With the holidays well behind us now, many of our patients are coming in trying to make good on New Year’s resolutions. At the top of the resolution list is weight loss; an important goal to work towards not just because of the health risks associated with excess weight, but also the more obvious feelings of frustration, low self-esteem and lack of self-worth. Our aim is to provide patients with effective tools to help aid successful weight loss so patients are both physically and mentally fit in 2017.
Many patients are told that if the amount of calories consumed is less than the calories expended, weight loss will occur. However, this equation leaves out the complex interplay between hormones and the metabolic process and how estrogen influences metabolism in both men and women. Males tend to accumulate more visceral fat (abdominal fat), leading to the classic android or “apple” body shape. Visceral fat has been correlated to increased cardiovascular risk, abnormality of fatty acid metabolism, increased oxidative stress, endothelial dysfunction, liver insulin resistance and inflammation, increased VLDL and small dense LDL particles, and reduced HDL cholesterol levels.
In contrast, females tend to accrue more subcutaneous fat (fat right under the skin) in pre-menopausal years, which appears to protect against the negative health consequences associated with obesity and metabolic syndrome. Estrogens and their receptors influence adipocyte cells’ ability to expand, increasing the subcutaneous depot and inhibiting the visceral depot. After menopause, women start to see a more visceral pattern. This shift is accompanied by an increase in metabolic risk eerily reminiscent to that seen in men. A 2013 study found estrogen in women protects against adiposity, insulin resistance, type II diabetes, and also regulates energy intake and expenditure.
Estrogen imbalance is not the only culprit to hormonally linked weight gain. Testosterone is also a key hormone in metabolic diseases such as obesity. Low testosterone levels are associated with increased fat mass (particularly visceral adiposity) and reduced lean mass in males. The Journal of Diabetes Complications reports a study suggesting that low testosterone and elevated estradiol may be associated with greater risks of insulin resistance and type II diabetes by interacting with obesity in men.
Notably, estrogen replacement in deficient postmenopausal women, and testosterone replacement in androgen-deficient men have been shown to favorably modulate body fat distribution and cardiometabolic risk to various degrees.
Just as this hormonal imbalance pattern seems clear, it is important to also note that while estrogen deficiency is correlated to visceral adiposity, excess estrogen is also problematic. Inappropriate estrogen function can actually provoke insulin resistance by exhausting beta-cells through insulin overstimulation. Insulin resistance and elevated blood sugar levels are linked to excess visceral adiposity. As with so many medical pathologies, it is the overall balance of hormones, neither excess nor deficiency, that is necessary for stable metabolic processes.
Weight loss can be one of the most elusive aspects to manage in your life. While research overwhelmingly agrees that excess weight has detrimental effects on health, effective weight loss tools are often underutilized. Understanding the role of sex hormones in metabolism can help to remove much of the self-blame that so often accompanies excess weight, and lead you towards participatory and proactive treatments.
Behind the healthy, vital patient is a positive outlook on life and a loving relationship to the physical body. With education, our patients often feel empowered and more energetic as self-confidence and self-esteem improve. If you are frustrated by your inability to lose weight, even after improvements in diet and exercise have been implemented, you should consider hormone testing to look for potential hormone imbalances. Knowing the full picture might be your key to losing weight and keeping it off.