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Dr. John Cleek Discusses Weight and Metabolism Learn more about the Vanderbilt Center for Medical Weight Loss.

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Laura Osterman: Welcome to this edition of the Vanderbilt University Health and Wellness Wellcast. I am Laura Osterman with Health Plus. I am here today with John Cleek, Assistant Professor and Director of the Vanderbilt Center for Medical Weight Loss. Thank you for joining us. Dr. John Cleek: Thank you for having me. Laura Osterman: After weight loss, it can be challenging to maintain or keep the weight off. Can you give us some background as to what it is that can make this so challenging? Dr. John Cleek: Our body is set to maintain our weight. It has done this for millions of years. It is trying to maintain its weight in times of famine. So, as soon as we start losing weight by cutting calories, it is trying to slow everything down to defend its weight. It does not know that losing weight is actually better for it. So, it makes multiple adaptations for it including hormonal changes and metabolism changes to try to keep its body weight at a level. Laura Osterman: Can you talk about metabolism? What it is and the role it plays with regard to keeping the weight off? Dr. John Cleek: Metabolism is just how many calories we burn. Burning calories can be going for a walk, so activity calories. Other calories are like fidgeting, shaking our foot while we are sitting. Other calories are actually the calories it takes to digest and absorb food called the thermic effect of the food and then the other calories are calories that are just required for living. So, the calories you burn just sitting at your desk, and those all make up our metabolism, and so, put all those together would be our 24 hour energy expenditure. The part we can change would obviously be the activity component of what we spend, and so, that is what we look at most when we talk about making changes for weight loss or even weight maintenance. Laura Osterman: Are weight management strategies different for weight loss and maintenance? What are some of the things you might recommend to help patients maintain after weight loss? Dr. John Cleek: Let’s talk a little bit about both, okay? Because I think they generally overlap. Some of the most important things are, believe it or not, sleep. For example, every night if you do not get a minimum of 6 hours of sleep, it causes a hormone to go up that increases appetite and slows your metabolism the next day. In particular, it increases your desire to eat carbohydrates because carbohydrates turn to sugar and give us energy to keep going. One of the biggest predictors of controlling your weight is using some sort of journal or diary. We generally underestimate our food calorie intake by 30%, and this helps us see what we are actually taking in. So, that is really, really important. The same can be said with using a fitness tracker. You can even use the one on your phone to count steps. There are lots of other devices to name a few Fitbit, Jawbone UP, Vivofit by Garmin, etc. Just like We overestimate activity, just like we underestimate caloric intake, getting a true picture of how much activity we have is critical. Maintenance is to me much harder than weight loss because we can do anything for a few months, but what can we do for a few years or many years, and that is why, it is so important to find what you can live with a balance. Now, what my patients complain about is that means the weight loss is slower, and that is okay with me because I am more worried about where your weight is at 1 year, 2 years, or 3 years, not that I lose 15 pounds a month, but we are such on microwave instant gratification society, that is hard to overcome sometimes. Laura Osterman: Seeing that big picture can be helpful. Dr. John Cleek: It can be, yeah. We want to get through the forest not trying to get past a tree here and a tree there, and that is what we need to look at. Laura Osterman: Regaining weight can be difficult for individuals who have lost weight and how would you counsel individuals who have noticed that they are starting to gain weight back on that they have previously lost? Dr. John Klick: The first thing I tell patients is it is not because they are a failure. It goes back to the physiology of what is going on. So, we briefly touched on that. Let’s talk a little bit more. When we lose weight, and generally, anything over 10% weight loss causes our metabolism to slow. Our body has become more efficient with the calories we give it. So, metabolism can slow 300, 400, and if you have lost lots of weight, 100 pounds and 200 pounds, it can slow as much as 500 or 600 calories a day, and that was the big recent splash about The Biggest Loser that was in a lot of media. We have known about that for a longtime and especially with some surgery patients who lose 150, 200 pounds that their metabolisms drop significantly. So, that was not new, but it means that your maintenance calorie level is not going to be what you were eating before. It is still going to be at a low level and that can be hard for some of us to wrap our minds around that we still have to be at such a low calorie level. So, that is going to be one thing that is normal that are sometimes hard to deal with. The second thing is we still need to keep that food journal because we start gaining weight how do we know what we have changed if we are not keeping the journal, and it is nice then we can look at a current journal versus a journal when we were losing or when we are maintaining and we can try to look at the differences. Now, a journal is not perfect because there is such a thing as portion creep where our portions go up without us really realizing it and that may not reflect in our journal, but it will still give us some idea. I do not want to come across as completely negative. So, there was a study called the Look AHEAD trial which was a study of patients with diabetes. Now because of medicines they take insulin in particular, diabetics have much harder time losing weight in general. So, if you look at this trial, there were about 900 patients who lost at least 10% of their body weight, and if you look 10 years later, there were still over 300 patients, 325 who were still keeping 10% of their body weight off. Let’s say a third or just over of those patients were keeping their weight off at 10 years. So, there is still success. It is just some people will say “Well, I am 200 pounds and that is 180.” That is not good enough, but that is good enough for major improvements of blood sugar, blood pressure, cholesterol, reduction in joint pain, etc. That is going to be very helpful to long-term health. For us, 10% is success. Laura Osterman: Thank you so much for joining us today. Thanks for listening. Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page. If you have a story suggestion, please email it to us at health.wellness@vanderbilt.edu or you can use the “Contact Us” page on our website at healthandwellness.vanderbilt.edu. -- end of recording --