The Challenges of Managing Appetite – How You Can Hack Your Brain To Help You Lose Weight – Part 1

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM; Carrie Lam, MD


Weight loss and managing appetiteHave you ever found yourself eating a cookie without knowing how or when you got it in your hands in the first place? And then, to make things worse, you just keep eating one cookie after another, even though you weren’t hungry and you don’t even really want that next cookie? Maybe you’ve tried different ways of managing appetite only to repeat this scene over and over again and then give up in frustration.

Unfortunately, not only is this cycle detrimental to your health, but also to your self-esteem. Feelings of guilt, shame, frustration, and powerlessness seem to follow you around and infuse one of the most natural things human beings do every day: eating.

The first thing you need to understand is that it’s not a will power issue, and you’re not alone. Only about 8% of people who have lost weight manage to keep it off for two or more years. This creates the disaster of the yo-yo dieting cycle, with the average person trying to diet four times a year.

The failure rate of maintaining weight loss through extreme diet and exercise regimens is actually higher than maintaining sobriety from other addictions. And that’s for good reason.

First of all, you can’t quit food and then avoid it altogether. So you have to maintain a healthy balance where you can still eat and enjoy your food without flipping back to overeating. Secondly, and more importantly, the same mechanism of drug and alcohol addiction can be triggered for eating. This mechanism is called the reward cascade.

This important yet commonly overlooked mechanism is responsible for almost all the participants on programs like “The Biggest Loser” regaining all of their weight despite their best intentions. It is also to blame for the aggravating instructions you get from some doctors about managing appetite without giving you any real resources to do so. It also causes the hopelessness you feel whenever you try your best to get healthy but just can’t keep it up.

But the information we’ll present to you here, with some new tips and methods for managing appetite and losing weight, will give you some hope. You’ll be relieved to know there’s far more in play than just eating healthy and exercising. Although you will still need to apply these to your day to day routine, you’ll find that by addressing other underlying issues, eating healthy and staying active will become much easier to begin and maintain.

For most of human history, malnutrition and starvation were much more common than obesity. However, this is starting to change. This is not found just in high-income countries, but also in middle-income and low-income countries as well.

Obesity has become a worldwide epidemic, and it needs to be treated as such. It’s not just a personal battle you’re fighting at home. The statistics show that not only is it on the rise, it is starting to overtake other mortality risk factors quite quickly, including smoking and being underweight. It thus poses a major challenge for public health.

Obesity and the Different Types of Fat

Obesity affects 35% of the global population, and 50% of the American population. The most worrying statistic of all is that it affects around 17% of children and adolescents in the US.

Concerted efforts need to be made in order to help people overcome this treatable disorder. The problem, however, is that conventional advice is just not working for most people. On top of that, not everyone is properly informed about the causes and dangers of obesity and how to tackle it in day to day life.

Managing appetite and obesityAccurate and comprehensive understanding is key. Just like any other long-term project, if you’re looking for options in managing appetite and losing weight, you need to be well informed about the different methods and risks you have in front of you. The first piece of information you should know is that there are actually different types of fat.

Adipose tissue, which is the technical term for fat, is a loose connective tissue made up of adipocytes, or fat cells. These adipocytes store excess fatty acids and then release them when you need more energy.

There are two types of adipose tissues: visceral fat, which is found between your organs, and subcutaneous fat, which is found right beneath your skin. The first type, visceral fat, is actually more dangerous than the fat underneath the skin, though both pose health risks. This is why you may have heard that waist circumference is a bigger predictor of health problems than BMI.

There are several reasons for that.

First of all, it is one of the jobs of adipose tissue to release fatty acids into the system when you need energy. Visceral fat, however, releases fatty acids into the wrong places, like into portal circulation, which is not healthy.

This circulation takes the fatty acids to the liver, where they build up and eventually cause non-alcoholic fatty liver disease. They can also go to the pancreas, where they can cause issues with glucose and insulin, and to the heart, where they can cause issues with blood pressure and cholesterol.

Next, visceral fat secretes adipokines, which are a type of proinflammatory cytokines that signal information back and forth between cells during an immune response. Specifically, visceral fat secretes leptin and adiponectin, both adipokines that are intimately involved in obesity.

Leptin is the hormone that signals to the brain when you’re satiated so you stop eating. If it is out of balance, it can cause inflammation and issues with managing appetite. Adiponectin helps with the breakdown of fatty acids and the regulation of glucose in the system. If it is out of balance, you can develop insulin resistance, which is another common factor in weight gain.

Finally, weight issues can mess with the body’s NeuroEndoMetabolic (NEM) Stress Response and the adrenal glands. While on the other end of the equation, dysregulation of the NEM and adrenal fatigue can cause weight gain, including concentrating the fat around the midsection of the body. Cortisol receptors are more concentrated in the visceral fat than in peripheral fat. It should come as no surprise that many with weak adrenals and subsequent cortisol imbalance often also suffer from excessive fat in the center part of the body. The so-called “muffin top” look is a common result, along with other metabolic imbalances.

The NEM Stress Response and Weight

The NEM is the body’s global response to stress, and it is composed of six circuits: the hormonal, the metabolic, the cardionomic, the neuroaffect, the detoxification, and the inflammation responses. Part of the hormonal response is the hypothalamic-pituitary-adrenal (HPA) axis, which is composed of the hypothalamus, the pituitary gland, and the adrenal glands.

The NEM stress response and managing appetiteAny kind of stress, whether a real or perceived threat to the body’s state of homeostasis, will trigger the stress response, starting with the hormone cascade of the HPA axis. Signals from the hypothalamus and pituitary gland in the brain will stimulate the adrenal glands into secreting cortisol.

Cortisol is responsible for many important functions in the body, such as regulating blood pressure and blood glucose, maintaining heart and blood vessel function, suppressing the immune system, and neutralizing inflammation.

Although the adrenals and the rest of the NEM are capable of handling stress, they are not made to deal with a constant state of stress. When stress becomes chronic, these delicate systems can dysregulate, causing Adrenal Fatigue Syndrome (AFS) and other imbalances.

In the beginning stages of AFS, cortisol levels rise, and this can trigger weight gain. In fact, chronic stress has been cited as one of the possible environmental factors that are contributing to the rise in obesity rates, and especially in visceral adiposity.

Chronic stress causes the concentration of energy at the midsection, as well as an increase in the acquisition of energy. This has a lot to do with how cortisol is produced. The production of cortisol occurs through several conversions of other hormones: cholesterol is first converted to pregnenolone, and pregnenolone is then converted into DHEA or progesterone, and then finally to cortisol.

Each of these steps needs energy. That means your system triggers the hunger signal more often when you’re under stress so that you have enough energy to make cortisol. Plus, the fat cells that store the cholesterol that is converted into all these hormones are redistributed to the midsection in order to be closer to the organs involved in the conversion process. That way you don’t need even more energy.

AFS and managing appetiteThat’s why easily gaining weight and difficulty losing it are two common symptoms of AFS, because your body needs all the energy it can get to deal with stress. Also, the main symptoms of AFS are fatigue and low energy, which makes physical activity even harder. Because of this low energy, you can get sugar cravings. As soon as you eat sweets, your blood glucose will spike, triggering an overproduction of insulin that then leads to a crash, which then turns into a craving again.

These spikes and crashes in blood glucose levels mess with insulin balance in the body, which is another very important factor in managing appetite and weight problems. Later down the line, the risk for insulin resistance and even type 2 diabetes becomes increasingly high. Most who suffer from adrenal fatigue tend to be on the heavy side of the weight scale relative to their height and age, with the exception of those in very advanced stages of adrenal fatigue, where the body is in desperate need of energy. In such cases, the body will start to break down muscle mass for energy, resulting in gradual loss of muscle mass and weight loss. This catabolic phase impacts the body negatively. In extreme states, the sufferer can become very much underweight.

Read Part 2 | Part 3

© Copyright 2018 Michael Lam, M.D. All Rights Reserved.


Dr. Lam’s Key Question

The same reward centers in the brain that light up when a drug addict feels a craving light up when an overweight person craves comfort foods. Dealing with this imbalance first can help in managing appetite, increasing physical activity, and losing weight.


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