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Overweight and obesity may be viewed as the development of excess body fat related to an energy imbalance between ‘energy in’ (calories consumed from food and beverages) and ‘energy out’ (calories burned on basic body functions and physical activity). However, there are many factors that influence these two components of energy balance. Understanding these factors can help assess, identify and address the etiological determinants of positive energy balance; thereby assisting in developing an optimal individualized plan for effective weight management.
The factors that control ‘energy in’ and ‘energy out’ to maintain energy homeostasis have provided a survival advantage as humans evolved. However, in our current social context of increased food availability and technological and transportation advances that have reduced daily physical activity, body weight regulation is a challenge. Energy balance is impacted by a number of variables.
When considering factors that affect ‘energy in’ it is important to understand the difference between hunger and appetite. Hunger is a physiological sensation that drives an individual to search for and ingest food. This sensation is elicited after a variable period following the absorption of the nutrients ingested with the previous meal. After the ingestion of a certain amount of food, a suppression of hunger occurs that will lead to the termination of food intake – referred to as satiation.
While the factors that affect ‘energy in’ are very complex, from a clinical point of view, the following four categories are helpful to understand:
• Traditions or habits, belief systems, peer pressure, food availability, how food is presented and consumed.
• Living in a neighborhood with many fast food restaurants, exposure to food advertising, decreasing affordability of healthy foods, work environment, home environment.
• Lack of nutrition knowledge.
Physiological or Homeostatic
• Hyperphagia can result from genetic factors (rare but possible – e.g. Prader Willi Syndrome)
or from acquired defects related to head trauma or certain cancers).
• Hunger versus appetite influences as described above
• Eating patterns and food choices (e.g. extended period of time between meals/snacks, poor satiating food choices) are more commonly related to hyperphagia.
• Peptide neurotransmitters such as cholecystokinin (CCK), glucagon-like-peptide (GLP)-1, peptide YY3-36(PYY), neuropeptide Y (NPY) and amylin.
Psychological or Emotional
• Certain psychiatric conditions can make it more difficult to maintain a healthy diet
(e.g. depression, binge eating, night eating, attention deficit disorders, post-traumatic stress syndrome, sleep disorders, chronic pain, anxiety disorders, addictions, seasonal affective disorder and cognitive disorders).
• Eating may be used as a coping strategy to deal with a wide range of emotions from stress, loneliness, anger, and grief to happiness.
Medications/drugs that Increase Hunger and Appetite
These medications/drugs can include oral antidiabetic medications, antidepressants, atypical antipsychotics, anticonvulsants, certain hormonal preparations including corticosteroids and oral contraceptives as well as medicinal and recreational use of marijuana. Medication monographs can be reviewed to determine the side-effects that may impact body weight. Alcohol and mind-altering drugs can promote overeating by increasing appetite and promoting disinhibition.
Many people with obesity have difficulty achieving and then maintaining a healthy weight in the long term. Although maintaining a weight reduction of 5% can result in improvement in co-morbidities, this is often difficult to sustain. Therefore, as with other chronic conditions, lifelong intervention is needed for individuals with obesity.
Eloise Crowley, New Leaf Health Dietitian