Obesity has reached epidemic proportions. Over 30 percent of Americans are obese, and around 300,000 die each year from obesity-related disease. Though a significant medical condition itself, obesity also increases the risk of other conditions, such as heart disease, diabetes, cancer, and neurodegenerative disease. As a result, obesity is a significant risk factor on a patient’s chart.
Weight loss is the obvious remedy for obesity. Even a 5 percent bodyweight reduction can significantly improve the prognosis of an obese person. However, finding sustainable weight loss regimens remains a challenge.
One promising avenue is the high-fat ketogenic diet, which promotes weight loss through a variety of mechanisms and can consequently reverse type 2 diabetes, a metabolic disorder often intertwined with obesity.
This article explores the problem of obesity, its link to diabetes, and how the ketogenic diet can help.
Obesity Defined
A person is considered obese when his or her Body Mass Index (BMI) exceeds 30.
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- Underweight: less than 18.5
- Normal weight: 18.5 to 24.9
- Overweight: 25 to 29.9
- Obese: Over 30
- Morbidly obese: Over 40
To calculate your BMI, follow the calculations below:
Imperial: [weight (lb) / height (in) / height (in)] x 703
Metric: [weight (kg) / height (cm) / height (cm)] x 10,000
The primary feature of obesity is excess fat accumulation. This stored fat, called adipose tissue, is how humans store long-term energy—and it’s not necessarily pathological. But in obesity, too much energy is stored, and body fat accumulates to dangerous levels.
Still, obesity doesn’t have just one cause. It’s a multifactorial condition in which dietary choices, exercise, stress, sleep, socioeconomic class, and genetics can each play a role. Certain variants on a gene called the FTO gene, for instance, appear to be linked to excess weight gain.
Obesity itself isn’t fatal, but it does predispose a person to other dangerous conditions. An obese person is at higher risk for heart disease, high blood pressure, Alzheimer’s, cancer, sleep apnea, type 2 diabetes, and other undesirable conditions and side effects.
Diabesity: The Obesity Diabetes Link
More than one-third of the American population is obese. Many are either diabetic or prediabetic. This trend is so pronounced that researchers have coined the term “diabesity” to describe it.
The diabesity epidemic is largely a product of the Standard American Diet (SAD). The SAD is notoriously high in sugar, and high sugar intakes have been shown to drive obesity, insulin resistance, and diabetes.
The progression from sugar to diabesity is logical. A high-sugar diet increases blood sugar levels, which in turn increases insulin levels. This blood sugar and insulin dysregulation eventually lead to a state called insulin resistance, or the inability of muscle and liver cells to effectively store blood sugar, even when insulin is present. As a result, blood sugar stays high, the pancreas releases more insulin, insulin resistance worsens, and diabesity progresses. High insulin levels also promote excess fat storage, leading to obesity.
To reverse this progression, it’s crucial to control blood sugar and insulin levels. That’s where the ketogenic diet comes in.
How the Ketogenic Diet Helps with Obesity
The ketogenic diet is a low-carbohydrate high-fat diet designed to induce a fat-burning metabolic state called ketosis. In ketosis, the body stops turning to sugar/glucose for energy and instead relies primarily on fatty acids and ketones/ketone bodies for energy. (This is achieved by severely limiting carb intake so the body instead has to burn fat and covert it to ketone to use for energy.)
As a result of switching energy gears, so to speak, less glucose is required to fulfill normal functions. The only way to get into and stay in ketosis (and to achieve keto weight loss) is to maintain reasonably high ketone levels by eating a diet rich in healthy fats, moderate in protein intake, and very little in the way of carbohydrates.
Contrary to popular belief, maintaining the above mentioned keto meal plan is not just about cheeseburgers and Bulletproof Coffee. It includes meat, fish, chicken, veggies, and healthy oils, such as coconut oil, olive oil, and MCT oil, and of course avoiding all high-carb foods, including sweeteners and processed and whole grains. But the most important element is that your daily net carbs intake remains under 20 grams.
The ketogenic diet affects metabolism differently than the Standard American Diet. By restricting carbs, the ketogenic diet keeps blood sugar and insulin levels low. Instead of encouraging fat storage like the SAD, the ketogenic diet encourages the body to use fat stored within the body as well as fat from daily food intake.
Because of this, low-carb diets have proven effective for weight loss, especially in obese and diabetic populations. There is a growing amount of evidence pointing to this fact. Consider these:
- Just 24 weeks of keto dieting improved blood lipids and stimulated weight loss in obese people.
- Overweight adolescents lost more weight on a low-carb diet than on a low-fat diet.
- In those maintaining weight-loss goals, a ketogenic diet increased energy expenditure and decreased hunger hormones compared to a high-carb diet.
Let’s review why, exactly, the ketogenic diet helps obese people lose weight:
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Insulin function
Of all the macronutrients, carbohydrate raises blood sugar and insulin levels the most. It follows that restricting carbohydrate consumption on a ketogenic weight-loss diet (eating keto-friendly foods and fewer calories than needed for homeostasis) and improves these markers in obese, diabetic populations. And it does. Blood sugar falls, insulin falls, and insulin function stabilizes. This is why the ketogenic diet is such a powerful treatment for type 2 diabetes. In a one-year controlled study run by Virta Health, 60 percent of patients on a supervised ketogenic diet reversed their diabetes. The average weight loss was 30.4 pounds.
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Appetite management
A higher fat, ketogenic diet may prevent overeating (and subsequent weight gain) by several mechanisms, including:
– Decreased ghrelin, the primary hunger hormone
– Decreased neuropeptideY,an appetite stimulating brain factor
– Increased synthesis of the hormone cholecystokinin(CCK), which promotes a feeling of fullness by binding to the hypothalamus
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Leptin function
The hormone leptin regulates appetite and body weight by binding to receptors in the brain. Simply put, leptin is a satiety hormone. High levels of leptin, like high levels of insulin, are linked to obesity. Specifically, high leptin causes leptin resistance. When someone is leptin resistant, they have difficulty regulating food intake. High-carb intakes increase circulating leptin and exacerbate leptin resistance. The ketogenic diet, on the other hand, appears to improve leptin sensitivity.
The Final Word
It’s no coincidence that rates of obesity and type 2 diabetes are rising in lockstep. The two conditions are driven by similar metabolic disorders—high blood sugar, high insulin, and insulin resistance.
Research shows that the keto diet plan can help. The strict carb restriction of the ketogenic diet has myriad health benefits, and can restore insulin sensitivity, improve leptin function, reduce hunger hormones, promote weight loss (water weight in the short term/first week and the fat loss over time), and even reverse type 2 diabetes.
Can the obesity epidemic be halted? If the medical community, dietitians, and dieters embraces the ketogenic diet, perhaps it can.
