If you were watching any news program last week, you undoubtedly saw the headline, “It’s not your fault you are overweight! Hormones are to blame!” These statements were triggered by a study published in the New England Journal of Medicine on October 27 (Sumithran, et al., 2011) that found that one year after a completing a 10-week low-calorie weight-loss program, dieters released more hunger-inducing hormones than they did before starting their diets. The authors concluded that these hormonal shifts are largely responsible for the all-too-common weight regain that occurs for many people after a diet. Therefore, they suggested that long-term maintenance of weight loss may require medication to counteract such hormonal changes.
We are getting more and more scientific evidence every day that genetics, hormones and brain circuitry all play a role in determining our hunger levels, when we feel full, and ultimately how much we weigh. As a clinical psychologist specializing in obesity treatment, I am fascinated by research that seeks to better understand why people have such difficulty losing weight and keeping it off. I use this very data to explain to my patients that the difficulty of their struggle is real – based in neurochemicals and DNA.
I fear, however, that these findings are often misconstrued by two important groups: 1) overweight individuals trying to lose weight and 2) the scientists themselves.
To begin, I’ll put myself in the shoes of an obese person who is failing in her weight-loss efforts. Reading this headline, I might draw the conclusion: “Well, there’s no point in continuing this weight-loss program if my hormones are just going to lead me to gain the weight back. I guess I’m doomed to be overweight forever.” This is a dangerous line of thinking because it creates feelings of powerlessness, apathy, discouragement and maybe even anger.
Following through with plans to make healthier food choices and exercise more is challenging enough without these self-defeating emotions getting in the way. Further, this interpretation discounts the possibility that individuals are indeed capable of learning techniques and strategies to counter these hormonal effects. For instance, limiting exposure to tempting foods, pre-planning meals, and committing to a regular program of exercise have all been shown to assist people in losing weight and keeping it off for good. We are not solely a product of our bodily chemistry, and we always retain the power to choose what goes into our mouths and how much we move our bodies.
Secondly, I would hope that scientists conducting this research realize and acknowledge that people make choices around food and exercise based on a wide variety of factors – and physical hunger (regulated by the hormones they study) is likely not the most influential. Many of my overweight patients tell me that they eat when they are hungry, but they also eat when they are anxious, angry, depressed, bored or even happy.
Further, they often continue eating (even when they feel uncomfortably full) because the food tastes so good or because they are seeking distraction from emotional pain. Thus, it is unlikely that any medication – no matter how well it tames a person’s hunger – will be the cure-all for our obesity epidemic.
Advances in medicine will undoubtedly play a role in the future of obesity treatment, but a combination of pharmacological/surgical and behavioral/psychological approaches will always be necessary to address the complex reasons that people overeat.