Obesity is a multifactorial disease of complex interlinked factors like metabolism, genetics, hormones, environmental factors, etc.

General population including some clinicians always think that obesity treatment is very easy, just diet and exercise. But science and data state otherwise. An almost negligible percentage of people lose significant weight at the end of three years. This is because of the compensatory physiological changes in the body which try to regain the lost weight. For example, as one starts losing weight, the level of hunger hormone starts increasing and the metabolic rate slows down. Even muscles start smart adaptation so as to perform the same task in much lesser calories. Hence, exercise is never advised as a treatment of obesity in any medical literature. However, exercise is important for better health and has a role in the maintenance of weight loss.

Can patients with morbid obesity join Gym?

Patients who wish to join a gym or start a vigorous exercise programme should check their BMI before starting. Those with BMI more than 32.5 are morbidly or severely overweight / obese and such people are unlikely to lose weight and maintain it. However, they may induce harm to their body and joints. Excess weight, in fact, may stress or strain their joints and ligaments and can further induce orthopaedic problems or worsen them. A bariatric physiotherapist is an integral part of an obesity surgery centre and should advise exercise to such a person after proper evaluation.

Correlation Between Obesity and joints and bones:

Most of the patients with obesity have a deficiency of Vit D and may have some degree of osteoarthritis. Excess weight induces strain on the joints and ligaments, changes the centre of gravity, pain on movements or stiffness. Sometimes, torque during exercise may induce a fall or even a fracture.

Every kg of excess weight adds four to six kg of weight over the knee joints, states AAOS (American Association of Orthopaedic Surgeons) knee joints, hip joints, spine and ankles are most frequently affected in Indians. Obesity also induces diseases like diabetes, GOUT, heart disease, sleep apnoea, respiratory disorders, neuropathy and these diseases along with musculoskeletal disorders of obesity with or without pain, making it difficult for a person to do routine exercises.

Patients with morbid obesity with OA knees are recommended bariatric surgery prior to joint surgeries. These may prevent joint interventions and improve outcomes of orthopaedic surgeries if needed

Metabolic and Bariatric Surgery and the role of a physiotherapist:

Metabolic and bariatric surgeries are keyhole, laparoscopic surgeries on the stomach or intestines which improve the metabolism, reduce food intake, reduce excess hunger and thereby induce long term and sustained weight loss.

Patients need physiotherapy before and after surgery over the long term. Pre-operative focus is on diet-induced weight loss and improving respiratory reserve as well as ambulatory status. The main focus is on less weight-bearing exercises or short walks more frequently to minimise chances of deep venous thrombosis.

Post-operatively, as the patients start losing weight, all other aspects of physiotherapy are introduced and accelerated slowly in phases and according to the weight loss, as well as tolerance of the patient.

life experiences:

Physiotherapists who work in the bariatric unit have their relatives with obesity undergo bariatric surgery as soon as they see the involvement of joints. The same holds true with orthopaedic surgeons.

Picture perfect example:
A lady with severe osteoarthritis of the knee, who has advised spine surgery as well as knee replacement, is being seen free from all the joint pains after bariatric surgery and physiotherapy.

Having a healthy and Fit life is always the need of the hour amongst us Humans, not only it affects us on the outside but also on the inside i.e. being obese does not only downgrade our confidence about how we present ourselves to the society but also makes us prone towards various harmful diseases which is very well familiar among the people. The moment we step on the weighing machine and notice our weight on the higher side we immediately turn towards the decision to change our eating habits on a healthier side and start exercising which may help in weight management in case it is reversible. However, there is a catch here! There is more to our weight management than just the eating habit and exercising. As the title of this blog suggests there are various types of hormones that play a vital role in our weight management, which also controls what type of food we tend to enjoy, eating habits, regularity of food intake, laziness etc

Let’s list down the hormones which have been identified in affecting the weight management and how they can be controlled:

1. Insulin

Insulin plays a vital role in maintaining optimal blood sugar (glucose) levels in the body and is the key for recovering from exercise and muscle building. During high carbohydrate intake insulin runs in the body largely and it can inhibit the breakdown and burning of stored fat. On eating more carbohydrates more insulin will be released in the body resulting in lesser burning and breakdown of stored fat, ultimately causing weight gain.

In order to optimize Insulin level for fat loss:

2. Glucagon

Glucagon is a hormone that works directly opposite to insulin. Glucagon is responsible for breaking down stored carbohydrates and fats and releasing energy in the body.

In order to maximize Glucagon level for fat loss:

3. Leptin

Leptin, released from fat cells, is an adipokine hormone that regulates energy balance in the body by inhibiting hunger. Leptin signals the brain to eat less and burn more calories. With excess sugar-rich food fat gets deposited in various regions including the liver where fat cells continue to release leptin. This excess fat causes excess leptin release giving rise to more leptin signals to the brain for eating less. However, too much of the signaling brain becomes numb to leptin signals and becomes leptin resistant, making the body lose its control over eating.

Losing weight increases Leptin sensitivity and results in Leptin to become more effective to control the weight. In order to optimize Leptin level for fat loss:

4. Adiponectin

Adiponectin is also an adipokine hormone like Leptin, but unlike Leptin, the fat cells release more Adiponectin when the body is leaner. Adiponectin enhances muscle’s ability to consume carbohydrates for energy, boost metabolism, increases fat breakdown rate and curbs your appetite.

In order to maximize Adiponectin level for fat loss:

5. Cortisol

Adrenal glands secrete cortisol is a hormone when a person is depressed, anxious, stressed, nervous, angry, or physically injured in order to decrease stress levels by increasing blood sugar levels, suppression of the immune system and helping the metabolism of fat, protein, and carbohydrates. Due to a stressful lifestyle, the body leads to the secretion of cortisol aiding visceral fat deposition and stimulating the maturation of fat cells, which is detrimental to overall health.

In order to maximize Cortisol level for fat loss:

6. Estrogen

Ovarian calls in women or eating food rich in estrogen give rise to overproduction of estrogen and can cause high estrogen levels. Due to this the cells producing insulin get stressed making the body resistant to insulin, causing a rise in the blood glucose level and leading to weight gain. Both low and high levels of estrogen can lead to weight gain.

In premenopausal women or in old age the body has lower levels of estrogen. For replenishing the estrogen supply body starts looking for sources such as fat cells, the body starts converting all available sources of energy to fat to replenish the glucose levels, causing weight gain.

In order to balance Estrogen level for fat loss:

7. Thyroid hormones

Thyroid glands which are situated at the base of the neck produce these hormones responsible for maintaining the body’s metabolism, namely T3, T4, and calcitonin. Underproduction of thyroid hormones, that is hypothyroidism, causes accumulation of water in the body and results in weight gain. Hyperthyroidism also reduces the body fat burning rate, and causes fatigue and sluggishness. This also leads to slowed digestion leading to constipation. Sluggish metabolism leads to weight gain. The thyroid hormones are also needed for the production of Serotonin hormone, which plays a significant in weight gain.

Hyperthyroidism can be be prevented by:

8. Serotonin

Like Leptin, Serotonin hormone also signals the brain after eating that the body has sufficient food. Lower levels of thyroid hormones result in lower production of Serotonin. Low Serotonin levels give rise to depression, lethargy, tells the body that it is starving and its increased desire to eat refined carbs, leading to overeating and resulting into weight gain.

Serotonin level can be maintained by:

9. Testosterone

Testosterone helps the body to strengthen bones, muscles, burn fat and maintain libido. However, due to various lifestyle factors, such as age, stress can reduce testosterone levels and can lead to obesity in both men and women.

In order to maintain a good level of Testosterone for fat loss:

10. Progesterone

Progesterone is required for the smooth functioning of the body. Progesterone levels drop due to stress, intake of contraceptive pills and menopause. This can cause weight gain.

In order to maintain a good level of Progesterone for fat loss:

11. Ghrelin

Ghrelin, produced in the stomach, is known as the hunger hormone. It signals the brain to stimulate the appetite and increases fat deposition. Reducing calories for losing weight, causes an increase in Ghrelin. Hence, Ghrelin levels are high when people are on a strict diet or while fasting.

In order to optimize level of Ghrelin for fat loss:

12. Melatonin

Melatonin hormone regulates sleep and wakefulness. During the sleep body releases growth hormones to heal the body, improve body composition and build lean muscle. When the body does not get proper sleep, the healing process gets disrupted causing stress, subsequently leading to weight gain.

In order to optimize level of Melatonin for fat loss:

13. CCK

CCK stands for Cholecystokinin. This hormone is released from the cells in intestines whenever protein or fat is consumed. It signals the nervous system to flip the satiety switch while simultaneously working with the stomach to slow the rate of digestion. Lower level of CCK in the body results in weight gain.

In order to optimize level of CCK for fat loss:

14. Epinephrine

Epinephrine is well known as a fight or flight hormone. It drives the burning of fat to release energy in the body. It can also aid in appetite suppression. Lower level of Epinephrine in the body results in weight gain.

In order to maximize level of Epinephrine for fat loss:

15. Growth Hormone

Growth Hormone, which is considered to be the fountain of youth by many, can affect weight gain. Growth hormone signals fat cells and induces them to burn and break down fat stored into energy. Lower level of Growth Hormone in the body results in weight gain.

From the above detailed description, we understand how hormones play an important role in weight management and how we can control them.

Mostly when it comes to obesity we slam the other person suffering from it blaming their lack of will power because we assume that they lack control over following healthy food habits and exercise very less frequently. But, from the above blog we understand how hormones play an important role in weight management which turns obesity reversal a nightmare for those who are suffering from it. In our next blog we shall understand the role of will power to cure or reverse obesity, in order to perform essential weight loss treatment including bariatric surgery to overcome obesity.