Wait-Am I on the right road?

Eating Behaviors:

External Eating

External eating is when one is motivated to eat because of  external cues

See also:

 

What is “Emotional Eating?”

People normal eat when they are physically hungry; those who are overweight often eat in response to external cues. External eating isn’t the single cause of obesity but is a factor for unnecessary eating that contributes to being overweight or obese.

Individuals with heightened sensitivity to external cues such as visual images or smells of desirable foods, are more likely to be triggered by these cues to engage in greater food intake in the absence of hunger (hedonic eating). This has been confirmed in studies evaluating functional magnetic resonance imaging (fMRI).

Additionally, studies have shown that greater sensitivity to food cues predicts increases in body weight as well as reduced success when participating in weight-loss programs. Therefore it is important for those individuals motivated to lose weight to assess their sensitivity to external cues in order to overcome the unintended drive to eat.

Education and counseling regarding external cues and hedonic eating can improve one’s success in losing weight.

 

The following is a list of eating behavior and their associated cues:

  • When I’m around others, I’ll eat something even if I’m not hungry. VISUAL
  • When I’m shopping, I’ll buy something I hadn’t planned because it looks good. VISUAL
  • I have to try a little food if it smells good. FOOD SMELL
  • It’s hard to ignore the smell of freshly baked goods. FOOD SMELL
  • If a food tastes really good, I’ll eat more than I planned to. TASTE
  • If I’m hungry, I won’t eat unless the food tastes good. TASTE
  • If it’s time for dinner but I’ve already eaten, I’ll eat dinner anyways. TIME OF DAY
  • When I lose track of time, I may forget to eat. TIME OF DAY
  • When I go to movies, I buy popcorn or other snacks even if I’m not hungry. EATING RITUALS
  • I like to have something to eat or drink when I watch TV. RITUALS
  • I read or watch TV when I eat by myself SOLO EATING
  • If I’m alone, I’d rather snack than eat a regular meal. SOLO EATING
  • It wouldn’t be Thanksgiving holiday if I didn’t eat too much. CELEBRATIONS
  • Whenever there’s a special event or occasion, I celebrate with food. CELEBRATIONS

 

Types of External Eating cues:

Visual Cues:

    • TV, restaurants, vending machines, office snacks, free samples, magazines, check out lines, seeing other people eat,
    • social events with food, all-inclusive vacations/cruises

Olfactory Cues:

    • Food court, Food items at work or another person’s house (cookies, popcorn).

Time Cues:

    • Lunch: 12:00  Dinner:  6:00

Traditions/Rituals:

    • Special Occasions, Holidays (weight gain from Thanksgiving to New Years), Carnival/Fairs, Baseball game, Movies

 

Other maladaptive eating patterns:

Mindless Eating

    • Eating while we watch tv, read, work, with others, etc
    • Eat with 1 person = 35% more
    • Eat with 7+ people = 50% more
    • If food is there, we’ll eat it:   Serving bowls: – People eat 40% more when serving bowl remains full

Eating fast

    • It can take 20 minutes from when you eat to when your brain gets the message that you’re full.

 

Improving your eating patterns:

Consider:

    • What situations are there for you where just the sight of food triggers eating?
    • What are certain food smells you can’t resist?
    • What time do you routinely eat even if you’re not hungry?
    • Do you distract yourself when you’re eating alone (i.e. TV, reading, phone?)

Out of sight, out of mind;

    • increase distance between you and the food
    • Use aluminum foil over plastic for food items
    • Store foods that are more tempting on top shelves
    • At home, keep food in the kitchen area only

Be mindful of how you’re eating and where

    • stay away from rooms where the food is kept at social events
    • Eat in a relaxed atmosphere (quiet, non-stimulating if possible)
    • Eat slower
    • Drink 8-12 oz of water before meals.
    • Drink some water in between bites.
    • Put your fork down in between bites (wait 10 seconds).

Portion control:

    • Use smaller plates
    • Don’t buy bulk items, instead purchase single serving items

Know your own routines:

    • What are situations of eating that occur in a certain situation even if you’re not hungry?
    • Do you tend to desire/need snacks while watching television?
    • Are there any daily tasks/chores you do that are then followed by a treat or a snack?
    • Is food a reward when you get home from work?

Resources

The following list includes resources that may be helpful in coping with being overweight as well as facilitating weight loss.

www.nutrition.gov

Nutrition.gov provides easy access to vetted food and nutrition information from across the federal government. It serves as a gateway to reliable information on nutrition, healthy eating, physical activity, and food safety for consumers.

Providing science-based dietary guidance is critical to enhance the public’s ability to make healthy choices in the effort to reduce obesity and other food related diseases. Since dietary needs change throughout the lifespan, specialized nutrition information is provided about infants, children, teens, adult women and men, and seniors.

Users can find practical information on healthy eating, dietary supplements, fitness and how to keep food safe. The site is kept fresh with the latest news and features links to interesting sites.

 

www.naafa.org – National Association to Advance Fat Acceptance

Founded in 1969, the National Association to Advance Fat Acceptance (NAAFA) is a non-profit, all volunteer, civil rights organization dedicated to protecting the rights and improving the quality of life for fat people. NAAFA works to eliminate discrimination based on body size and provide fat people with the tools for self-empowerment through advocacy, public education, and support.

 

www.obesityaction.org

The Obesity Action Coalition (OAC) was born with the goal that the organization could create needed change for those who are living with and/or are affected by the disease of obesity. The OAC is a more than 85,000 member-strong 501(c) national nonprofit organization dedicated to serving the needs of every individual affected by obesity.

 

List of Weight Loss Programs

 

Phone Apps

 

Other Resources for Help

 

References

NEW ARTICLES

  1. Association of Obesity With Prescription Opioids for Painful Conditions in Patients Seeking Primary Care in the US – PMC – 2020
  2. Chronic pain management in the obese patient- a focused review of key challenges and potential exercise solutions – 2015
  3. Chronic Stress, Cortisol Dysfunction, and Pain_ A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation – PMC – 2014
  4. Clinically Combating Reward Deficiency Syndrome (RDS) with Dopamine Agonist Therapy as a Paradigm Shift- Dopamine for Dinner? – 2015
  5. Effects of changes in sleeping behavior on skeletal muscle and fat mass- a retrospective cohort study – 2023 Leptin and Inflammation – 2008
  6. Sleep Deprivation_ Effects on Weight Loss and Weight Loss Maintenance – 2022
  7. The role of insufficient sleep and circadian misalignment in obesity – 2023

 

Obesity – Visceral Fat

Visceral Fat – Overviews

  1. Pathophysiology of Human Visceral Obesity – An Update

Visceral Fat – Biomarkers

Biomarkers – Adinopectin

    1. The role of fat topology in the risk of disease. – PubMed – NCBI

Biomarkers – IL-6

    1. Metabolic obesity: the paradox between visceral and subcutaneous fat. – PubMed – NCBI

Biomarkers – Hypertriglyceridemia

    1. Hypertriglyceridemic waist – a useful screening phenotype in preventive cardiology? – 2007

Visceral Fat – Exercise

  1. Effect of exercise training intensity on abdominal visceral fat and body composition

Visceral Fat – Genetics

  1. Genetic and behavioral influences on body fat distribution. – PubMed – NCBI
  2. The genetics of fat distribution – 2014

Visceral Fat – Stress

  1. Interleukin-1 beta – a potential link between stress and the development of visceral obesity – 2012

 

Obesity – Comorbid Conditions

Obesity – Fatty Liver

    1. The role of visceral and subcutaneous adipose tissue fatty acid composition in liver pathophysiology associated with NAFLD. – PubMed – NCBI
    2. What non-alcoholic fatty liver disease has got to do with obstructive sleep apnoea syndrome and viceversa? – PubMed – NCBI

Obesity – Kidney Disease

    1. Association of visceral fat area with chronic kidney disease and metabolic syndrome risk in the general population

 

Obesity – Metabolic Syndrome

    1. Association of visceral fat area with chronic kidney disease and metabolic syndrome risk in the general population
    2. Abdominal Obesity and the Metabolic Syndrome – Contribution to Global Cardiometabolic Risk – 2008
    3. Metabolic syndrome and adipose tissue: new clinical aspects and therapeutic targets. – PubMed – NCBI
    4. Subcutaneous and Visceral Adipose Tissue: Their Relation to the Metabolic Syndrome: Endocrine Reviews: Vol 21, No 6

Obesity – Oxidative Stress

    1. Oxidative stress drivers and modulators in obesity and cardiovascular disease: from biomarkers to therapeutic approach. – PubMed – NCBI

Obesity – Sleep Apnea

    1. Visceral fat and respiratory complications – 2004
    2. What non-alcoholic fatty liver disease has got to do with obstructive sleep apnoea syndrome and viceversa? – PubMed – NCBI

Wt Loss Program

Wt Loss Program – Body Composition Analysis (BCA)

  1. Body Composition Analysis – Patient Preparation handout
  2. Measurement of visceral fat by abdominal bioelectrical impedance analysis is beneficial in medical checkup. – PubMed – NCBI
  3. The clinical importance of visceral adiposity – a critical review of methods for visceral adipose tissue analysis – 2012
  4. The use of bioelectrical impedance to detect excess visceral and subcutaneous fat – 2007

 

Wt Loss Program – Appetite Suppressants

Appetite Suppressants – Prescription Medication List

  1. Adipex (Phentermine)
  2. Belviq (Lorcaserin)
  3. Bupropion
  4. Contrave (Bupropion/Naltrexone)
  5. Invokana (Canagliflozin)
  6. Naltrexone
  7. Orlistat (Xenical, Alli)
  8. Qsymia (Phentermine and Topiramate)
  9. Saxenda (Liraglutide)
  10. Topamax (Topiramate)
  11. GLP-1 Receptor Agonists
  12. Wegovy (Semaglutide)

 

Appetite Suppressants (Rx) –  Semaglutide

    1. Semaglutide Medications – Information
    2. Ozempic Information
    3. RYBELSUS Information
    4. Wegovy Information
    5. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity – PMC – 2021
    6. Review Wegovy (semaglutide)- a new weight loss drug for chronic weight management – 2022
    7. Once-Weekly Semaglutide in Adults with Overweight or Obesity – 2021
    8. Once-Weekly Semaglutide in Adults with Overweight or Obesity – PubMed – 2021
    9. Effect of semaglutide and liraglutide in individuals with obesity or overweight without diabetes- a systematic review – 2022
    10. GLP-1-Medications-Article-References-and-PubMed-Links
    11. Sublingual Semaglutide Supportive deposition
    12. The Impact of GLP1 Agonists on Bone Metabolism: A Systematic Review.- 2022
    13. Efficacy and safety of dulaglutide 3.0 and 4.5 mg in patients aged younger than 65 and 65 years or older: Post hoc analysis of the AWARD‐11 trial – 2021
    14. Safety of Semaglutide – 2021
    15. Semaglutide for the treatment of overweight and obesity_ A review – 2023
    16. Two-year effects of semaglutide in adults with overweight or obesity_ the STEP 5 trial 2022
    17. Semaglutide for the Treatment of Obesity – 2021

 

Appetite Suppressants (Rx) – Wegovy (Semaglutide)

    1.  Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity – PMC – 2021
    2. Singh G, et al. J Investig Med 2022;70-5–13. doi-10.1136 jim-2021-0019525 Review Wegovy (semaglutide)- a new weight loss drug for chronic weight management – 2022
    3. Once-Weekly Semaglutide in Adults with Overweight or Obesity – 2021
    4. Once-Weekly Semaglutide in Adults with Overweight or Obesity – PubMed – 2021

Appetite Suppressants –  CAM

    1. Appe-control and Hunger Block

 

 

Wt Loss Program – Diet

Diet – Guidelines

 

Diet – Fasting

  1. Calorie restriction increases life span: a molecular mechanism. – PubMed – NCBICalorie restriction increases muscle mitochondrial biogenesis in healthy humans. – 2007
  2. A double-blind, placebo-controlled test of 2 d of calorie deprivation – effects on cognition, activity, sleep, and interstitial glucose concentrations – 2008
  3. Fasting and refeeding differentially regulate NLRP3 inflammasome activation in human subjects – 2015

Diet – Foods

  1. Chia Seeds
  2. Pistachios
  3. Fiber

 

Diet – Supplements

Supplements – Vitamins

Vitamins – Overviews

    1. Vitamin status in morbidly obese patients – a cross-sectional study – 2008

Vitamin C

Vitamin D

    1. Decreased bioavailability of vitamin D in obesity – 2000
    2. Higher visceral fat area increases the risk of vitamin D insufficiency and defic
      iency in Chinese adults – 2015
    3. Obesity and vitamin D 2004
    4. Rising serum 25-hydroxy-vitamin D levels after weight loss in obese women correlate with improvement in insulin resistance. – PubMed – NCBI
    5. The Effect Of Vitamin D Supplementation On Serum 25OHD In Thin And Obese Women – 2012
    6. The Longitudinal Association of Vitamin D Serum Concentrations & Adiposity Phenotype – 2013
    7. Vitamin D and Its Relationship with Obesity and Muscle – 2014
    8. Vitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markers – 2009
    9. Update on vitamin D – pros and cons – 2015

Diet – CAM Supplements

  1. Multi-Nutrient Supplements
  2. NRF2 Activators
  3. CoQ10
  4. Nicotinamide Riboside (NR)

 

 

Wt Loss Program – NLAL Lipolysis

NLAL Lipolysis – Handouts

  1. NLAL Lipolysis
  2. NLAL – Patient Treatment Info

NLAL Lipolysis – References

  1. Fat Liquefaction – Effect of Low-Level Laser Energy on Adipose Tissue
  2. Application of low-level laser therapy for noninvasive body contouring. – PubMed – NCBI
  3. Body contouring using 635-nm low level laser therapy. – PubMed – NCBI
  4. Efficacy of low-level laser therapy for body contouring and spot fat reduction. – PubMed – NCBI
  5. Independent evaluation of low-level laser therapy at 635 nm for non-invasive body contouring of the waist, hips, and thighs. – PubMed – NCBI
  6. Low-level laser therapy as a non-invasive approach for body contouring: a randomized, controlled study. – PubMed – NCBI

 

 

Maladaptive Eating

Eating Behavior – Emotional Eating

  1. Emotional Eating

Eating Behavior – External Eating Cues

  1. External Eating Cues

 

Eating Behavior – Cravings

  1. Food craving – new contributions on its assessment, moderators, and consequences – 2015
  2. Pickles and ice cream! Food cravings in pregnancy – 2014
  3. Relationship of cravings with weight loss and hunger – Results from a 6 month worksite weight loss intervention – 2013
  4. How Relevant is Food Craving to Obesity and Its Treatment? – 2014

Cravings – Treatment

Cravings Treatment –  CAM Supplements

    1. Quercetin
    1. Synaptamine

Eating Behavior – Binging  (BED)

BED – Overview

    1. Binge Eating Disorder – Recognition, Diagnosis, and Treatment

BED – Dopamine </sp an>

    1. Binge eating disorder and the dopamine D2 receptor: genotypes and sub-phenotypes. – PubMed – NCBI
    2. Dopamine for “Wanting” and Opioids for “Liking” – A Comparison of Obese Adults With and Without Binge Eating-2009

 

BED – Treatment

BED – Treatment, Overview

    1. Current and Emerging Drug Treatments for Binge Eating Disorder – 2014
    2. Pharmacological management of binge eating disorder – current and emerging treatment options

BED -Treatment, Bupropion

    1. Bupropion for Overweight Women with Binge Eating Disorder – Randomized Double-blind Placebo-controlled Trial – 2013

BED -Treatment, Chromium

    1. Chromium Picolinate – Summary
    2. A Double-blind, Randomized Pilot Trial of Chromium Picolinate for Binge Eating Disorder – Results of the Binge Eating and Chromium (BEACh) Study – 2013
    3. Dietary chromium supplementation for targeted treatment of diabetes patients with comorbid depression and binge eating. – PubMed – NCBI

BED -Treatment, Contrave

    1. Treatment of Binge Eating Disorder in Obesity: Naltrexone: Bupropion Combination Versus Placebo – Full Text View – ClinicalTrials.gov

 

Maladaptive Eating – Reward Deficiency Syndrome

  1. Clinically Combating Reward Deficiency Syndrome (RDS) with Dopamine Agonist Therapy as a Paradigm Shift- Dopamine for Dinner? – 2015

“Dopamine for Dinner” by Joan Borsten, 2014

Avaliable online at Amazon.com: Kindle subscriber: free;  Kindle book: $9.95  Paperback: $149.00

“Dopamine for Dinner,” is the first Malibu Beach Recovery Diet Cookbook, based on their famous low-glycemic diet. The recipes developed by four accomplished chefs are both pleasant eating as well as healthy. Based on the use of low glycemic index foods, the recipes emphasize nutritious eating in a manner that promotes maintaining high brain levels of dopamine and serotonin as a means of supporting healthy brain chemistry.

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thous
ands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

 

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