Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast, episode number 48.

Announcer:
Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
Good morning everyone. I am excited to bring you today’s episode. You can probably hear it in my voice. I have been a bit under the weather. We have had a family illness. Everyone in our household is sick and it has been a slow thing to recover from, so I’m feeling quite a bit better, but I sound pretty froggy today. I did want to share this episode with you though I’ve been thinking about this, talking with some of my patients about it, and it’s fresh on my mind, and so despite the froggy voice, I had to share it with you today. Today we are talking about satiety or fullness, and this is such an important thing in our weight loss journey to understand what satiety is, how it happens, and what are the things that we can do to help influence our satiety so that we aren’t feeling so hungry all of the time.

So satiety is simply fullness. Now, there are a couple of reasons why we’re often disconnected from our satiety. One is that we are really just, we haven’t been paying attention. We’ve gotten out of tune with it years and years of hearing things like clean your plate or just one more bite, or you better eat, you don’t know when you’ll have a chance to eat later. All of those things are reasons that we often eat even though we aren’t hungry, sometimes we eat, even though we’re already feeling full, we eat beyond our fullness, and so we get out of touch with what it is our body needs and how much we should eat in order to feel satisfied rather than feeling full or feeling overly full. Many of us have gotten to this point where we feel overly full is sort of our normal, and so it takes some time to pay attention to what is actually the amount of food that my body needs.

And I’ve said this before, it’s really interesting when you look at young children and you look at just how tuned in they are to their bodies. They know when they should start eating. They know when they should stop eating, and day to day, we see really drastic shifts in this. Little kids go through growth spurts, and so it’s even more apparent sometimes for them. But there’s days where little children are simply ravenous. I see my little children and some days I feel like they’re like, my tiniest baby is 18 pounds. She’s a year old, and there’s days where I feel like she eats almost as much food as I do. And then there’s other days where I look at my three-year-old or my five-year-old, and they may have just a couple of bites of food, but even into adulthood, when you be really tuned into our satiety signals, it’s interesting.

There are days where we are simply requiring more energy. Maybe we’ve been more active, maybe we’ve really been thinking hard on a project and we feel as a result of that more hunger. And so paying attention to how much food we need, that satiety may come at a different point. We’ve talked before about the hunger scale, and that can be such an excellent way to assign a number, to put a quantitative value onto what is really a pretty subjective or qualitative thing, but really just starting to hone in on that. So for many of us, simply we are really out of tune with our bodies and the act of bringing awareness, bringing that conscientiousness, we can start to get more in tune so that we can eat when we’re hungry and we can stop eating when we’re full. But the other part of this is that for people who struggle with chronic excess weight, there is a hormonal dysregulation that occurs as a result of that chronic excess fat mass.

So one of the big things that happens is that our bodies try to send us fullness signals, but we’re unable to properly receive and process that message. Part of this happens because of leptin and leptin resistance. So we’re going to talk a little bit about where satiety comes from, but I want to go ahead and talk about leptin because this is such an important thing and why obesity is not an issue of willpower, but is a hormonal dysregulation that happens. So leptin is one of the primary hormones in our body that sends this signal to say, I am full. So the interesting thing, when leptin was first discovered, we thought, wow, this is going to be the magic cure for obesity. People who struggle with obesity must be dealing with really low levels of leptin. And so you can imagine if you had low levels of leptin, you have low levels of something telling you to be full, that you wouldn’t be able to experience fullness in the way that you should, such that you would eat and overeat and maybe never quite feel satiated from your food.

And when leptin was very first discovered, we thought we had found the magic bullet that all we would have to do is give people who struggle with obesity, a medication that would help to replace their leptin and bam, we would solve their weight issues. What we learned quickly thereafter though is that’s actually not an issue of too little of leptin, but an issue of leptin resistance. So similar to what we’ve talked about before in insulin resistance. Insulin, as we are exposed to higher and higher levels of insulin over time, our body starts to ignore that signal. It starts to decrease the number of receptors such that even though you have a really high amount of insulin in your body, your body is not responding into it in the way that we would expect. So the exact same thing was happening with leptin where people who deal with chronic obesity were actually having very high levels of leptin, yet they were experiencing leptin resistance.

So high levels of leptin in and of themselves, we would think, wow, someone who has obesity is going to have high levels of leptin. That makes sense. Leptin comes from our fat cells. After we eat a meal, we get the signaling to our fat cells, our adipose tissue to tell us, okay, release leptin now to send that satiety signal to our body. And so that part of the mechanism is actually working. For the majority of people who deal with obesity, they do have these very high levels of leptin, which should be telling their bodies to stop eating that they are feeling fullness, feeling that satiety. But actually because of that chronic increased leptin levels, they actually start to deal with leptin resistance. And so what happens is that there are those levels, they’re very high, but their bodies aren’t paying attention to them, and so they aren’t able to feel the same fullness or satiety as we would expect because of that leptin resistance.

So treatment for obesity often works in how are there other ways that we can impact the pathways in order to reduce that leptin resistance to fuel satiety in other ways to use foods, maybe to use medicines in order to help induce that satiety or fullness sensation? So I want to talk a little bit about what are the normal satiety pathways and how they impact us and how we can utilize that to our advantage in order to best support us in our weight loss journey. So there’s many different satiety mechanisms in our body. I like to think of them as our early satiety mechanisms and then our late satiety mechanisms. So our very earliest satiety mechanism comes from the stretching sensation of the stomach. So as we eat food, or even if we drink a large volume of water, for example, there is a stretching that happens of the stomach and the nerves that surround the stomach interpret that stretch signal.

They send a message to the vagus nerve, which goes up to the brain to say, okay, I’m feeling this stretch. That must mean that my body is getting full. That is one of the earliest signals of satiety. Then we have more delayed satiety signals, which comes from the absorption of our different macro and micronutrients into our bloodstream that then start to signal throughout our body and most importantly into our brain where we are able to interpret these receptors or interpret rather these chemical signals. So as we absorb protein, as we absorb fat, as we absorb carbohydrates in the form of glucose, all of those things help to send signals to our brain in order to say, yes, I am full. And that’s where some of our more delayed satiety comes from. So you can imagine, for example, if you ate something that stretched your stomach but didn’t have a lot of nutritional content.

So imagine that you had a huge bowl, a bowl the size of your head or larger filled with iceberg lettuce and you ate a huge volume like an entire head of iceberg lettuce. You ate it and you ate it and you ate it, you would probably feel full right away because that iceberg lettuce comes into the stomach, it stretches it out, provides you with that stretch sensation. So you get that early feeling of, yes, I’m full, but then there’s no delayed feeling that follows it. While there is certainly some fiber in that, there’s not protein, there’s not fat, there’s not anything that’s helping to send those delayed satiety signals. And so while you feel full maybe for many minutes or for an hour even, you are going to turn around and feel hungry again pretty quickly thereafter. If you contrast that to a meal that does have lots of protein, does have lots of healthy fat, that may provide you with both early satiety signals as well as some of our delayed satiety signals.

So I want you to imagine eating a meal that has a large serving of even let’s say a salad for example. So you have a very large salad. It’s made with your lettuce of choice, let’s say spring mix onto that salad. You put on some beans and you put on some chicken, you put on a little bit of cheese, you put on a good layer of salad dressing that has lots of healthy fats in it, and you eat that same amount of food. Let’s say it’s a very similar volume that’s going into your stomach. But what happens is very different. So initially we do get that stretch sensation. You’ve had a large volume because you’ve had all this lettuce, you’ve had all this other food. It stretches that stomach sends those signals to the brain to say, oh, yep, I’m starting to feel full. And with the absorption of the protein, the absorption of the fat, this increased amount of fiber that we have, it is slowing down our absorption of nutrients.

We are getting those fat and protein signals into the brain such that that salad is going to keep you full for many hours. And so that is going to be a lot different compared to just a very simple lettuce only or vegetable only even salad. So it’s interesting. We need both of those components to be at play in order to feel full and then more importantly to stay full. So it’s not just good to feel full after your meal. You also want to feel full until your next eating window and not feel like you have to eat so frequently. So one of the things that we can think about are what are the tools that we can use in order to help support a healthy mechanism of satiety signaling? And there’s a few things we can do that have been proven over and over again in order to help our weight loss journeys.

One of the most important things is being mindful of your eating. And when I say that, I don’t mean choosing the right foods or having a meditative experience or anything like that. I mean when the food is in front of you to sit and focus on eating that meal, not to be scrolling on your cell phone, not to be multitasking, but to really pay attention to how the meal tastes, how you’re enjoying it, and to eat it in a slow and deliberate way such that you are able to pay attention to when you are feeling full from that meal. In addition to that, eating slowly is really one of these keys here because we want to allow those signals of satiety to reach our brain when we wolf down our food too quickly, we often eat more quickly than our stomachs are able to interpret that stretch sensation than we’re able to get those delayed satiety signals of some of those hormone processes.

And so we end up overeating simply because we ate too quickly. And so if you’re able to slow down your eating, that is one of the biggest things you can do in order to help support interpreting those satiety signals. That can happen in a lot of different ways. Sometimes I recommend to my patients to eat with their non-dominant hand in order to just be a little bit more awkward, slow them down. You hear people say, set your utensil down in between bites can be a really good tip. Maybe to have a sip of water in between bites, those things can really help to slow down your eating. And then one of the most important things we can do is make sure that we are emphasizing the macronutrients that are going to support our weight loss journey. And so what that looks like is emphasizing protein in the diet, emphasizing healthy fats in the diet, and emphasizing plenty of fiber in the diet.

So people talk about carbohydrates as if they’re bad. Carbohydrates, as we’ve talked about before, are a huge category of food. Eating pure sugar or pure flour is not going to help with delayed satiety, but when we have whole carbohydrates, whether we’re talking about whole fruits or whole vegetables or grains in their whole form, all of that fiber is really helpful for slowing down our digestive process so that we can continue to have those delayed satiety hormones signaling to our brain for many hours after our meal. So if these are things that you are not yet doing, these can be really excellent tools to implement. Slow down your eating, pay attention when am I starting to fill up, and then make sure to emphasize both proteins and healthy fats and fiber into our diet in order to help support our satiety signaling. If you have been struggling with chronic excess obesity, all of these things are going to support you as well.

But because of that leptin resistance that can happen, there may be other tools like medication that can help to support you in your weight loss journey. And so if you’ve been trying some of these more basic tools like slowing down your eating, like paying attention to the nutrition and the macronutrients of your food, speak with an obesity medicine physician, speak with your primary care physician and ask them if there are other tools like medications that you may be able to use in order to support your weight loss journey. If you live in Illinois or Virginia where I’m licensed to practice medicine, I would love to see you as a patient and my telemedicine based weight loss practice. You can visit my website at www.sarahstombaughmd.com. That’s S-A-R-A-H-S-T-O-M-B-A-U-G-H-M-D.com. And I would love to connect with you to see how I can best support you in your weight loss journey. Thank you all for joining me today. I look forward to seeing you all next time. Bye-bye.