, seeds, and olive oil are vital for hormone production, brain function, and cell structure. They also help the body absorb fat-soluble vitamins (A, D, E, and K), which are crucial for bone health and immune function. Plus, fats provide lasting energy and help maintain fullness and satisfaction after meals.⁵³

• Monounsaturated fats rich in omega-3 fatty acids, such as olive oil, avocados, macadamia nuts, pine nuts, pumpkin seeds, chia seeds, and flax seeds, can help improve heart health and reduce inflammation.

Balancing macronutrients ensures the body operates at its best. A well-balanced diet not only fuels energy and physical health but also helps maintain a healthy weight and lowers the risk of chronic diseases.

Micronutrients: vitamins and minerals

When it comes to weight management, certain micronutrients—vitamins and minerals—are essential for supporting metabolism, immune function, energy production, and many other systems in the body. Here are some key micronutrients to focus on:

• B vitamins: Convert food into energy, reduce stress, and support metabolism.
• Calcium: Helps with fat metabolism and may reduce fat storage.⁵⁴
• Iodine: Essential for thyroid function, which regulates metabolism and energy levels.
• Iron: Essential for oxygen transport and energy production; deficiency can lead to fatigue and a slower metabolism.
• Magnesium: Aids in energy production, glucose metabolism, and muscle function.
• Omega-3 fatty acids: Reduce inflammation, improve insulin sensitivity, and support heart health.
• Vitamin D: Crucial for metabolism regulation and immune support.
• Zinc: Regulates appetite, supports thyroid function, and plays a crucial role in protein synthesis.

Ensuring adequate intake of these micronutrients through a balanced diet and supplementation can optimize metabolism and boost energy, making it easier to maintain a healthy weight.

Dietary strategies

Effective weight management requires a comprehensive, well-rounded approach that incorporates dietary adjustments, physical activity, and behavioral modifications.³⁰ This journey takes time, and seeking support from family and friends is not only acceptable, but encouraged. Instead of viewing this as a “diet,” consider it a sustainable and long-lasting lifestyle change. Diets are often temporary by nature—they “die” out, as the word suggests—but a lifestyle change involves creating new, enduring habits.  

Caloric intake should be personalized and suited to one’s culture, activity level, and food access. With regard to the amount, it is generally around 1,200–1,500 kcal per day for women and 1,500–1,800 kcal per day for men. Structured, evidence-based diets like DASH, Mediterranean, or low-carbohydrate plans help to create a healthy and sustainable energy deficit. These diets all prioritize protein, whole foods, unrefined and fiber-rich carbohydrates, and healthy fats that can increase satiety, reduce hunger, and support long-term weight management. Incorporating portion control and structured eating habits further aids in maintaining a healthy weight.³⁰

DASH (Dietary Approaches to Stop Hypertension) diet: The DASH diet is specifically designed to prevent and treat high blood pressure, but it also helps lower cholesterol and improve insulin sensitivity.⁵⁵ It’s a powerful strategy for reducing cardiovascular disease risk.

• The diet focuses on fruits, vegetables, whole grains, and lean proteins while limiting salt, red meats, added sugars, and fats.
• It's rich in heart-healthy nutrients like potassium, magnesium, calcium, and fiber.

Mediterranean diet (MedDiet): The MedDiet reflects the eating habits of Mediterranean populations known for their exceptional longevity.⁵⁶ It’s widely recognized for its numerous health benefits, including reduced mortality and a lower incidence of cardiovascular disease, certain cancers, and other chronic conditions.⁵⁷

• A balanced, plant-based diet emphasizing fresh fruits and vegetables, whole grains, legumes, nuts, and seeds, with moderate amounts of fish and poultry, and olive oil as the primary fat source.
• Limits red and processed meats, sweets, and dairy, focusing on yogurt as the main dairy product.

Low-carbohydrate, ketogenic diet: Low carbohydrates is an approach that involves significantly reducing carbohydrate intake while emphasizing higher protein and fat consumption. By reducing carbohydrate intake, the body shifts from using glucose as its primary fuel source to utilizing ketones, produced from fat breakdown, leading to a state of ketosis.⁵⁸

• The metabolic shift created by a ketogenic diet has profound effects on blood sugar regulation, insulin sensitivity, and weight management and improves cardiovascular risk factors in individuals with type 2 diabetes and metabolic syndrome.⁵⁹
• Diets rich in refined carbohydrates can be harmful, especially if they include refined sweets and other ultra-processed foods instead of fresh fruits, vegetables, and legumes as sources of carbohydrates.
• This approach can improve glycemic control in individuals with diabetes.⁶⁰

Improvements in metabolic health markers with a low carbohydrate diet:⁶¹

• Reduced blood glucose levels.
• Reduced insulin resistance.
• Reduced triglycerides.
• Increased HDL (“good”) cholesterol.
• Reduced waist circumference.
• Reduced body weight.

A low-carbohydrate diet improves blood sugar regulation, insulin sensitivity, and cardiovascular risk factors, particularly in individuals with type 2 diabetes and metabolic syndrome.⁶⁰

Elimination diet: Understanding food sensitivities and allergies helps tailor food choices to minimize inflammation, which is the root cause of many chronic diseases and weight gain.⁶² Eliminating foods to which the body reacts negatively can have a profound impact on digestive health, improving nutrient absorption, reducing gastrointestinal discomfort, and creating a healthier and more balanced gut environment.⁶³ When the body is inflamed or struggling with digestive issues, it can lead to insulin resistance and metabolic disturbances that make weight management challenging.

• Reducing inflammation: Chronic inflammation can disrupt metabolic processes, making weight management more challenging by promoting insulin resistance and fat storage, particularly in the abdominal area. An elimination diet helps identify and remove these foods, potentially reducing inflammation and aiding weight loss. Dietary interventions like elimination diets are associated with lower inflammatory markers.
• Identifying food triggers: Avoiding food triggers that cause bloating can improve digestion, reduce inflammation, and support more effective weight management. An elimination diet systematically removes common triggers such as gluten, dairy, soy, and nightshades to identify an individual’s particular triggers.
• Improving gut health: A healthy gut is crucial for a properly functioning immune system. An elimination diet can help heal the gut lining by removing foods that cause irritation or leaky gut syndrome, a condition in which the gut lining becomes permeable and allows toxins and undigested food particles to enter the bloodstream.

Key features of an elimination diet include the following:

• Initial phase (elimination phase): In a standard elimination diet, remove all potential trigger foods from the diet.²⁶‍
  • The following foods are usually removed from the diet: grains, legumes, dairy, refined sugars, processed foods, industrial seed oils, eggs, nuts, seeds, nightshade vegetables (like tomatoes, potatoes, peppers, and eggplants), and food additives.
  • This phase typically lasts 4-6 weeks.

• Allowed foods: Focuses on nutrient-dense, anti-inflammatory foods like lean meats, fish, vegetables (except nightshades), fruits, healthy fats (like olive oil and coconut oil), and fermented foods.
  • This phase usually lasts 21 days to three months before a phased and gradual reintroduction of potentially inflammatory foods.

• Reintroduction phase: After the elimination phase, foods are gradually reintroduced one at a time to monitor for any reactions such as bloating. This helps identify specific food intolerances and sensitivities.
  • This phase usually lasts 30-60 days.

• Maintenance phase: Focusing on nutrient density, this phase emphasizes consumption of foods rich in vitamins, minerals, and other essential nutrients to support overall health and immune function.

Assessing Nutritional Needs

The role of fiber

Fiber is an essential component of a healthy diet, offering numerous benefits for digestive health, blood sugar regulation, and weight management. Fiber supports weight management by promoting satiety, which helps control appetite and can thus reduce calorie intake. Benefits of fiber for weight management include:

• Digestive health: Fiber promotes regular bowel movements and supports a healthy gut microbiome by feeding beneficial bacteria.
• Blood sugar regulation: Fiber slows the absorption of glucose in the bloodstream, which helps to regulate blood sugar levels and prevent spikes that can lead to insulin resistance, a major risk factor for type 2 diabetes.⁶⁴
• Satiety: Fiber enhances satiety by slowing digestion, helping individuals feel fuller for longer and reducing the likelihood of overeating, which is key for weight management.
• Mediates gut hormones: Fiber stimulates the release of gut hormones glucagon-like peptide-1 (GLP-1) and peptide YY (PYY). GLP-1 slows gastric emptying and enhances insulin secretion, while PYY reduces appetite by signaling fullness and satiation to the brain.⁶⁵

Incorporating fiber into the diet is a powerful strategy to reduce the likelihood of overeating and support long-term weight management goals.

Nutritional deficiencies

Identifying and addressing nutritional deficiencies is essential for optimal health and effective weight management. Deficiencies can lead to decreased energy levels, impaired metabolic function, and increased chronic disease risk.

• Impact energy levels: Nutritional deficiencies, particularly iron, vitamin B12, and magnesium, can lead to significant fatigue and low energy by impairing the body’s ability to convert food into usable energy.⁶⁶
• Impaired metabolic function: Deficiencies in key nutrients like iodine and selenium can disrupt thyroid function, slowing the metabolism and making weight management more challenging.⁶⁷
• Increased disease risk: Lacking essential nutrients like vitamin D and antioxidants like vitamins C and E increases the risk of chronic diseases, including cardiovascular disease, type 2 diabetes, and cancer.^68,69

Addressing nutritional deficiencies is essential for maintaining energy, supporting metabolic function, and making weight management efforts more effective.

Meal Planning and Preparation

Tips for meal prep

Effective meal prepping is a powerful tool for maintaining a healthy eating routine, saving time, and reducing stress. Planning and preparing meals in advance makes it easier to keep nutritious options available on even the busiest days.

1. Plan weekly menus: Planning meals for the week increases organization  and reduces the temptation to choose unhealthy options.
2. Batch-cooking: Batch-cooking saves time later in the week and can help control portion sizes, reducing the likelihood of overeating. Batch meals can be pre-measured and divided into individual portions. This improves management of calorie intake and helps maintain a balanced diet.
3. Prep ingredients in advance: Preparing ingredients ahead of time (e.g., cooking proteins at the beginning of the week to make them easy to chop up and add to salads) can simplify and speed up meal assembly.
4. Rotate recipes: To keep things interesting, rotate recipes regularly. This can help prevent meal fatigue and ensures consumption of that a wide variety of nutrients from different foods. It can also encourage adventurous eating, such as trying new fruits and vegetables outside of  one’s normal repertoire.

Effective meal prepping is a game-changer for maintaining a healthy eating routine. A little organization and preparation can make healthy eating convenient, affordable, and sustainable.

Benefits of Regular Physical Activity

Regular physical activity improves cardiovascular health, strengthens muscles and bones, improves immune function, and enhances weight management. For more information on the role of exercise in overall health, visit Exercise 101.

Increasing physical activity while reducing sedentary time is key. A minimum of 150 minutes per week of moderate-intensity activity, such as brisk walking or cycling, is recommended for weight loss, with 200–300 minutes per week suggested for weight loss maintenance.²⁵ Aerobic activities should be the focus, supplemented with resistance training to preserve lean muscle mass; the combination will enhance both metabolic health and physical function.⁷⁰ Tailoring exercise plans to individual fitness levels, preferences, and goals increases adherence and effectiveness. Setting realistic goals, tracking progress, and varying workouts can also help maintain motivation. Social support can also contribute to long-term commitment. Tailored exercise programs should consider the unique needs and abilities of people with disabilities, ensuring that recommendations are adaptable, inclusive, and focused on safe, accessible activities that promote health and well-being.⁷¹

Exercise acts as a natural antidepressant. It stimulates the release of endorphins, often referred to as “feel-good” hormones, which help alleviate symptoms of depression and anxiety, improve mood, and enhance cognitive function.⁷²

Physical activity also increases the production of neurotransmitters like serotonin and dopamine, boosting mood and helping individuals feel more motivated and positive about their weight management journey, which makes it easier to stick to a healthy lifestyle.⁷³

Exercise is not just about burning calories—it’s about creating a mental and emotional environment that supports long-term health and well-being.

Gut Health

The gut-weight connection

Gut health plays a pivotal role in weight management, as a balanced gut microbiome supports efficient digestion, nutrient absorption, and metabolic regulation. For more information, visit Gut Health 101.

Gut microbiome and metabolism

The gut microbiome is a complex ecosystem of trillions of microorganisms living in the digestive tract. It plays a critical role in various aspects of health, including digestion, nutrient absorption, and metabolic regulation:

• Role in digestion and nutrient absorption: The gut microbiome helps break down carbohydrates and fibers, producing short-chain fatty acids (SCFAs) like butyrate that enhance nutrient absorption and support energy balance.⁷⁴
• Metabolic regulation: An imbalance in the gut microbiome, known as dysbiosis, can lead to metabolic disruptions like insulin resistance, increased fat storage, and inflammation, all of which contribute to weight gain and obesity.⁷⁵
• Maintaining a balanced microbiome: Diets rich in fiber, prebiotics, and probiotics (particularly those containing Bifidobacterium longum) help nourish beneficial bacteria, while high-fat, high-sugar diets can lead to dysbiosis. Incorporate fermented foods like sauerkraut as well as yogurt and kefir (for those who can tolerate dairy),  and consume plenty of unprocessed carbohydrates to support a diverse and balanced microbiome.⁷⁶

Signs of poor gut health

Poor gut health can manifest in a variety of symptoms, including bloating, constipation, diarrhea, and unexplained weight changes. These symptoms indicate an imbalance in the gut microbiome. Addressing gut health is essential for improving overall health and supporting effective weight management.

Improving gut health

Probiotics and prebiotics

Probiotics are beneficial live bacteria that support gut health and help maintain the integrity of the gut lining, enhance immune function, and reduce the risk of digestive issues.⁷⁷ Prebiotics are non-digestible fibers that serve as food for probiotics, helping them thrive in the gut. Prebiotics contribute to better digestion, nutrient absorption, and immune health. The combination of probiotics and prebiotics works together to maintain a healthy gut microbiome.

GLP-1 probiotic support

GLP-1 is an incretin hormone that plays a crucial role in glucose metabolism by enhancing insulin secretion in response to meals, slowing gastric emptying, and reducing appetite. This hormone is particularly beneficial in managing blood sugar levels and supporting weight loss in individuals with type 2 diabetes and metabolic syndrome.

GLP-1 probiotics contain beneficial bacteria like Akkermansia muciniphila and Clostridium butyricum that enhance the body’s own production of GLP-1 and restore balance to the gut microbiome.⁷⁸ This improves glucose regulation, insulin sensitivity, and appetite control.

Anti-inflammatory foods

Antioxidant-rich foods, such as berries, leafy greens, and nuts, help neutralize free radicals in the body, reducing oxidative stress and inflammation. This is crucial for protecting the gut lining from damage.⁷⁹ Antioxidants also play a key role in supporting gut health by protecting the gut microbiome and promoting the growth of beneficial bacteria.

Omega-3 fatty acids, found in fatty fish (e.g., salmon), walnuts, and flaxseeds, are powerful anti-inflammatory agents. Omega-3 fatty acids support gut health by maintaining the integrity of the gut lining and reducing gut permeability.⁸⁰ This helps prevent conditions like leaky gut syndrome.

Hormonal Balance

Understanding hormones and weight

Key hormones involved in weight management

The regulation of appetite, metabolism, and fat storage in the human body is a complex process governed by several key hormones, including insulin, leptin, ghrelin, cortisol, and thyroid hormones. Each of these hormones plays a critical role in maintaining energy balance and body weight, and disruptions to their normal function can contribute to metabolic disorders such as obesity and diabetes.

Insulin: Insulin is a hormone produced by the pancreas in response to elevated blood glucose levels, typically after eating. Insulin helps cells absorb glucose for energy or storage, but when insulin resistance develops—where cells become less responsive to insulin—it promotes fat storage and weight gain, leading to metabolic disorders like obesity and type 2 diabetes.^{81 82}

Leptin: Leptin, the “satiety hormone,” signals the brain to stop eating when energy stores are sufficient. Individuals with obesity may develop leptin resistance, in which the brain fails to receive satiety signals. This resistance leads to overeating and further weight gain, contributing to the cycle of obesity.⁸³

Cortisol: The stress hormone cortisol increases glucose availability and fat storage, particularly in the abdominal area. Chronically elevated cortisol increases the risks of metabolic syndrome, diabetes, and cardiovascular disease.⁸⁴

Thyroid hormones (T3 and T4): Thyroid hormones regulate metabolic rate by converting nutrients into energy rather than fat, but thyroid dysfunctions like hypothyroidism can slow metabolism and increase fat storage, leading to weight gain.³⁹

Ghrelin: Ghrelin, known as the “hunger hormone,” increases appetite and promotes fat storage. Elevated ghrelin levels in those who have lost weight can make it difficult to maintain weight loss.⁸⁵

Disruptions in these hormones can lead to metabolic disorders, including obesity, diabetes, and metabolic syndrome, underscoring the importance of maintaining hormonal balance for overall health and effective weight management.

Strategies for Hormonal Balance

Nutritional support

A balanced diet filled with whole foods, healthy fats, and adequate protein is key to maintaining hormonal balance.

• Whole foods: Whole foods like fruits, vegetables, and whole grains, which are packed with antioxidants, fiber, and phytonutrients, provide essential nutrients that support hormone production and regulation. They also reduce inflammation and oxidative stress, which can negatively affect hormone levels.⁸⁶
• Healthy fats: Healthy fats, especially omega-3s, are crucial for hormone production and help regulate cortisol, reducing inflammation and alleviating symptoms of hormonal imbalance.⁸⁷
• Adequate protein: Protein is essential for hormone production, supporting muscle maintenance, metabolism, and stable blood sugar levels, which help regulate hormones like insulin and glucagon.⁸⁸
• Avoiding processed foods and excessive sugar: Processed foods and excessive sugar can disrupt hormonal balance by causing insulin resistance and introducing endocrine disruptors like bisphenol A (BPA)—which is found in plastic packaging and can seep into food—that interfere with natural hormone production.^26,89

A balanced diet rich in whole foods, healthy fats, and adequate protein supports hormonal balance. Avoiding processed foods and excessive sugar intake is also important.

Avoid exposure to “obesogens”

Obesogens are environmental chemicals that disrupt normal metabolic processes and contribute to the development of obesity. These chemicals disrupt endocrine signaling, alter gene expression, and affect the function of key metabolic tissues like adipose tissue, liver, and pancreas. These disruptions can lead to increased fat storage, altered energy homeostasis, and appetite dysregulation, contributing to the obesity epidemic on a large scale.⁹⁰ Obesogens also increase the risk of developing type 2 diabetes and heart disease.

Common obesogens that lead to an increased susceptibility to weight gain include:

• Bisphenol A (BPA): Found in plastics and epoxy resins used in food containers and water bottles.
• Phthalates: Used in a variety of consumer products, including food packaging, personal care products, and medical devices.
• Per- and polyfluoroalkyl substances (PFAS): Found in non-stick cookware, water-repellent fabrics, and food packaging.
• Organotins: Used in PVC products and as biocides in marine paints.
• Polychlorinated biphenyls (PCBs): Persistent environmental pollutants that accumulate in the food chain.
• Dichlorodiphenyltrichloroethane (DDT): A pesticide banned in many countries.
• Atrazine: A widely used herbicide found in agricultural runoff.
• Nicotine: Found in tobacco products.
• Perchlorate: A chemical used in rocket fuel and explosives.
• Fructose: Found in high-fructose corn syrup in processed foods, and can lead to insulin resistance, increased fat storage, and obesity.⁹¹

The role of sleep

Sleep quality is essential for weight management, as it regulates hormones that control hunger and metabolism, reducing the risk of overeating and weight gain. For more information, visit Sleep 101.

Poor sleep disrupts the balance of hormones that regulate hunger, stress, and metabolism, leading to increased appetite and weight gain. Hormones affected by poor sleep include the following:

• Ghrelin and leptin: Poor sleep increases levels of ghrelin, the hormone that stimulates appetite, and decreases levels of leptin, the hormone that signals fullness. This leads to overeating and weight gain.⁹²
• Cortisol: Sleep deprivation raises cortisol levels, which increases stress, stimulates appetite, and promotes fat storage, particularly in the abdominal area.⁸⁴
• Insulin: Inadequate sleep impairs insulin sensitivity, leading to higher blood sugar levels, increased fat storage, and a greater risk of developing type 2 diabetes.⁹³

Prioritizing good sleep hygiene—for instance, by maintaining a regular sleep schedule, creating a restful environment, and avoiding screens and caffeine before bed—is essential for hormonal balance and overall health. Adequate sleep helps control appetite and supports healthy eating habits while lowering the risk of metabolic disorders.

The role of stress management

Chronic stress can hinder weight management by elevating cortisol levels, which increases appetite and promotes fat storage, particularly around the abdomen. For more information on mental health and stress management, visit Mental Health 101 and Stress Management 101.

Cortisol, often called the “stress hormone,” plays a key role in the body’s response to stress. When stress becomes chronic, cortisol levels can remain elevated, leading to increased fat storage, heightened appetite, and weight gain.⁹⁴

Incorporating stress reduction techniques like meditation, deep breathing, and yoga into one’s daily routine can help lower cortisol levels, reduce stress, and support healthier weight management:

• Mindfulness meditation: Regular meditation can significantly reduce cortisol levels. Alleviating stress is essential for maintaining hormonal balance and preventing stress-related weight gain.⁹⁵
• Deep breathing: Deep breathing exercises activate the parasympathetic nervous system, reducing cortisol levels and helping to control appetite and weight.⁹⁶
• Yoga: Yoga effectively lowers cortisol levels, reduces stress, and supports many other bodily functions, making it a valuable practice for weight management.⁹⁷

Managing stress isn’t just about improving mental well-being—it’s a crucial part of maintaining hormonal balance and achieving long-term weight management goals.

Behavioral and Psychological Factors

The mind-body connection

Emotional eating and triggers

Emotional eating is often triggered by stress, boredom, or negative emotions, leading to overeating of unhealthy foods (particularly high-calorie, sugary, or fatty foods) and weight gain. Identifying these triggers is critical, as stress increases cortisol levels, driving cravings for “comfort foods” that are typically unhealthy.⁹⁴

To control emotional eating and achieve sustainable weight management, it’s essential to develop healthier coping mechanisms like mindfulness, meditation, and regular physical activity. Mindfulness improves emotional regulation and reduces emotional eating,⁹⁸ while regular exercise reduces stress and boosts mood by promoting release of endrophins.⁹⁹

Addressing emotional triggers and adopting better coping strategies supports sustainable weight management and overall health.

Psychological barriers to weight loss

Identifying and addressing these psychological barriers through cognitive-behavioral strategies can significantly improve one’s ability to achieve and maintain health goals. Common barriers to successful weight management often include:

• Lack of motivation: Maintaining motivation can be challenging. Cognitive-behavioral strategies, such as setting specific, achievable goals and tracking progress, can help maintain motivation by providing a clear sense of direction and accomplishment.¹⁰⁰ Focusing on intrinsic motivation—finding personal meaning and value in one’s health goals—can sustain long-term commitment.
• Low self-esteem: Low self-esteem often leads to negative thinking and self-sabotage. Cognitive-behavioral techniques, such as reframing negative thoughts and practicing self-compassion, can help improve self-image.
• Unrealistic expectations: Unrealistic expectations can lead to frustration. Cognitive-behavioral strategies encourage setting realistic, attainable goals and focusing on gradual, sustainable progress rather than quick fixes, reducing the likelihood of burnout and promoting long-term success.¹⁰¹

Effective weight management strategies are empowering. They include self-monitoring, goal setting, controlling environmental cues such as food availability, managing stress, and enhancing sleep quality and quantity. These behavioral changes support sustained weight loss and health improvements.³⁰

Disordered eating and its impact on weight management

Disordered eating patterns profoundly impact weight management, complicating the relationship individuals have with food, their bodies, and overall health, making it challenging to achieve and maintain a healthy weight.^[b][c]

• Anorexia nervosa: Anorexia nervosa is characterized by extreme food restriction, intense fear of gaining weight, and distorted body image. Individuals with anorexia often maintain dangerously low body weights, which can lead to severe malnutrition, weakened immune function, and even life-threatening complications.¹⁰²
• Bulimia nervosa: Bulimia nervosa involves cycles of binge eating followed by vomiting, excessive exercise, or laxative use. This cycle of binging and purging can cause significant fluctuations in weight, electrolyte imbalances, and damage to the digestive system.¹⁰³
• Avoidant/restrictive food intake disorder (ARFID): ARFID is characterized by an aversion to certain foods or a limited food intake driven by fear of choking or a lack of interest in food. ARFID can lead to significant nutritional deficiencies and challenges in maintaining a healthy weight.¹⁰⁴
• Obsessive-compulsive disorder (OCD): OCD can also manifest in eating behaviors, with individuals becoming excessively focused on specific dietary rules, food rituals, or fears of contamination. This can lead to restrictive eating patterns that are difficult to break and may contribute to unhealthy weight loss or nutritional imbalances. Addressing the underlying OCD symptoms is crucial for restoring a balanced approach to eating and weight management.¹⁰⁵
• Trauma: Trauma can deeply impact eating behaviors, leading to the use of disordered eating patterns like emotional eating as a maladaptive coping mechanism. These behaviors can disrupt normal weight management efforts and require a trauma-informed approach.¹⁰⁶

Understanding and treating disordered eating requires a root cause approach that considers both the psychological and physiological factors at play. Developing a healthy relationship with food can support sustainable weight management. This guide is not intended to provide a comprehensive overview of these complex issues.

Mindfulness and Weight Management

Mindful eating practices

Mindful eating is a powerful practice that involves being fully present during meals, paying close attention to the body’s hunger and fullness signals, and savoring each bite with intention. This approach to eating not only enhances the enjoyment of food but also promotes better digestion and helps prevent overeating—a common challenge in today’s fast-paced world.

• Listening to hunger and fullness cues: Mindful eating encourages eating when truly hungry and stopping when satisfied, not stuffed. This helps to regulate food intake, preventing overeating and supporting a healthier relationship with food.¹⁰⁷
• Eating slowly and savoring each bite: Eating slowly is another key aspect of mindful eating. Taking the time to chew thoroughly and savor each bite gives the body more time to signal when it’s full, which can prevent overeating. Additionally, eating slowly enhances the sensory experience of food, allowing more complete enjoyment of its flavors, textures, and aromas. This not only increases satisfaction but also supports better digestion, as slower eating promotes more efficient breakdown of food.¹⁰⁸
• Reducing overeating and improving digestion: Mindful eating reduces overeating by increasing awareness of the body’s needs, and it improves digestion by promoting slower, more deliberate eating habits. This can lead to a healthier weight and improved metabolic health.¹⁰⁹

Incorporating mindful eating into a daily routine is a simple yet transformative way to improve one’s relationship with food and reduce overeating, leading to enhanced digestion and greater enjoyment of meals.

Meditation and stress reduction

Chronic stress can hinder weight management by elevating cortisol levels, which increases appetite and promotes fat storage, particularly around the abdomen. For more information on mental health and stress management, visit Mental Health 101 and Stress Management 101.

Meditation practices, including mindfulness meditation, have been shown to reduce cortisol levels significantly. Regular meditation can help calm the mind, reduce the body's stress response, and promote relaxation, which is essential for managing emotional eating and preventing stress-related weight gain. Thus, incorporating regular meditation can aid weight management.⁹⁵

Setting Realistic Goals

Short-term vs. long-term goals

When it comes to achieving and maintaining a healthy weight, it’s wise to set both short-term and long-term goals. Short-term goals, such as incorporating whole fresh fruits and vegetables and planning and prepping meals, act as immediate milestones that provide quick wins, boosting motivation and confidence in the long run.

On the other hand, long-term goals focus on sustained success and on the bigger picture. They help form a clear vision of future success, such as reaching a healthy weight, improving overall fitness, or managing a chronic condition. Long-term goals require patience, persistence, and support, but setting them creates a roadmap for lasting change.

Tracking progress

Tracking progress when creating new habits or lifestyle shifts can improve accountability and make it easier to adjust strategies as needed. Whether through journaling, using a tracking app, or seeking professional support, regular monitoring helps track progress, identify areas for improvement, and make real-time adjustments to stay on track.

Journaling facilitates reflection on habits and celebration of small victories, while apps offer convenient tracking of food, exercise, and health metrics. Working with a health coach provides personalized feedback and support, ensuring that goals are tailored to one’s individual needs. This ongoing feedback loop is essential for long-term success and reduces the likelihood of feeling “stuck” during the weight loss journey.

Supplements and Other Medical Interventions

Supplements for weight loss and their role

Supplements can support weight loss by addressing nutritional deficiencies, enhancing metabolism, and reducing appetite. However, it’s important to choose evidence-based supplements and consult a healthcare provider before use. For more information, visit Supplements 101.

Green tea extract (EGCG)

• Benefits: Green tea extract—especially  its active compound, epigallocatechin gallate (EGCG)—aids in weight maintenance, helps prevent weight regain, and is useful as part of a long-term weight management strategy.¹¹⁰
• Dosage: 500-100^[d] mg of EGCG.
• Frequency: Once daily, preferably in the morning.
• Mechanism of action: EGCG enhances thermogenesis (the process of heat production in organisms), increasing energy expenditure and fat oxidation. It also improves insulin sensitivity, which improves blood sugar management and reduces fat storage.

Conjugated linoleic acid (CLA)

• Benefits: CLA is a fatty acid that has been shown to reduce body fat mass by increasing energy expenditure, so it is useful as an adjunct for weight management.¹¹¹
• Dosage: 3.2-6.4 grams.
• Frequency: Divided into two doses, with meals.
• Mechanism of action: CLA modulates lipid metabolism by reducing lipogenesis (the formation of fat) and enhancing fat oxidation. It also affects adipocyte differentiation, which can reduce fat accumulation.

Berberine

• Benefits: Berberine is known to reduce systemic inflammation, a common feature in obesity and metabolic syndrome. It improves insulin sensitivity by enhancing the regulation of gut hormones, including glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), which play crucial roles in glucose metabolism and appetite regulation.¹¹²
• Dosage: 500 mg.
• Frequency: Three times daily, before meals.
• Mechanism of action: Berberine activates AMP-activated protein kinase (AMPK), a key regulator of energy metabolism, which enhances fatty acid oxidation and glucose uptake in cells and reduces fat storage.

Forskolin (Coleus forskohlii)

• Benefits: Forskolin improves body composition by supporting fat loss and increasing lean body mass.¹¹³
• Dosage: 250 mg of 10% forskolin extract.
• Frequency: Twice daily, before meals.
• Mechanism of action: Forskolin increases cyclic AMP (cAMP) levels in the body, stimulating fat breakdown (lipolysis) and inhibiting fat synthesis.

Chromium picolinate

• Benefits: Chromium picolinate supports weight loss efforts by improving insulin sensitivity, which can improve regulation of blood sugar levels.¹¹⁴
• Dosage: 200-1,000 mcg.
• Frequency: Once daily, with meals.
• Mechanism of action: Chromium enhances the insulin signaling pathway by increasing the activity of insulin receptors and promoting the translocation of glucose transporter proteins to the cell membrane. This helps cells absorb glucose more efficiently, reducing blood sugar levels and potentially decreasing fat storage.

5-HTP (5-hydroxytryptophan)

• Benefits: 5-HTP is a precursor to serotonin, a neurotransmitter that regulates mood and appetite. It has been shown to help reduce food intake and promote weight loss.¹¹⁵
• Dosage: 100-300 mg.
• Frequency: Once or twice daily, preferably before meals.
• Mechanism of action: 5-HTP increases serotonin levels, which can reduce appetite and decrease calorie intake, particularly from carbohydrates.

L-carnitine

• Benefits: L-carnitine plays a role in fat metabolism and has been shown to aid in weight loss and improve exercise performance.¹¹⁶
• Dosage: 2-4 grams.
• Frequency: Once or twice daily, preferably before exercise.
• Mechanism of action: L-carnitine helps transport long-chain fatty acids into the mitochondria, where they are oxidized for energy production. This process may enhance fat oxidation and contribute to weight loss.

Lactobacillus probiotics (especially Lactobacillus gasseri)

• Benefits: Probiotics, particularly Lactobacillus gasseri, reduce abdominal adiposity and overall body fat while supporting weight loss.¹¹⁷
• Dosage: 10 billion CFUs.
• Frequency: Once daily, with meals.
• Mechanism of action: Lactobacillus gasseri modulates gut microbiota composition, reducing the absorption of dietary fat and promoting the excretion of fat in the stool.

GLP-1 probiotics (Akkermansia muciniphila and Clostridium butyricum)

• Benefits: Enhance insulin secretion, slow gastric emptying, and reduce appetite, leading to improved glucose control and weight management.^118,119
• Dosage: 10 billion CFUs.
• Frequency: Once daily.
• Mechanism of action: GLP-1 probiotics work by modulating the gut microbiome to increase the abundance of certain beneficial bacteria. These bacteria produce short-chain fatty acids (SCFAs), particularly butyrate, which stimulates the production of GLP-1 in the gut.

When combined with a balanced diet and regular physical activity, these supplements can provide additional support for weight loss. However, it’s important to consult with a healthcare provider before starting any new supplement regimen.

Bioidentical hormone optimization

Bioidentical hormone replacement therapy (BHRT) refers to the use of hormones that are chemically identical to those naturally produced by the human body.¹²⁰ Hormonal imbalances can lead to weight gain, particularly around the abdomen, as well as difficulties in losing weight. Here’s how BHRT may support weight management:¹²¹

• Regulates metabolism: Normalization of thyroid hormone levels boosts metabolic rate and promotes weight loss.
• Reduces abdominal fat: Estrogen therapy reduces visceral fat (fat stored around the abdominal organs) and improves body composition.
• Improves insulin sensitivity: Progesterone and estrogen therapy enhance insulin sensitivity, reducing fat storage and supporting weight management.
• Regulates appetite: BHRT stabilizes progesterone levels, reducing appetite and food cravings, and supporting healthier eating patterns.
• Preserve lean muscle mass: Testosterone therapy helps preserve lean muscle mass, supporting a higher metabolic rate.
• Regulates stress and cortisol: BHRT can balance cortisol levels, reducing stress-related weight gain.
• Enhances energy and motivation: Balancing estrogen, progesterone, and testosterone helps improve energy levels, reduce fatigue, and enhance overall well-being, leading to increased physical activity and improved weight management.
• Improves sleep quality: Balancing hormones that regulate the sleep-wake cycle, such as melatonin and progesterone, improves sleep quality. Better sleep is associated with lower levels of the hunger hormone ghrelin and higher levels of the satiety hormone leptin, which help control appetite and prevent overeating.¹²²

Menopausal hormone therapy (MHT)

Menopausal hormone therapy (MHT), including bioidentical hormone replacement therapy (BHRT), can enhance metabolic health by improving insulin sensitivity, reducing central obesity, preserving lean body mass, and positively affecting lipid profiles. This can support weight management and reduce the risk of metabolic syndrome. HRT primarily influences body weight distribution and the proportion of fat versus lean mass and does not significantly alter body weight.¹²¹

GLP-1 agonists for weight loss

Glucagon-like peptide-1 (GLP-1) agonists, such as semaglutide, aid weight loss through appetite reduction and improved blood sugar control. This is achieved by mimicking the action of the naturally occurring GLP-1 hormone, which is released in response to food intake.

• Appetite suppression: GLP-1 agonists activate GLP-1 receptors in the brain, particularly in the hypothalamus, reducing hunger and promoting a feeling of fullness. This leads to decreased food intake and weight loss.¹²³
• Prolonged feeling of fullness: GLP-1 agonists delay stomach emptying, keeping food in the stomach longer, which prolongs satiety and helps control portion sizes and calorie intake.¹²⁴
• Improve glycemic control: GLP-1 agonists enhance insulin secretion and inhibit glucagon release, improving blood sugar levels and preventing weight gain linked to hyperglycemia and insulin resistance, particularly in individuals with prediabetes and type 2 diabetes.¹²⁵
• Reduce visceral fat: GLP-1 agonists may also reduce visceral fat, which is associated with metabolic issues and weight gain.¹²⁶

These benefits make GLP-1 agonists valuable for managing obesity, especially in individuals with type 2 diabetes and higher cardiovascular risk. However, GLP-1 agonists should be used under medical supervision, with consideration of their potential downsides:

• Gastrointestinal side effects include nausea, vomiting, diarrhea, and constipation.
• Expensive and may not be covered by all insurance plans.
• Risk of pancreatitis (inflammation of the pancreas).
• May be associated with an increased risk of thyroid cancer.
• Their long-term safety implications are still under investigation.
• During a drug shortage, compounded versions of semaglutide may become available in the market. However, compounded GLP-1 agonists are not FDA reviewed for safety, effectiveness, or quality.¹²⁷

GLP-1 agonists offer several benefits, particularly for weight loss and glycemic control, but they also come with potential side effects and risks that healthcare providers must carefully consider and monitor.

Other interventions

For individuals living with severe obesity, medical interventions often include both surgical and non-surgical options, and are typically considered when lifestyle changes and medications have been ineffective:

• Bariatric surgery: Effective for long-term weight loss, reducing obesity-related comorbidities such as type 2 diabetes, hypertension, and cardiovascular diseases.¹²⁸
• Endoscopic bariatric therapies: Less invasive than traditional bariatric surgery and typically recommended for individuals with a BMI of 30-40.¹²⁹
• Vagal nerve blockade (vBloc): Vagal nerve blockade devices reduce hunger and promote satiety, leading to moderate weight loss.¹³⁰
• Bariatric arterial embolization: This experimental procedure reduces the production of ghrelin (the hunger hormone) by blocking stomach arteries, thereby decreasing appetite.¹³¹

Each intervention has its risks and benefits, so treatment choices should be carefully evaluated and made in consultation with healthcare providers as part of a comprehensive weight management plan.

Building a Support System

Join support groups and partner with healthcare providers

Support groups and healthcare providers can play a critical role in the weight management journey by offering guidance, encouragement, and accountability. Engaging with a supportive community can enhance motivation and success. Nutritionists, dietitians, and fitness experts can offer personalized advice, helping maintain weight-loss efforts and with personalized, evidence-based strategies.¹³²

Accountability and motivation: tools and apps for tracking

In today’s digital age, tools and apps designed to track nutrition, eating habits, and exercise have become invaluable for weight management. These tools provide real-time feedback and offer insights into progress, making it easier to stay accountable to one’s goals. Consistent tracking is linked to greater success in maintaining weight loss and achieving long-term health goals.¹³³

Function Tests for Weight Management

• Erythrocyte sedimentation rate (ESR): A systemic inflammatory biomarker.
• High-sensitivity C-reactive protein (hs-CRP): A systemic inflammatory biomarker.
• Heart: Evaluates heart health and possible risk factors for obesity and cardiovascular disease.
• Hormones: Evaluates hormonal imbalances that may contribute to weight gain.‍
  • Thyroid (TSH, Free T3, Free T4, Thyroid antibodies): Assesses thyroid function, which is essential for diagnosing and managing conditions that affect metabolism and weight.‍
  • Adrenal (cortisol, DHEA): Assesses the adrenal glands’ stress response and potential adrenal fatigue.‍
  • Female health: Hormonal assessments for women help address issues related to menstruation, menopause, and weight management.‍
  • Male health: Hormonal assessments for men focus on testosterone levels and other factors affecting weight.

• Metabolic: Provides insights into an individual’s metabolic rate and into potential issues that may impact weight management by measuring insulin, leptin, and adiponectin, which can impact insulin sensitivity and fat storage.
• Nutrient and vitamin levels: Nutritional deficiencies can hinder weight loss.
• Pancreas: Pancreatic function tests are important for diagnosing and managing diabetes and other metabolic disorders.
• Food sensitivity testing: Identifying food allergies helps tailor a diet that minimizes inflammation and supports weight management.
  • IgE food allergy profile
  • Celiac and gluten sensitivity testing (deamidated gliadin IgA/IgG, TTG IgA/IgG, anti-endomysial antibodies)

• Heavy metal and toxin testing: Whole blood mercury, lead, arsenic, aluminum
  • BPA and PFAS testing

Conclusion

Key takeaways

• Achieving and maintaining a healthy weight is crucial for overall well-being, helping prevent chronic diseases like hypertension and diabetes, enhancing physical and mental performance, and improving quality of life.
• Personalized weight management strategies tailored to an individual’s genetic, metabolic, and lifestyle factors increase the chances of long-term success.
• Maintaining a healthy weight lowers the risk of neurodegenerative diseases like Alzheimer’s by reducing inflammation and oxidative stress while improving vascular and mitochondrial function.
• Effective weight management requires lasting lifestyle changes, including balanced nutrition, regular physical activity, and behavioral modifications to prevent obesity and boost overall health.
• The carbohydrate-insulin model shows that carbohydrate type and quantity affect weight and metabolism, with lower glycemic index foods supporting improved weight management.
• A balanced diet of proteins, carbohydrates, and healthy fats is essential for health, supporting muscle repair, energy production, and hormone function.
• Regular physical activity enhances cardiovascular health, strengthens muscles and bones, and acts as a natural antidepressant, enhancing mood and cognitive function.
• A healthy gut microbiome is vital for digestion, nutrient absorption, and metabolism, with imbalances contributing to weight gain and metabolic disorders.
• Key hormones like insulin, leptin, and cortisol regulate appetite, metabolism, and fat storage, making hormonal balance crucial for effective weight management.
• Poor sleep and chronic stress disrupt hormone balance, leading to increased appetite and weight gain, making sleep hygiene and stress reduction essential for weight management.
• Addressing emotional eating, low self-esteem, and unrealistic expectations with cognitive-behavioral strategies can boost motivation and support long-term success in the weight management journey.

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