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Weight Management

Visceral Fat

Visceral Adipose Tissue (VAT) or “Visceral Fat” is a type of fat that is found around the abdominal organs, including liver, stomach, and intestines. It is different from “subcutaneous fat” which is just under the skin. Visceral fat is significant because it is the type of fat that contributes most to the health risks associated with being overweight, including heart disease and diabetes.

See:

 

See also:

 

 

Vhat Weight?

People have many motivations for losing weight, notably to reduce their pain, improve their personal appearance and enhance their physical performance. However, perhaps the most important motivation to lose weight is to reduce one’s risk for developing the cardio-metabolic diseases associated with being overweight.  These conditions include:

  • heart attacks
  • heart disease
  • type 2 diabetes
  • raised blood pressure
  • stroke
  • breast and colorectal cancer
  • Alzheimer’s disease

Traditionally in the medical community weight loss is mostly directed at obesity because it correlates with increase risk for these diseases. However, the definition of obese is commonly based on metrics such as BMI that in of themselves may not actually be the best measures to address.  Research has now demonstrated that it is not just the total amount of fat but the type of fat that is in excess which is the most important contributor to the health risks associated with being overweight,

 

Visceral Fat

Visceral fat, or Visceral Adipose Tissue (VAT) is a type of white adipose tissue characterized by large adipocytes (fat cells) that builds up in the mesentery and omentum tissues surrounding the internal organs within the abdomen. Visceral fat, more than subcutaneous fat, contributes to the cardio-metabolic health risks associated with being overweight.

Subcutaneous fat does contribute to adiposity, but it is generally less influential on insulin resistance compared with VAT.  Subcutaneous adipocytes are small and insulin-sensitive compared with those in VAT, so they act as “sinks” or “buffers,” which can absorb free fatty acids (FFAs) and triglycerides that are circulating after eating. Fat cells are capable of expanding to store large amounts of fat and remaining healthy, but when their expansion is excessive, inflammation is induced.

Visceral adipocytes, are much larger, more insulin-resistant, and more metabolically active and they release more free fatty acids (FFAs), glycerol, hormones, and cytokines that promote inflammation. The “portal theory” may explain why visceral fat is harmful. Visceral fat which surrounds the intestines, pancreas and spleen, releases these inflammatory compounds that travel through the portal vein to the liver.

As a result, the fatty acids and inflammatory compounds build up in the liver and potentially lead to fatty liver, liver insulin resistance and type 2 diabetes. This explains why the amount of VAT may be better for predicting T2D is, compared to subcutaneous fat, 

Visceral Fat and Type 2 Diabetes (T2D)

The flagship of the diseases associated with obesity is Type 2 Diabetes (T2D). High levels of visceral fat can result in increased insulin resistance, which may lead to glucose intolerance and then type 2 diabetes. Obese individuals are more likely to develop T2D than those with healthy weights for a number of reasons. Obese individuals secrete more insulin after eating carbohydrates, which leads to elevated levels of insulin in the blood.  Because of this, their pancreas may dysfunction and tissued may become insulin resistant. Although obesity does not always predicts an eventual diagnosis of T2D, it does increase the risk of developing T2D.

There is also evidence of the opposite, where T2D can contribute to obesity.Individuals who are genetically predisposed to T2D may become obese over time due to their insulin resistance. This is because they have abnormal amounts of glucose and dysfunctional insulin in their bloodstream, which results in fat accumulation.

Type 2 diabetes (T2D) is commonly attributed to obesity which is one of the biggest risk factors for T2D, but obesity as determined by BMI assessment is not the strongest indicator of T2D risk. Instead, the measure of VAT has emerged as the key determinant for whether or not an individual will develop T2D.

 

Identifying Risk for T2D with BMI

Approximately 10–20% of diabetes cases correspond to non-obese individuals (defined by BMI) around the world, This proportion markedly increases to 60–80% in India and mainland China which have the highest number of non-obese T2D patients, despite externally appearing to be in good condition. Additionally, despite an overwhelming recent increase in obesity and T2D,  57.9% of T2D-related deaths worldwide as of 2019 were attributed to patients whose BMI categorized them as non-obese.

These statistics indicate that there are numerous other factors that can play a role in T2D onset other than patient weight, and this “unexpected” group of T2D cases may be even more dangerous because they may not arouse the suspicion necessary to trigger diagnosis and treatment. One of the most important of these factors is the presence of increased VAT.

Many individuals fall into a category referred to as “metabolically healthy obesity” (MHO). MHO describes a group of people who are considered obese by BMI but do not exhibit any metabolic or cardiovascular issues, such as T2D. Despite their BMI, people with MHO do not often gain many health benefits from losing weight, though they are advised not to gain additional weight. This is another argument that other characteristics may be more significant for predicting the risk of T2D than BMI.

Though MHO is associated with several characteristics, one of the most relevant is that individuals with MHO have less VAT, less liver fat, and more lower body subcutaneous fat compared with their counterparts with Metabolically Unhealthy Obesity (MUO). This once again indicates that adipose tissue deposition is one of the most significant factors when it comes to the development of T2D.

 

Identifying Risk for T2D with BMI

Studies have determined that when assessing risk for T2D, the amount of VAT in an individual is a significantly better indicator of diabetes than any of the other measures of obesity including waist circumference (WC), waist/height ratio (WHR), waist/hip ratio, and waist/thigh ratio. 

 

Factors that Influence VAT Levels

When eaten, dietary fats are digested and broken down into smaller components, free fatty acids (FFAs,) which enter into the bloodstream. These FFAs are either taken up and stored as triglycerides in subcutaneous fat or in VAT.  There are several factors that influence whether an individual will have more subcutaneous adipose tissue, or VAT.

Genetics

For example, those with Asian heritage tend to have more body fat, subcutaneous and visceral, at a similar BMI compared to those with European heritage. Japanese Americans have the most VAT while African-Americans have the least. This is significant because Japanese Americans have relatively low obesity prevalence rate of 8.7% compared with the obesity prevalence rate of African-Americans, which is drastically higher at 49.5%. These statistics demonstrate how independent BMI and body fat composition are from each other as a group, when non-obese by BMI is associated with the highest amount of VAT.

Gender and Sex Hormones

A person’s gender and sex hormones play a significant role in VAT levels. Females tend to have more estrogen, which maintains FFA distribution to subcutaneous fat with limited distribution to abdominal VAT, leading to a “pear” shape. The effects of estrogen is demonstrated clearly in post-menopausal females, who have much lower levels of estrogen, resulting in a decrease in their capacity for FFA uptake in subcutaneous fat and thus increases uptake into VAT as they age. 

Data supports the idea that females have a significantly higher capacity to store FFAs in their subcutaneous fat, so fewer FFAs enter their VAT. Whereas the decreased FFA storage capacity in the subcutaneous fat of males leads to more FFA uptake by VAT, thus promoting VAT accumulation. This greater accumulation of visceral fat compare to subcutaneous fat in males may be one of the reasons that males typically develop T2D at a lower BMI than females in the same age range.

Diet

Finally, factors that an individual can modify!

 

Food to Avoid

“Ultra-processed” food is strongly linked to increased age-related VAT over subcutaneous fat This may be due to the fact that ultra- processed food is often calorie-dense while having poor nutritional quality. Ultra-processed foods (UPFs) are industrially made foods that are high in chemical additives and low in natural whole foods. They are often designed to be convenient, cheap, and tasty. UPFs generally contain sugar and are often made from genetically modified crops like corn and soy, and may include a long list of ingredients including added preservatives, colorings, and flavorings.. These additives can extend the shelf life of the food. However, the production process can strip UPFs of their natural vitamins, minerals, and fiber.

Some examples of UPFs include:
    • Frozen pizza
    • Ready-to-eat meals
    • Instant noodles
    • Store-bought breads
    • Soda and carbonated drinks
    • Sweet and savory packaged snacks
    • Breakfast cereal
    • Energy bars or granola bars
    • Candy
    • Fast food

Soda and carbonated beverages

Another  link has been found between visceral adiposity and sugar-sweetened beverages  where daily consumption of sugar-sweetened beverages is positively correlated to an individual’s VAT-to-subcutaneous-fat ratio.

It is also believed that fructose amplifies this effect, especially in men, while glucose consumption is more closely correlated to subcutaneous fat deposition. This is because when fructose is absorbed into various tissues which has many effects, one of which leads to low-grade inflammation. This inflammation increases cortisol in the blood, which increases the release of fatty acids out of subcutaneous adipocytes and allows for more to be taken in by visceral adipocytes.

The worst offender in sodas is high fructose corn syrup (HFCS), a powerful but very unhealthy sweetener, the most common one found in sodas. High fructose corn syrup increases your appetite and promotes obesity more than regular sugar. High fructose corn syrup contributes to diabetes, inflammation, high triglycerides and non-alcoholic fatty liver disease,

 

Saturated fatty acids

 Saturated fatty acids are a type of fat that have all single bonds between the carbon atoms in their fatty acid chains. .They increase VAT and fat in the liver and can increase cholesterol levels, which can increase the risk of heart disease. Replacing foods high in saturated fat with healthier options, like unsaturated fats from canola, soybean, and olive oil, can help lower VAT and the risk of heart disease.  Saturated fatty acids occur naturally in many foods, including:

    • Animal products: Meat, dairy, and poultry (especially with skin)
    • Tropical fats: Coconut, palm, and palm kernel
    • Other foods: Beef fat (tallow), lard, cream, butter, cheese, and ice cream

Low-Carbohydrate Diet

Many studies have demonstrated that low-carbohydrate diets are an effective way to reduce visceral fat, even more effective at reducing visceral fat than low-fat diets. In an 8-week study including 69 overweight men and women, it was found that people who followed a low-carb diet lost 10% more visceral fat and 4.4% more total fat than those on a low-fat diet. Additionally, the ketogenic diet, a very low-carb diet that drastically reduces carbohydrate intake and replaces it with fat, may also help reduce visceral fat.

 

Lifestyle

Changes in diet are critical, but other lifestyle aspects are also significant.  The best way to lose visceral fat is by maintaining a healthy lifestyle. One can lower their visceral fat level by focusing on the same diet and exercise plans one would engage to lose weight and lower your total body fat.

Ways to reduce visceral fat include:

  • Exercise: When able, exercise for at least 30 minutes a day, including cardio or strength training.
  • Smoking: Smoking contributes to increased VAT.
  • Intermittent fasting: Intermittent fasting may help reduce levels of VAT
  • Good sleep: Getting enough sleep may reduce risk of increasing VAT.
  • Reduce stress: Stress activates the hormone, cortisol, which triggers the storage of more VAT
  • Limit alcohol intake: Consuming alcohol may increase VAT

 

Exercise

Exercise is an excellent way to reduce fat, but exercise but has preferential effects on visceral fat reduction. People should include both Cardio (or Aerobic) exercise, which raises a person’s heart rate, and  Resistance exercise, which improves muscle size, into their routines. 

Cardio exercise includes:

    • running
    • cycling
    • swimming
    • aerobics
    • circuit training

Cardio (or Aerobic) exercise,

An analysis of 15 studies in 852 people found that moderate and high-intensity aerobic exercises were most effective at reducing visceral fat, even without dieting. However,, combining aerobic exercise with a healthy diet is even more effective at reducing visceral fat than doing either one alone. It has been found that a modest exercise program equivalent to a brisk 30-minute walk six times a week can prevent accumulation of visceral fat, while even more exercise can actually reduce the amount of visceral fat.

 

Resistance exercise

Resistance exercise is most beneficial to help maintain muscle mass when one is losing weight. Calorie restriction diets result in the body metabolizing both fat and muscle in order to generate the necessary nutrition to meet the body’s needs. 

Resistance exercise includes:

    • squats
    • weights
    • pushups

 

Reduce Stress

Stress plays a role in storing excess visceral fat because stress releases a hormone called cortisol, which increase fat stores. Relaxation techniques, such as meditation, deep breathing, and other stress management practices can be beneficial and help a person lose visceral fat more efficiently.                                                                                  

 

Summary

Individuals who consume fewer “ultra-processed” foods, less fructose, and less saturated fatty acids are less at risk of increased VAT. Those who avoid smoking and consuming alcohol are also less likely to accumulate VAT.

Diet and lifestyle are factors within a person’s control, and making changes in these areas can prevent the growth of VAT and lower one’s risk of developing insulin resistance. Understanding the difference between the types of adipose tissues and what predisposes individuals to have one or the other may help explain the prevalence of metabolic diseases in certain groups.

It has been shown that a simple estimate of visceral fat area by BCA is positively associated with insulin, triglycerides, CRP, IL-6, leptin and other inflammatory biomarkers, independent of relevant covariates including smoking, sedentary behavior, and moderate-to-vigorous physical activity.

The Body Composition Analyzer (BCA) is the best means of assessing ones level of visceral fat and a good indicator of risk for cardiometabolic disease in adults. Current data suggests an increased cardiometabolic disease risk with a visceral fat area at or above 100 cm2,

Research has demonstrated that a reduction in VAT is associated with clinical improvements in several inflammatory and adiposity markers, including insulin, and these improvements may contribute to a reduction in systemic inflammation and obesity-related metabolic disturbances.

 

Assessing Visceral Fat

Determining the amount of visceral fat one has is challenging due to a lack of affordable, precision tools to do so. Imaging scans, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans are the most accurate way to determine how much visceral fat someone has these scans are both expensive and time-consuming.

Indirect measurements can be made by measuring waist circumference or assessing waist circumference against total body height. However convenient these methods are, they offer only gross assessments with limited ability to use them as means of monitoring change related to a weight loss diet.

In most people, about 90% of body fat is subcutaneous, the kind that lies in a layer just beneath the skin  and feels soft. The remaining 10% is visceral — or intra-abdominal fat — which is out of reach, inside the abdominal wall. It’s found in the spaces surrounding the liver, pancrease, intestines, and other organs. It’s also stored in the omentum, an apron-like flap of tissue that lies under the abdominal muscles and blankets the intestines. The omentum gets harder and thicker as it fills with fat and can be responsible for the bulging appearance of the mid-abdomen in those with increased visceral fat. The omentum is a large contributor to the size of an individual’s waist circumference which is predictor of excessive visceral fat

 

As a rough guide, a woman whose waist circumference measured at the belly button is 35 inches or more is likely to have excess visceral fat. The same is true of a man whose waist circumference measures 40 inches or more, but the predictive accuracy of these numbers can be influenced by an individual’s height.

 

The best option at this time is to perform a Body Composition Analysis (BCA) using an electronic device that uses bioelectric impedance to provide a quantitative analysis of visceral fat that allows monitoring for change. Since the measure of visceral fat with this technique is not exact, it is measured on a scale in which the cut-off for excessive values may vary from device to device with cut-off values ranging from 10-13.

 

This BCA provides a full breakdown of one’s percent body fat, percent skeletal muscle mass, percent body water and a measure of one’s visceral fat level. Moreover, one will be able to calculate the daily calorie needs for maintenance of one’s current weight and from that one is able to identify a definitive target calorie intake to allow a predictable rate of reliable weight loss.

See: Body Composition Analysis (BCA) 

 

Screening for Visceral Fat

A simple preliminary screening for visceral fat is to evaluate waist circumference (WC) versus height(Ht) of an individual.  If this ratio, WC/Ht, is greater than 0.5, the person is at greater risk for increased visceral fat. Even if this individual has a BMI less than 30, especially if other risk factors for cardio-metabolic diseases are present (family hx of cardio-metabolic disease, vulnerable lifestyle such as unhealthy diet or lack of exercise),  then a BCA should be performed for further assessment to explore potential treatment options. Consideration should also be given to blood work to assess biomarkers for systemic inflammation.

 

Biomarkers for Visceral Fat

While there is not a specific biomarker that targets visceral fat, there are biomarkers that target systemic information, including C reactive protein (CRP), interleukin-6 (Il-6) and tumor necrosis factor-α (TNF-α) which have all been unequivocally shown to promote both insulin resistance (IR) and development of atherosclerosis.

Additionally, homocysteine, an amino acid, is also a biomarker that helps identify low B vitamin levels, B6 and B12, that represent risk factor for Alzheimer’s disease, another condition associated with heightened risk related to obesity and systemic inflammation related to visceral fat.

 

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

Phone Apps

 

Other Resources for Help

 

References

Body Composition

Body Composition Analysis (BCA) – Overviews

  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
  5. Reliability-of-bioimpedance-in-the-assessment-of-visceral- 2023
  6. A Simple Estimate of Visceral Fat Area by Multifrequency Bioimpedance Analysis Is Associated with Multiple Biomarkers of Inflammation and Cardiometabolic Disease_ A Pilot Study – 2023
  7. Visceral fat area measured by electrical bioimpedance as an aggravating factor of COVID-19- a study on body composition – 2023
  8. Measurement of visceral fat by abdominal bioelectrical impedance analysis is beneficial in medical checkup – PubMed – 2008

 

Body Composition – Obesity

    1. Optimal Body Fat Percentage Cut-Off Values in Predicting the Obesity-Related Cardiovascular Risk Factors- A Cross-Sectional Cohort Study – 2020
    2. A new framework for the diagnosis, staging and management of obesity in adults – 2024

Body Composition – BMI

    1. Body mass index is a barrier to obesity treatment – 2024

 

Body Composition – BMI vs Percent Body Fat

    1. Defining Overweight and Obesity by Percent Body Fat instead of Body Mass Index – PubMed – 2024
    2. Assessment of Age-Induced Changes in Body Fat Percentage and BMI Aided by Bayesian Modelling- A Cross-Sectional Cohort Study in Middle-Aged and Older Adults – 2020
    3. Body mass index and measures of body fat for defining obesity and underweight- a cross-sectional, population-based study. – 2014pdf

 

Body Composition –Visceral Fat

    1. Age-related increase in visceral adipose tissue and body fat and the metabolic risk profile of premenopausal women – 1999
    2. Editorial – Importance of body composition analysis in clinical nutrition – 2023
    3. Visceral Adipose Tissue- The Hidden Culprit for Type 2 Diabetes – 2024

 

Obesity – Visceral Fat

Visceral Fat – Overviews

    1. Pathophysiology of Human Visceral Obesity – An Update

Visceral Fat – Biomarkers

    1. Association of Inflammatory and Oxidative Status Markers with Metabolic Syndrome and Its Components in 40-to-45-Year-Old Females_ A Cross-Sectional Study – 2023
    2. The Preventive Mechanisms of Bioactive Food Compounds against Obesity-Induced Inflammation – 2023
    3. Biomarkers of dysfunctional visceral fat – PubMed – 2022
    4. Leptin and Inflammation – 2008
    5. Reliability-of-bioimpedance-in-the-assessment-of-visceral- 2023
    6. A Simple Estimate of Visceral Fat Area by Multifrequency Bioimpedance Analysis Is Associated with Multiple Biomarkers of Inflammation and Cardiometabolic Disease_ A Pilot Study – 2023
    7. Visceral fat area measured by electrical bioimpedance as an aggravating factor of COVID-19- a study on body composition – 2023
    8. Measurement of visceral fat by abdominal bioelectrical impedance analysis is beneficial in medical checkup – PubMed – 2008
    9. Visceral and Subcutaneous Adipose Tissue Volumes Are Cross-Sectionally Related to Markers of Inflammation and Oxidative Stress – 2007
    10. Biomarkers of dysfunctional visceral fat – ScienceDirect
    11. The Triglyceride_High-Density Lipoprotein Cholesterol (TG_HDL-C) Ratio as a Risk Marker for Metabolic Syndrome and Cardiovascular Disease – 2023

Biomarkers – Adinopectin

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

 

Biomarkers – Homocysteine

      1. Homocysteine Test_ MedlinePlus Medical Test

 

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
    2. Lifestyle Factors and 5‐Year Abdominal Fat Accumulation in a Minority Cohort The IRAS Family – 2011
    3. Effects of diet macronutrient composition on body composition and fat distribution during weight maintenance and weight loss -2013
    4. Association of decrease in carbohydrate intake with reduction in abdominal fat during 3-month moderate low-carbohydrate diet among non-obese Japanese patients with type 2 diabetes – PubMed 2015
    5. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women – 2004
    6. A systematic review and meta-analysis of the effect of aerobic vs. resistance exercise training on visceral fat – PubMed – 2012
    7. The Effect of Exercise on Visceral Adipose Tissue in Overweight Adults- A Systematic Review and Meta-Analysis – 2013
    8. Inactivity, exercise, and visceral fat. STRRIDE – a randomized, controlled study of exercise intensity and amount – 2005

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. 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. 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
    5. The Preventive Mechanisms of Bioactive Food Compounds against Obesity-Induced Inflammation – 2023

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
  5. Reliability-of-bioimpedance-in-the-assessment-of-visceral- 2023
  6. A Simple Estimate of Visceral Fat Area by Multifrequency Bioimpedance Analysis Is Associated with Multiple Biomarkers of Inflammation and Cardiometabolic Disease_ A Pilot Study – 2023
  7. Visceral fat area measured by electrical bioimpedance as an aggravating factor of COVID-19- a study on body composition – 2023
  8. Measurement of visceral fat by abdominal bioelectrical impedance analysis is beneficial in medical checkup – PubMed – 2008

 

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)
  5. The Preventive Mechanisms of Bioactive Food Compounds against Obesity-Induced Inflammation – 2023

 

 

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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