A Functional Medicine and Nutrition Approach to Obesity and Weight Management

Updated On January 30, 2025

In the USA, 41.9% of adults and 17% of children and adolescents are obese. Obesity is a chronic condition influenced by genetic, environmental, socioeconomic, psychological factors, and lifestyle choices, and is associated with many other health concerns.

Most notable is the relationship between obesity and food insecurity (typically seen in those experiencing poverty), which is a situation of being unable to get enough food due to insufficient resources or money. Many communities in the USA experience a "food desert" where no full-service supermarkets are readily available, making fast food and processed food the only affordable food options.

If obesity and weight management are something that you are struggling with, just know that there are many more risk factors at hand, other than diet and exercise, and many of which you can adjust when you have all of the integrative tools. Even a modest weight loss of 5-10% of your body weight may help reduce the risk factors of many other health concerns.

What is Obesity?

Obesity is a common condition measured by excess body fat and weight. It is a significant factor for many other health conditions, such as cardiovascular concerns, diabetes/metabolic issues, high blood pressure, and even certain cancers.

The major issue with BMI is that it does not differentiate between lean body mass (i.e., muscle mass) and body fat mass. So, it is possible to have a high BMI yet a low body fat mass and vice versa.

One way to address this issue is by measuring a person's waist circumference. Men with a waist circumference over 40 inches (102 centimeters) and women with a waist circumference over 35 inches (89 centimeters) may have a higher risk of weight-related health concerns, which is why health practitioners typically measure both BMI and waist circumference.

What Causes Obesity & Weight Gain?

In general, obesity and weight gain are influenced by a combination of overeating and under-exercising. The energy that food gives us is measured in "calories." So, when too many calories are eaten and not enough calories are burned off, the resulting energy is stored as fat.

Another implication of poor dietary choices is that many sugary or processed foods can spike blood sugar, which over time may contribute to insulin resistance, another factor in weight gain and eventually obesity. Specific foods like processed foods and soda may impact these regulatory pathways leading to weight gain in the long term. However, foods like cheese or milk act neutrally on these regulatory pathways. Foods like vegetables, fruits, nuts, whole grains, and yogurt may positively affect these regulatory pathways, supporting weight management in the long term.

Lack of exercise or daily movement is also a leading factor in obesity. The CDC recommends 150 minutes of moderate-intensity aerobic exercise per week to maintain current weight. But, with 25% of adults in the USA physically inactive, 150 minutes or more per week may seem like a challenging goal for many.

Other Factors for Obesity and Weight Gain Include:

Poor sleep, referring to either an insufficient amount of sleep or lacking quality of sleep. This is associated with difficulty in controlling appetite, which may contribute to obesity.
Research on depression shows that it is predictive of developing obesity, and obesity also increases the risk of depression.
Certain medical conditions may contribute to weight gain and obesity. Two examples are hypothyroidism (underactive thyroid gland) and Cushing's syndrome (a rare condition where there is an over-production of steroid hormones).
Some medications, such as corticosteroids, diabetes medications, epilepsy medications, antidepressants, and medications for schizophrenia, can all contribute to weight gain and obesity.
Genetics plays a crucial role in predisposing individuals to obesity. It may contribute to up to 70% risk for the condition.
Chemical toxins may also play a role in the obesity epidemic since there is evidence that low concentrations of some chemicals have powerful weight-promoting actions.

Functional Medicine Labs to Explore Factors of Obesity and Weight Gain

Since there are many potential factors of obesity, there are, luckily, several helpful functional medicine labs to help take a closer look at the potential contributors.

The DNA Diet test by dnalife is a genetic test that can help individualize diet and lifestyle suggestions for weight management by assessing specific weight/obesity genes. This test may help evaluate genetics as well as help guide dietary suggestions that work with your genes instead of against them.

Because insulin resistance is a factor in obesity, it should also be evaluated. Fasting Insulin and Fasting Glucose by Access Med Labs in combination can assess how the body is reacting to blood sugar/glucose, and can indicate if insulin resistance is already occurring.

To assess poor sleep, conventionally, a sleep study would be done to evaluate if there is a sleep problem and what the exact problem is. Occasionally there is a hormonal reason for poor sleep.

Attending annual physical exams and getting routine yearly bloodwork is essential for detecting any underlying medical conditions contributing to weight gain and obesity. This is the best initial step to take. Although hypothyroidism is routinely screened in bloodwork via the TSH marker, it could still be useful to assess the thyroid further since this condition is quite common and a known factor for weight gain and obesity.

If chemical toxin exposures are suspected of playing a role in your obesity, the GPL-TOX test by Great Plains Laboratory gives a comprehensive screening for 173 environmental toxins.

Conventional Approaches for Obesity and Weight Management

The most common conventional approaches for obesity and weight management, outside of diet and exercise suggestions, are:

Weight management medications, which are intended to be used alongside diet, exercise, and behavior changes, not instead of them. The most commonly prescribed choices are Bupropion-naltrexone (Contrave), Liraglutide (Saxenda), Orlistat (Alli, Xenical), and Phentermine-topiramate (Qsymia). They may not work for everyone, and it is possible to regain much or all of the lost weight after stopping these types of medications.
Endoscopic procedures can alter and limit the space in the stomach without requiring incisions in the skin. Some examples are an endoscopic sleeve gastroplasty (stitches in the stomach to decrease size) and an intragastric balloon (small water balloon in the stomach to decrease free space).
Weight loss surgery (bariatric surgery) can limit the amount of food that can comfortably fit in the stomach. However, there is a known risk of nutritional and vitamin deficiencies associated with these procedures.

An Integrative Approach to Obesity and Weight Management

An integrative approach to weight management includes the conventional wisdom of diet and exercise but goes a step further to individualize a custom plan based on many factors of obesity.

There are a lot of diet choices out there, and many have been researched in terms of efficacy for long-term weight management. Of the studied diets (hypocaloric diet, low-fat, low-carb, Mediterranean Diet, high protein, formula diets, and intermittent diets), research is still unable to identify one diet that works the best for all people. All of the mentioned diets have both pros and cons. However, there are certain dietary principles that can be deduced from this research. A healthy diet with the greatest chance of helping to maintain weight has variety and consists of vegetables, fruits, high-quality proteins, and whole grains. It is also low in added sugar, refined grains, and highly-processed foods.

Exercise should also be tailored to your abilities and should take into consideration any other present medical conditions that may interfere with the recommended 150 weekly minutes of aerobic activity.

Sleep optimization is important since poor sleep quality is associated with obesity. Sleep hygiene schedules, proper micronutrient status, and balancing hormone/neurotransmitter imbalances are imperative for healthy sleep.

A gentle detox may be indicated if environmental toxins are playing a role in your obesity. Please use caution when detoxing and work with a knowledgeable practitioner who can guide you on best practices.

Seeking therapy or counseling is helpful and important in maintaining weight management in the long term.

If your thyroid is suboptimal, you will want to work with a functional medicine practitioner to optimize thyroid function. A positive side effect of supporting your thyroid may be healthy weight management. If you have other known or suspected medical conditions, a full workup by your physician is indicated.

Summary

Obesity is a chronic condition and a factor for several other health concerns. Diet choices and exercise play a significant role in obesity and weight management and should be at the core of an initial plan. However, many more factors play a part, and all of them should be considered when understanding the contributors to obesity and weight gain to address them best.

Integrative medicine is the best of two worlds - the conventional and complementary/alternative medical worlds. It considers all of the suggestions from conventional medicine and utilizes the benefits of functional medicine labs to dig deeper and assess the factors at play. Obesity is a national concern and a serious health issue. But if diet and exercise alone have not been successful, seek care from a functional medicine or integrative provider who can help.