Accurate Education – Obesity: Impact on Health and Pain

Weight Management:

Obesity:

Impact on Health and Pain

Obesity is a chronic, relapsing disease that places a substantial health burden on affected individuals, especially those with chronic pain. Being overweight or obese are commonly known to be key risk factors for medical conditions including cardiovascular diseases. 

 

See:

• Accurate Weight Loss Program
• Body Composition Analysis
• Diet & Diets
• Weight Loss Medications
• Dysfuntional Eating Behaviors
• Improving Self-Control

 

See also:

• Diet & Diets
• Diet & Pain
• Diet & Fasting 
• Diet & Depression 
• Diet & Dopamine
• Nutrition and Supplements
• Nutrition Medical Services
• Gut Microbiota
• Gut Microbiota and Pain
• Weight Loss Medications
• GLP-1 Receptor Agonists (Ozempic etc.)
• Natural Appetite Suppressants
• Dysfuntional Eating Behaviors
• Emotional Eating
• External Eating
• Hedonic Eating
• Night Eating Syndrome

 

Definitions and Terms Related to Pain

 Key to Links:

• Grey text – handout
• Red text – another page on this website
• Blue text – Journal publication

 

Introduction – The Impact of Obesity on Health and Pain

 

Obesity and Pain

This burden is especially true for those with chronic pain. Obesity contributes to pain and pain contributes to obesity – it is a vicious and destructive cycle. There are multiple variables whereby obesity contributes to pain, including mechanical loading, promotion of inflammation, alteration of the gut microbiome (micro-organisms in the G.I. tract) as well as having an impact on mental health:

Mechanical Factors

Poor Mechanics:

• • • Feet: Inadequate arch support
    • Shoulder: Compensating scapulo-thoracic motion
    • Back: Forward shift due to adipose tissue distribution
    • Knee: Misalignment of tibio-femoral joint

Increased Compressive Loading:

• • • Feet: Excessive compressive plantar loading
    • Back: Posterior loading to structural areas of spine and compression vertebral column and disc space narrowing
    • Knee: Each 1 lb body weight results in 4-6 lb pressure on each knee joint

Promotion of Inflammation

Fat tissue generates hormones, adiponectin and leptin, that bind to receptors that stimulate production of a variety of inflammatory agents that impact immune cells, cartilage and bone, resulting in osteoarthritis and destruction of joints. This production of inflammation throughout the body, systemic inflammation,  contributes significantly to chronic pain as well as other diseases associated with aging. So, excessive fat is not just a mechanical burden contributing to chronic pain but also a chemical burden that drives inflammation and pain. Addressing systemic inflammation through the use of dietary approaches and anti-inflammatory supplements are important components of a proper weight loss effort,

Not all fat in the body contributes the same amount to systemic inflammation. The fat directly under the skin that one can pinch with their fingers is subcutaneous fat, but the fat surrounding the organs in the abdominal cavity, visceral fat, is responsible for the most production of inflammatory agents. Assessing and targeting visceral fat and systemic inflammation is stressed in our Weight Loss Program.

Alteration of the Gut Microbiome

The billions of micro-organisms that inhabit the stomach and intestinal tract, known as the gut microbiome, plays a exceedingly important role in general health and specifically chronic pain. Diet and obesity influence the balance of healthful and destructive organisms that contributes to the production of inflammatory agents and breakdown products that can penetrate the gut wall and subsequently impact not only our joints and organs, but also the brain. This process contributes not just to the health of our tissues and joints, but also to mental health, including depression. See:

• • Gut Microbiota
  • Gut Microbiota and Pain

Learning how to support a healthy gut microbiome with diet and the use of probiotics and prebiotics is an important component to any successful effort for losing weight and is a focus of our Weight Loss Program.

Impact on Mental Health

As a fat person living in a society that values thin people, or worse, shames fat people, obesity contributes to feelings of failure, insecurity and loss of self esteem which in turn contribute to failing efforts towards weight loss.  The poisonous voice of self-doubt can be persistent, discouraging and even destructive, leading to depression which in turn can drive emotional eating and magnify the experience of pain. The importance of self esteem in achieving life goals, including weight-loss, is immeasurable. With support and counseling when needed, and with the understanding how self esteem can be shaped and influenced, one can acquire the essential awareness necessary for change. 

 

Guidelines for weight loss and treating obesity

Guidelines for weight loss and treating obesity encourage lifestyle modifications, including decreased caloric intake, moderate to vigorous exercise, and behavioral therapy as the first steps in the intervention. Achieving and maintaining long-term weight loss is challenging for many reasons, but largely because of the difficulty of adhering to the necessary lifestyle interventions of diet and exercise.

To gain substantial clinical benefits from weight loss, including reducing cardiovascular risks and pain, it is generally necessary to sustain a weight loss of 5% to 15% of one’s total body weight. However, most weight loss interventions including medications provide only moderate effectiveness (3%-8% body weight reduction beyond lifestyle interventions alone). Short-term treatment (3-6 months) generally fails to produce either persistent weight loss or long-term health benefits and several weight loss agents also have safety concerns. 

See: Weight Loss Medications

 

Medication Management

Although bariatric surgical procedures can be quite successful for some, they do represent an extreme approach that is usually left as the last resort. Many people can successfully lose significant weight with dietary intervention and the use of affordable appetite suppressant medications when desired. However, there has been an explosion of recent developments in weight loss medications that can match the large amount of weight loss offered by surgery. These medications include the GLP-1 Receptor Agonists of which Ozempic (semaglutide) is perhaps the best known.

See:  GLP-1 Receptor Agonists

This class of medications, previously unaffordable unless covered by insurance as part of diabetic management, is now available through the use of generic compounded versions. While these alternatives remain expensive they are much more in reach for some and can be prescribed (as well as other appetite suppressants) in our Weight Loss Program.

 

Additional Impacts of Obesity on Health

For those interested in learning more, please scroll to the bottom of this page where additional reference articles are available for download, including reducig risk for developing Alzheimer’s disease..

Interventions that can be employed to reduce the rest of developing Alzheimer’s disease and other forms of dementia can be found here, (taken from Evidence-based-prevention-of-Alzheimers-disease-systematic-review-and-meta-analysis-of-243-observational-prospective-studies-and-153-randomised-controlled-trials-2020.pdf)

 

Resources

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

Websites

MyFoodData.com

MyFoodData.com provides nutrition data tools and articles to empower you to create a better diet. All data is sourced from the USDA Food Data Central.This site includes many tools related to nutrition including one that allows you to look up any food for a nutritional analysis, including commercial products,

 

The Healthy Eating Plate – The Nutrition Source (Harvard Health)

Use the Healthy Eating Plate as a guide for creating healthy, balanced meals 

 

Cleveland Clinic Health Library

 

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

• My Fitness Pal
• Lose It
• MyPlate Plan
• HitMeal Calorie & Food Tracker

 

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

Biomarkers – IL-6

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

Biomarkers – Hypertriglyceridemia

1. 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 – Alzheimer’s Disease 

1. 1. B Vitamins_ MedlinePlus
   2. Folic Acid_ MedlinePlus
   3. Homocysteine Test_ MedlinePlus Medical Test
   4. Evidence-based prevention of Alzheimer’s disease- systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials – 2020
   5. Interventions To Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer’s-Type Dementia

 

Obesity – Fatty Liver

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

 

Obesity – Metabolic Syndrome

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

Obesity – Sleep Apnea

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

Vitamin C

Vitamin D

1. 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. 1. Quercetin

1. 1. Synaptamine

Eating Behavior – Binging  (BED)

BED – Overview

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

BED – Dopamine </sp an>

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

BED -Treatment, Chromium

1. 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. 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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