The weight loss world has been buzzing about (and because of) the game-changing STEP trials and these newer medications like semaglutide and tirzepatide. These studies have really shifted how we think about obesity - it's not just about willpower or choosing the right diet anymore. We're finally understanding that obesity is a complex biological condition that needs a personalized approach. As a medical community, the informed practitioners are moving past the old 'eat less, move more' mantra and diving into what really works for each individual. This exciting shift in our understanding brings up some key questions that my patients ask me all the time:

‍

"Many patients struggle with genetic predisposition to obesity. How can healthcare providers help patients develop self-compassion while pursuing weight management goals?"

Self love begins with forgiving ourselves for what we cannot control, and when it comes to weight struggles this starts by recognizing that obesity is irrefutably a disease. Estimates on the genetic contribution to weight vary, but most suggest it is somewhere around 50%. For example:

Using rough estimates from twin and family studies about weight, we can illustrate the relative challenges of reaching a goal of maintaining a BMI of 25 or less throughout adulthood:

-Someone with two lean parents (BMI <25) has roughly a 90% chance of maintaining this with standard healthy habits
-Someone with one parent with obesity typically has around a 65-70% chance with those same habits
-Someone with two parents with obesity has about a 30-40% chance with standard habits

Again, while these numbers are likely not perfect, they help illustrate the relative impact of genetics and why rates of obesity continue to rise. Environmental factors like poor food access 'protected' those with obesity-prone genes in the early 1900s. Cheap, calorically dense food is now available nearly effortlessly. Someone reaching mid-life has the financial means of further increasing accessibility to food as well as hormonal changes that can accelerate weight gain and impact where extra weight accumulates- now disproportionately more around the midsection more than the hips.

We build self love the same way we achieve fitness and weight loss goals. The latter requires consistency to effectively reprogram the body to accept the new equilibrium. This is how even with an unlucky set of genes, anyone can ultimately achieve a healthy weight. Self love takes the same repetition to shed perceptions of what a body "should" be. Both often involve "hard work" that eases into "work" and then eventually evolves into a seemingly effortless maintenance phase.

"What are the physiological benefits of structuring a diet around consuming a variety of colorful fruits and vegetables?"

Following a rainbow diet means choosing foods to deliberately complement each other based on color. The vitamins, minerals, and other micronutrients in foods — mostly fruits and vegetables — determine the colors, because these nutrients reflect and absorb light differently. Choosing foods with different colors means both obtaining a variety of important vitamins, antioxidants, and other health-promoting compounds as well as having a diet generally rich in vegetables and fruits and the fiber that goes with them. This fiber promotes satiation (fullness at the end of a meal) and satiety (fullness between meals), leaving less appetite for high caloric foods. Increased fiber also reduces calories absorbed from other foods during meals, instead allowing them to pass through as waste later.

This strategy can be highly effective for controlling appetite and promoting weight loss. If one combines the diet with adequate protein, roughly 100 grams per day for women, it can help maximize fat loss and minimize muscle mass loss. The most weight promoting meals have a mix of high carbs and high fat; rainbow diets are so high in fiber and carbs that there is little appetite left for substantial calories from fat.

"What role does exercise variety play in long-term weight management, particularly regarding metabolic adaptation and bone health?"

Incorporating adequate physical activity is critical for weight maintenance; initial weight loss is mostly driven by being in a caloric deficit over a given period of time. Intense exercise can increase the calories one can consume and still lose weight, initially. The body is frustratingly efficient at adapting to exercise, and this is especially true for steady-state aerobic exercise like jogging. Eventually, our bodies trick us into moving around less throughout the day to conserve calories, and after losing muscle mass, we require fewer calories for basic activities.

This is where exercise has its time to shine. Resistance training is our tool in fighting some of that throttling down of metabolism, because if you are getting stronger, you're burning more calories. That's just physics. Combination strength and aerobic training also stimulate the birth of new mitochondria in our cells to burn fat as fuel while also directly and indirectly supporting healthy thyroid hormone functions. Variety of exercise also prevents boredom and may reduce injury risks, allowing for the consistency that is key to seeing and maintaining results.

In the case of healthy aging, resistance training is the only way we are able to actually increase bone density after our 30s. Recent studies disproved the old paradigm of "whatever you've got is what you've got" when it comes to bone density. Weight loss without strength training increases risk of bone density loss and fractures, particularly due to the loss of muscle mass. Adding resistance training ensures there is no tradeoff to that weight loss in the long run and instead enhances the vitality weight loss promotes.

‍

‍