The relationship between obesity and our hormones

Obesity is a chronic metabolic disease where there is too much excess fat in the body. In this article, a consultant endocrinologist, Professor Carlos Rivas Echeverría, explains the role hormones play in the development and perpetuation of obesity.

What causes obesity?

The biggest misconception is that overeating is what causes obesity, but there are other intertwined factors that lead to the development and retention of obesity. Hormonal imbalances play a significant role in the development of obesity, and they can be caused by a variety of factors, such as stress, environmental conditions, genetics, childhood experiences, medications, and a poor quality of sleep.

How do hormonal levels contribute to obesity?

Hormones in the body play a vital role in maintaining balance and functionality of the organs and bodily systems. They can trigger feelings of hunger and fullness, allocate calories, and regulate fat storage. When the hormones become dysregulated, this can lead to weight that is easy to gain and difficult to lose, which can compound into more complex health conditions like diabetes and cardiovascular disease.

Of the many hormones present in the body, some of the main hormones that regulate body weight, caloric processing, and fat distribution include:

Insulin, which is produced in the pancreas, manages the levels of sugar in the blood and fat storage. In obesity, patients may develop a resistance to the effects of their regular insulin, which leads to higher levels of insulin in the blood and fat accumulation.
Leptin, which is produced by fat cells, signals when we are no longer hungry (satiety). In obesity, patients may also develop a resistance to leptin, leading to an increased feeling of hunger
Ghrelin, which is produced in the stomach, is also known as the ‘hunger hormone’ and stimulates appetite. Patients with obesity tend to have elevated levels of ghrelin, which often leads to overeating
Cortisol, which is produced by the adrenal glands at the top of each kidney, is known as the ‘stress hormone. When in high levels, cortisol facilitates fat retention.
Thyroid hormones (thyroxine and triiodothyronine), produced in the thyroid glands of the throat, serve to regulate metabolism, energy expenditure, and weight. When in low levels (hypothyroidism), calorie expenditure is impaired and weight is more easily gained.

How is obesity treated?

To prevent the development of obesity, there are many approaches with proven benefits, ranging from personal adjustments, to medications and therapies, to surgical procedures.

Diet and lifestyle

While obesity is not necessarily simply caused by overeating, diet still plays a significant role. Diets that have moderate levels of glucose prevent blood sugar spikes, which in term keep insulin levels stabilised. Patients, as always, are encouraged to avoid foods that are high in saturated fats, such as fatty cuts of meat and deep-fried and processed foods.
Managing stress levels by partaking in hobbies and leisurely activities, and practicing mindfulness with yoga and meditation can keep cortisol levels balanced.
It is recommended to get at least eight hours of uninterrupted, quality sleep nightly.
Consistent and regular exercise and physical activity to burn calories, improve insulin sensitivity, and boost the metabolism. At least 150 minutes of aerobic exercise is recommended weekly.

Medications

Injectables like semaglutide and liraglutide are part of a category of appetite suppression drugs called GLP-1 receptor agonists. They have been proven to improve blood sugar control, reduce appetite and amplify feelings of fullness, making them ideal for metabolic diseases.
Thyroid hormonal replacements to supplement the lack of thyroxine and triiodothyronine, and counteract the effect of their absence.
Metformin is a sort of medication formulated for type 2 diabetes treatment, but can also be used for treating obesity. It controls the blood sugar levels and heightens insulin sensitivity.

Surgery

Surgery tends to be the final option that doctors will explore when other treatments have been unsuccessful. Procedures within the category of bariatric surgeries, such as gastric bypass and sleeve gastrectomy, are designed to facilitate weight loss, prevent future overeating, and improve hormonal profiles.