Bergen Medical Associates’ Sandeep Kour, MD, discusses some of the endocrine-related causes of obesity as well as treatments for the disease
Approximately 40% of Americans classify as obese, defined as having a body mass index (BMI) of 30 or higher, note the Centers for Disease Control and Prevention (CDC). Obesity — a disorder of the endocrine system — raises the risk of developing such serious and potentially fatal health conditions as diabetes, hypertension, cardiac arrest, stroke, sleep apnea and arthritis/joint issues, and should be addressed as early as possible, studies show.
Offering insight on the topic, Sandeep Kour, MD, a physician specializing in endocrinology and metabolism at Bergen Medical Associates, which has six offices throughout Bergen County, discusses common endocrine-related causes of obesity and the range of treatments for this disease.
What is the endocrine system and how is it associated with obesity?
Dr. Kour: The endocrine system involves glands that secrete chemical messengers called hormones, which carry information between cells and regulate such bodily processes as our appetite, satiety, energy level and mood. All of these are tied to obesity, so the endocrine system plays a major role in the physiology of obesity. Excessive insulin production or insulin resistance — both controlled by the endocrine system — are also major factors leading to obesity.
What specific hormones can affect weight and lead to obesity?
Dr. Kour: One of the major hormones involved in obesity is thyroid hormone, which regulates the body’s metabolism and affects mood, energy level and the expenditure of energy. A slow thyroid will be an obstacle to losing weight. The adrenal glands situated on top of the kidneys produce cortisol, which helps sustain life and metabolism, but excessive cortisol in the body can make it hard to lose weight. Insulin produced by the pancreas also plays a role in obesity. Type 2 diabetes involves insulin resistance, a condition which makes it hard for individuals to lose weight no matter how hard they try. Finally, sleep plays an important role in weight management. Melatonin (produced by the pineal gland) is an agent that helps regulate our sleep cycle and sleep disturbances like insomnia can negatively affect weight.
Diet, medication, and surgery are all treatments for obesity. How do diet and exercise play a role in treating obesity?
Dr. Kour: The treatment for obesity is collaborative — e.g., no medication or surgery will work long-term without committing to a proper diet and adequate exercise, so diet and exercise go hand in hand with any treatment pursued. The most effective approach to weight loss is dietary restriction; it’s about the calories you’re taking in and the form in which they’re consumed — e.g., carbohydrates versus proteins and fats and the portion of each, as weight loss requires a shift toward more proteins and fewer fats and carbs. It may sound simple, but it’s very complex and can take some effort to get the hang of it. Many diets are available today, but some of the key strategies I recommend are portion control, calorie restriction, and small meals or snacks eaten frequently throughout the day. You don’t want to go into starvation mode and then eat a binge meal because that puts stress on the body and is counterproductive.
Once weight is lost, exercise is a great way to maintain it. The body likes to be challenged, so it’s important to switch up your exercise regimen or else the body will adapt and the same exercise won’t have as much of an effect. The main thing with exercise is consistency, so it’s best to pursue something you like so that you’ll do it regularly (at least three to four times a week). Walking is an extremely effective activity that helps regulate glucose metabolism and enhance bone strength, but any exercise you can commit to engaging in consistently is the best one for you.
What are the different types of weight loss medications and how do they work?
Dr. Kour: There are two common categories of medication for obesity, and they’re prescribed based on the underlying cause of the weight issue. The first type involves oral stimulants, which trigger appetite suppression and give patients the energy that enables them to exercise. The other category is injectables that work in the GI tract to address insulin resistance and metabolism; similar to bariatric surgery, they work by constricting the stomach, preventing the consumption of large portions, and by sending signals of fullness to the body’s satiety center. Each type of medication has pros and cons/side effects, and we apply them accordingly based on a patient’s co-morbidities and family history. It’s important to discuss all of these factors with patients and determine the medication that’s best for them.
When would medication be prescribed to treat obesity and how long does it take for medication to work?
Dr. Kour: We typically prescribe medication for patients who have a BMI of 30 and above or else a BMI of 27 and above with other co-morbidities such as high cholesterol, polycystic ovarian syndrome, pre-diabetes, or another metabolic disorder. In terms of their application, appetite suppressants/stimulants are designed for short-term use (a few months). Injectables are more long-term treatments and people can be on these for years and even for life. Upon getting off of injections, however, studies show that two-thirds of patients gain some weight back, so changes to diet and lifestyle are critical to maintaining weight loss. Intermittent fasting — e.g., limiting eating time to certain hours and not eating at all in certain hours — has been shown to be effective, as is refraining from late-night and/or emotional eating.
When does surgery become an option?
Dr. Kour: Surgery is a more aggressive treatment, but it may be appropriate for patients who are morbidly obese and have other co-morbidities that pose specific health risks.
What final thoughts can you share about obesity?
Dr. Kour: It’s important to think about obesity as a disease — much like heart disease or diabetes — that people don’t necessarily bring upon themselves, so it requires a lot of compassion; people struggling with obesity don’t want to feel judged or ashamed. Something has gotten them to that point, so we treat them with kindness first and help them accept that they have a problem with certain foods or exercise. We encourage them to pay attention to their body and mind and to be kind to themselves through the process. We also encourage them to seek help early, as they’ll have a better chance of losing a substantial amount of weight and maintaining it if they act sooner than later. But we want them to know that it’s absolutely possible to lose weight and that we’re here to help.
For More Information
With offices in Emerson, Paramus (2), Ridgewood, Northvale and Montvale, Bergen Medical Associates offers primary care and 12 areas of specialized care. Patients enjoy the “one-stop shopping” approach where so many medical services are provided under one umbrella. The multispecialty group fosters an environment of collaboration among the physicians, which results in a seamless continuum of care for patients. For more information, visit bergenmed.com or call 201-967-8221.Leave a reply