weight lossWhat if there were a way to lose weight and boost metabolism in addition to dieting or exercise? Hundreds of diets and exercises routinely make guarantees about their programs results. “100% success in just 15 minutes a day!” boasts one ad. “10 ways to win at weight loss” boasts another. With such optimistic advertisements and “successful” weight loss programs it’s surprising anyone is overweight. You can fool all dieters some of the time, and some dieters  all of the time. But you can’t fool all dieters all of the time. Right?

My personal weight loss experience

I have personally had my share of dieting experiences. Some were temporarily positive. Many were not. I have experienced starting a diet, only to find myself eating that birthday cake at the office a week later and conceding this diet is officially over. I have also completed a goal for weight loss after dieting, only to see that weight loss erode over the next few months. In more than one instance, I even gained back more than I lost.  It seems my experience with dieting is not unique. Weight loss researchers from UCLA who conducted extensive reviews of prior weight loss studies concluded that with many diets you can initially lose 5% – 10% of your body weight, but the weight returns over time. Sustained weight loss is rare, according to the lead author. Over time, the majority of dieters regain all of the weight they lost, “plus more.”

Disrupting the same old dieting formula

What if there was a way to lose weight, boost metabolism and help sustain weight loss in the longer term? What if the reason most diet and weight loss programs fail is because they are missing a key ingredient–a simple ingredient? We all know that diet + exercise = losing weight.  But does it, really? If that were completely true maybe we wouldn’t be part of the most obese nation in the world. Diets might have success rates higher than 5%. Weight loss would be sustained. Isn’t it possible that something is missing from the equation?

Exercise & burning calories

energizer bunnyLets digress towards exercise for a second. There are different types of exercisers. There are those who “exercise” by walking on a treadmill at a leisurely pace at the gym. They burn calories. If they are lucky they burn off that pizza they ate for lunch yesterday. Then there are those who really exercise. Every step comes with power–power walking, power stepping, power cycling. There is sweat pouring off their body. They burn more calories in a single workout than those found in an entire pizza. Even when they speak, they do so with an amped up energy. Their bodies are intimidating. What is more intimidating about these people is their energy. That energy they exude is a key ingredient in the success of their exercise. It may be that same energy is also an essential ingredient to ensure that weight loss can be sustained. I know I have just added what seems like another layer of complexity to this weight loss puzzle. If we need energy to sustain weight loss, how can we get that energy? How could you take that person moseying along on the treadmill and give them a boost so that they are more like the Energizer Bunny?

The solution please

I know I have only offered up a lot of questions rather than any concrete solutions up until this point. Now I am going to provide a short but sweet solution. Sorry in advance if this is a let down, but I think the answer is simple. James Carville coined the phrase “its the economy, stupid,” around the time of the 1992 United States presidential election, explaining how focusing on the economy would be key to winning the race. Bill Clinton listened to the advice and won. The answer here also may be simple: it’s sleeping, yooouuuuuu. While diet and exercise might lead to short-term weight loss, I would propose the following modification to the common diet and exercise prescription: Diet + exercise + quality sleep = sustained weight loss.

obesityTwo roads intersect weight gain & sleep

The obesity epidemic in the United States during the last century coincides with another major epidemic, a lack of sleep. Sleep is neglected in our society. Nearly 33% American don’t get the minimum 7 hours of sleep that their body needs.1 They are sleep deprived. One cause is not sleeping enough hours. Another major cause of sleep deprivation is sleep apnea. Sleep apnea, fragments sleep. It reduces the amount of sleep a person gets. It also takes away from the quality of sleep they get when they are sleeping. Even if you sleep enough hours, if you have sleep apnea you will remain sleep deprived. That will result in lower energy. It will also get in the way of losing weight in some unexpectedly scientific ways. I think there is more than just a correlation between the problem of weight loss and the growing lack of sleep in our society over the last 100 years.

Not sleeping enough makes you hungry

Have you ever started a diet and noticed all of a sudden you are super hungry? Like, hungrier than you have ever been? That is your ghrelin factor kicking in. Ghrelin is the “hungry” enzyme. It is secreted by your stomach, when you lack food. It makes you feel hungry. If you have a lot of ghrelin, you will feel very hungry. This level of ghrelin may vary from person to person based on genetics or based on sleeping conditions. Studies have shown that people with sleep apnea or sleep deprivation have higher levels of ghrelin. With higher levels the ghrelin factor, they feel hungrier and less satisfied when they eat. The bodies of individuals with sleep apnea also appear to build resistance to a beneficial hunger enzyme called leptin. In contrast to ghrelin, leptin is a natural enzyme that suppresses appetite. This enzyme has been found to be lower in persons who are sleep deprived. Resistance to leptin has also been seen in individuals with sleep apnea, making them feel hungrier.

sleep-deprivationNot only do individuals feel hungrier when they lack sleep, it turns out they even buy more fattening food when they are sleep deprived. One study looking at the purchasing behavior of food by sleep deprived individuals found that the food they bought was higher in calories than food purchased by well rested people.

Sleep deprivation & sleep apnea slows you down

The relationship between sleep apnea or sleep deprivation and obesity is complex. Individuals who are overweight are more likely to have sleep apnea. What is less well known, but also true, is that individuals who are sleep deprived or have sleep apnea are more likely to gain weight. The symptoms of sleep apnea and sleep deprivation are similar. Symptoms include feeling sleepy and lacking energy during the daytime, making individuals more prone to gaining weight. Here’s why: Imagine yourself at the gym at two separate times. On one occasion you have had a full night’s rest. You feel rested and full of energy. You may even be like the high energy person I told  you about who is oozing out energy. Now think about another occasion. This time your sleep has been interrupted. Forced to work out after only 2 hours of sleep, you lack energy, are sleepy and struggle to stay awake. Here you probably will look more like the individual, mentioned above, who is pacing yourself at an overly comfortable pace on the treadmill. Which one of these individuals is going to burn more calories when they work out? That’s what happens with individuals that have sleep apnea or individuals who are sleep deprived. They are more sluggish during the daytime. They have less energy. When they work out they are also less energetic so they burn less calories. Research confirms this. Individuals who lack energy don’t burn as many calories. They are exercising less often, exercising less intensely. Though, the body of evidence supporting this is less substantive than the data regarding the increase in “hunger enzymes,” in theory it makes a whole lot of sense.

A healthier approach to weight loss

A healthier approach to weight loss, that is also more holistic starts with analyzing our sleep. Firstly, do you get enough sleep–7 to 9 hours of uninterrupted and refreshing sleep? If you are getting enough sleep, is it quality sleep? This is harder to answer. You might think you sleep well, but many people who feel that way actually have an underlying sleep disorder. Is it possible that you have sleep apnea? Ask yourself the following questions: Do I lack energy, snore, have other symptoms of sleep apnea? Am I sleepy during the daytime or overweight? Do I have high blood pressure or diabetes? If the answer to some of these questions is yes, maybe, or unsure, screening by a sleep medicine doctor might be a good idea.

Diet + exercise + quality sleep = healthy & long lasting weight loss.

If you sleep well, you will have more energy, feel less hungry and have more stamina at the gym. I am not advocating that this is a guaranteed solution to lose weight as many of the weight loss programs out there do. I am suggesting that it is a common sense way to approach weight loss. It includes something very important, but unappreciated in our society–sleep. Improving sleep by itself might contribute to weight loss without any dieting or exercise. The better solution though, to living a healthier, more fulfilling life and sustaining weight loss is to combine this essential component into any weight loss program. The next time you are thinking about dieting or exercising, also think about sleep. It could mean having more energy, being less hungry, burning more calories and achieving sustainable weight loss.

Notes:

1. Seven hours is the minimum amount of sleep most adults need. 7.5 hours is an average. 7-9 hours is the normal range of sleep.

Michael Morgenstern, MD
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Michael Morgenstern, MD

About the author: Dr. Michael Morgenstern is double board certified in Neurology and Sleep Medicine and the founder of the American Sleep Apnea Society. He is the Director of the Morgenstern Medical in Lake Success, NY, where he treats patients with sleep disorders and other neurological conditions.
Michael Morgenstern, MD
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References:

http://escholarship.org/uc/item/2811g3r3#page-1

http://newsroom.ucla.edu/releases/Dieting-Does-Not-Work-UCLA-Researchers-7832

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1991337/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC535701/

http://onlinelibrary.wiley.com/doi/10.1002/oby.20579/full

http://www.nature.com/ijo/journal/v29/n10/full/0803015a.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC535701/

https://www.researchgate.net/profile/Karine_Spiegel/publication/24429270_Effects_of_poor_and_short_sleep_on_glucose_metabolism_and_obesity_risk/links/00463528dcf42a28d4000000.pdf

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