First, solve the hunger.

Stepping Stones

Stepping Stones (Photo credit: Rich Jacques)

Satiety-Focused Weight Health

A walk through …

This is not specific advice to be used without consultation with your personal doctor. This is presented for the purposes of discussion.

This is “the middle part”, which belongs within a larger context of each person’s unique health and medical situation, their resources and circumstances, and their goals, preferences and values.

For example, if you have any problems involving foods, such as digestive issues, gallbladder problems, food allergies, celiac disease, etc., these must be taken into consideration. Be aware that sometimes these only become newly apparent when eating patterns change. If you have, or suspect you may have, an eating disorder or food addiction, please seek personal knowledgable professional care.

The short version -

It’s all about:

  • finding what things may be pushing up your appetite
  • finding what things you can do to get the most satiety (fullness, sense of satisfaction of appetite) from the food you eat
  • during this learning time, understanding that eating to appetite (without over-eating) and having regular meals is fundamental to the process.

First, solve the hunger. Then, consider the weight goals.

For many people, it would go something like this:

  1. Be hopeful – the landscape of weight care has changed dramatically and will change more. Further, substantial health gains often do not require substantial weight loss. “Food peace” is a worthwhile goal in itself.
  2. Help, support and de-burden  – Help from your doctor plays a vital role before and during. Support from people who have made the same changes can make all the difference. Realize that change is work. Find ways to lessen other demands and burdens. Get help with understanding your physical and emotional responses.
  3. Cultivate satiety – the core strategy is to evaluate every aspect of your lifestyle, your health, and your circumstances for all means available to favor satiety and to lessen the things that promote a higher hunger drive. Keep looking, adjusting and learning over time. Nothing replaces this. There are countless factors that affect your appetite/satiety balance. Some are easier to do something about than others.
  4. The three critical “leverage points” that are most useful for most people are – stopping trying to go hungry as a means to weight control, avoiding high insulin levels and blood sugar swings by adjusting your intake of carbohydrates, and learning to recognise and avoid trigger foods. These can be make-or-break keys.
  5. Stop disrupting your appetite/satiety control system. Treating it as a war is not productive. It is now clearly established that using willpower to override the signals from this complex system (going hungry on calorie restricted diets) is not of substantial lasting benefit to most people. This leaves us with the only other option – finding ways to influence and work with the appetite/satiety control system.
  6. Consider the roles of sugar/carbohydrate craving, swings in blood sugar and high insulin levels - From the start, find out whether you are among the approximately two-thirds of the population who have a tendency towards metabolic syndrome – which is expressed as some degree of limitation in how much carbohydrates their body can handle without harm or metabolic strain. Planning your eating style starts with considering your metabolic responses.
  7. Notice the things that interfere with implementing your plans – such as time stress, emotional responses, lack of support, depression, fatigue, pain, insomnia, and many other possible extra burdens or interfering factors. As much as you can, address these. You may need help (e.g. doctor, counsellor, support group). Sometimes a change brings out symptoms of some other health problem.
  8. You may need an extra intervention. Recognize that not everybody can get to the point where their appetite/satiety control system is working in a way that allows them to reach their weight control targets  After implementing satiety-friendly strategies as much as possible, you may need to consider a “second level” intervention. Nutritional ketosis is under-recognized as a useful option to lessen hunger during weight loss. Some people benefit from making use of a soft calorie target. Although not of net benefit for most overweight people, some people prefer a calorie-restricted diet or a meal-replacement medical program and do well with it long term. A “third level” of possible interventions would be obesity management medications and obesity management surgery.
  9. Every one is different. Theories and research will only take you so far – trial and error plays an essential role. Remember that some aspects of how you respond to any given change/intervention will not be obvious. Work with your doctor. Do follow-up lab tests when indicated. Don’t take your response for granted – test, don’t guess, how your blood sugar and lipids (cholesterol and triglycerides) are doing. Once you have as much information as possible, only you can decide what you find worthwhile.

Expanding on this …

1/9  Be hopeful – Using today’s insights, you may have a much easier time with weight loss and weight control than you imagine. Still, we don’t have as many insights and tools as we need, so some people still find it difficult to lose much weight. Even without substantial weight loss, you still likely can greatly improve your sense of well-being, your enjoyment of your life and your health. By maintaining your health (including not sacrificing your health or your enjoyment of life for your weight goal) as much as possible, you will be in a better position to benefit from new developments as they come along. By exploring ways to lessen appetite drive and promote satiety, you may find relief from cravings, struggles with hunger and battles with weight control – this can be very worthwhile even without a return to target weight.

2/9  Help, support and de-burden - See your doctor to gain more insight into your health situation and to consider different options from the viewpoint of your unique situation. Some changes you might want to make may bring up the need for various lab tests before or during the initial stages. You may need review of any medications. You may need to make plans for close follow-up and rapid adjustment of medications if you are undertaking substantial changes to your food intake – especially if you plan to reduce your intake of carbohydrate foods (sugars and starches).

If you make major changes to your eating pattern, you will need some input from your doctor to help you fully assess how that has worked out for you. Some people have unusual and unexpected responses to health choices that may be wonderful choices for many other people. Don’t take your own unique response for granted – be sure to get follow-up evaluations or lab testing done as needed.

3/9  Cultivate satiety - Evaluate every aspect of your health, lifestyle and circumstances for all means available to favour improved functioning of your appetite/satiety control system. It is a big mistake to focus only on diet and activity. For example, one of the biggest barriers is that most people are far more willing to make changes to their food choices than they are to face their need for sleep. You may need to work closely with your doctor to find your way, as pain, insomnia, depression, fatigue, certain medications and many other medical factors may influence your appetite balance.

As you make changes to address the above goals as much as possible, monitor your response by paying attention to how much you feel a need to eat and how your body composition is responding. If you find over time that the amount of food you need to eat to avoid being hungry is not allowing you to reach your weight health goals, re-evaluate whether you are doing all that you reasonably can to support the function of your appetite/satiety control system. Remember to think about sleep, stress and whether your eating and sleeping patterns are consistent day by day – your body functions best on a regular circadian rhythm.

There are countless things that can affect appetite balance and you can expect more research findings to come. Of the things you identify that are, or may be, disrupting your appetite balance, some may be difficult to change and some may be things you can’t change at all. That places more importance on the things that you are able to change.

4/9  There are three critical “leverage points” that can have a make-it-or-break-it impact:

  1. calorie restrictive dieting and all related behaviours
  2. your metabolic response to sugar and starch intake
  3. food cravings and food addiction

5/9  Stop disrupting – Stop messing with your body’s weight control system – stop restricting calories, skipping or delaying meals, going hungry, dis-ordered eating and using stimulants such as stress and caffeine to delay meals. If any of these strategies were useful, we would not be in the situation we are now. As a general strategy, losing weight by going hungry has failed miserably and has probably caused a lot of harm along the way. Stop being at war with your appetite system and learn to work with it.

Learn to honestly recognize restrict/rebound eating patterns as the dead-ends that they are. The most common restrict/rebound eating pattern is skipping or restricting food intake in the early day, followed by over-compensation in the later day. The same pattern may be played out as restriction on week-days followed by overcompensation (rebound of appetite drive) on week-ends.  It also show up as weeks/months of strict calorie restriction followed by over-compensation due to an appetite on over-drive. I think that this restrict/rebound pattern is a major contributor to the current obesity epidemic. The things that indicate when a pattern like this is dysfunctional include – cravings and unwanted over focus on food, intake of food in types and amounts that are unintended and regretted, and over-compensation in the calories consumed in the appetite rebound phase.

Many people find that cravings and later-day over-eating fade away when they learn to eat in ways that promote stable blood sugar, avoid high insulin levels and avoid triggering stress hormones. Of course, eating disorders and addictions are complex disorders that require much more than a simplistic approach. If you have active addictions and eating disorders, your appetite/satiety control system will not have a chance to work properly. If you find that you are having great difficulty controlling your intake of sweets or starchy foods, it is important to know that full abstinence from these is a strategy that many people have chosen. Such an eating pattern can be healthy, enjoyable and very effective for relief from cravings and disruptive eating. An eating plan can be high or low volume according to need.

You can’t learn how to work on friendly terms with your body weight control system while at the same time poking it with a stick. Many people who have had long term struggles with their weight have not gone a day in decades without an appetite/satiety system that is chronically disrupted due to chronic or cyclic calorie restriction or meal skipping/skimping.

6/9  Consider the roles of sugar/carbohydrate craving, swings in blood sugar and high insulin levels - From the start, find out whether your metabolism is able to handle high carbohydrate meals without straining to cope. That is, whether the amount and/or rate of glucose coming into you body after eating a high carbohydrate meal is handled well by your body in your current state of health. Is your appetite being driven by swings in blood sugar?  This often shows as hunger a few hours after having a meal that would have seemed substantial enough to last until the next meal time.

Are you showing signs of metabolic syndrome and insulin resistance? Is your fasting blood glucose above normal?  Does your blood glucose go up above normal after meals? Do you have type 2 diabetes or pre-diabetes?  High insulin levels that occur from insulin resistance promote fat storage.  A tendency to gain weight around the middle is one of the hallmarks of metabolic syndrome.

All of these things affect the appetite/satiety control system.  Any of these effects can be so strong that weight control can, in some people, be very difficult without addressing them. If any of these conditions apply to you, you will likely find it much easier to improve your well-being and your health by adjusting your carbohydrate intake to within the amount that your metabolism can effectively handle. Carbohydrate load is more than just the total amount of carbohydrate in a meal or day. Carbohydrates that are quickly absorbed cause more strain on your metabolism and more tendency for ups and downs in blood sugar that the types of carbohydrate foods that are very slowly digested. Some people may find excellent improvement in their health from changing the types of carbohydrate foods they eat, without cutting down on the actual amount of carbs they are eating.  Some people can take steps to improve their insulin resistance and thus, if they are still making insulin, improve their ability to handle carbohydrates.

If you are not showing signs of difficulty handling high carb meals, you may do well on a lower fat, higher carbohydrate eating plan, provided that this focuses on low glycemic index foods (for example, with most carbs coming from foods with a glycemic index of 50 or lower). Some people do best focusing on a high volume of low-calorie-density foods.

7/9  Notice the things that interfere – In addition to the comments above, keep in mind that initiating changes in your life can bring out emotional reactions, sometimes in very unexpected ways. It can also bring out emotional responses in those around you. We all have blind spots when it comes to understanding ourselves. Friends, family and support groups can be invaluable. Sometimes getting professional help is needed.

8/9  You may need an extra intervention – Recognize that not everybody can get to the point where their appetite/satiety control system is working well enough that they can achieve reasonable weight control goals without sustained hunger or cravings. If it seems that you really are doing what you can and you feel you need some additional strategy, it is time to consider adding a “second level” intervention.

Nutritional ketosis is under-recognized as a useful option to lessen hunger during weight loss. Being in nutritional ketosis helps most people (not all) with appetite control.  This does not depend on whether or not you have any difficulties with handling carbohydrates or whether you would otherwise would be considering a low carb lifestyle. This is also called being on a “ketogenic diet”. Ketogenic diets are receiving quite a bit of research attention now as they can be remarkably effective for epilepsy and it may turn out that they are useful for a variety of medical conditions. Some people report that their energy and sense of well-being is improved when they maintain themselves in a state of nutritional ketosis (which is very different from ketoacidosis!).

Some people benefit from making use of a soft calorie target – for example, as a means to explore “habit eating” versus hunger, as a means to find what eating pattern gives them the most satiety, as a reminder to eat no more than they need, as an indication of how much to eat before stopping to see if a sense of satiety develops while waiting 20 minutes, or as a way to notice when inadequate sleep, stress, meal pattern disruption, etc. have acted to increase their appetite. (“soft” – that is, used for information feed-back, not rigidly enforced)

Although not of lasting benefit for most overweight people, there are some people who prefer a calorie-restricted diet and do well with it long term. If calories are not restricted much below need, a calorie-capped meal plan may serve as a quick way to break away from old habits, break restrict/rebound patterns of eating, end blood sugar swings, provide a focal point for lifestyle changes, and so on. This is listed under “second level” approaches because attempting to impose calorie restriction can completely block the process of finding benefit from a satiety-focused approach, and can cause more harm than good.  Still, some people find that, despite using all the strategies they can to promote satiety and avoid stimulation of excess appetite, they are not able to achieve their weight management goals without paying attention to calories. In this situation, it is vital to keep a very close eye out for any signs of the development of restrict/rebound eating patterns – such as cravings and episodes of excess eating.

There seems to be a role for medical programs that involve meal replacements. For some people, this might meet their needs in a particular way.

Some people find that a high exercise or activity output can play a central role for them in weight loss. The main role of exercise is for physical and emotional health. Research has shown that, for most people, a regular exercise program does not contribute substantially to weight loss. On the other hand, regular exercise does seem to be a tool to help prevent weight gain or regain. Still, some people are able to use a particularly high amount of exercise/activity as a major tool in their weight loss process.

A “third level” of possible interventions would be obesity management medications and obesity management surgery.

9/9  Every one is different – What will be best for you cannot be predicted solely by considering theories and looking at the research. Trial and error plays an essential role.  Recognize that each and every health intervention with each and every person is always a “trial of therapy”.  The outcome is never certain and must be evaluated, not taken for granted. With as much information as possible, evaluate your health responses over time. Keep adjusting your health practices and medical care according to your individual responses and needs, in context with your personal values and choices. Only you can decide what health habits and interventions you find to be worthwhile – that is, that give you enough benefit, balanced against “cost” and risk.

Related article, added Nov 22/12:

hunger” on www.hopefulandfree.wordpress.com  LINK

10 thoughts on “First, solve the hunger.

  1. I am so thankful for your good work. I am a part of the “needed extra intervention.” I had this in the form of a partial gastrectomy (a sleeve). Now, to maintain the loss – amusingly – I use all of the other tools in the toolbox you mention!

    I, quite honestly, have been hungry since puberty, and stopped eating because it was polite, or food was gone. It seemed there was no end to my capacity. Now I have what I could consider typical hunger and its satisfied with a typical portion of *nutrient dense* food. Fats, protein, and produce (low starch/sugar) are my mainstays and within this framework my hunger and satiety cues are what I would consider typical. The more processed a food, the more unneccesary ingredients, the less satiety I have, the sooner and more often I get hungry, and that “roaming lion” feeling comes back. Its not worth the price of admission, anymore, now that I see it for what it is.

    I applaud you. I am so thankful for folks like you who care for folks by offering what you have worked hard on so freely.

    You are appreciated.

    • Hi Brandi Lynn, Thanks for your story. It’s so important to understand that, just like any system of the body, for some people the body weight control system just is not functioning as it should and no amount of personal effeort will result in weight control without a pernicious chronic hunger that would be considered “cruel and unusual punishment” if it was visited on a criminal. I’m so glad that you persisted and put together a personal program that is workable for you. And thanks for the kind words. Dr. Dea

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