There are many common themes that I have been recognizing among my patients who truly struggle to lose weight. Perhaps the most common complaint I hear is: “I’ve tried everything, and I can’t lose weight.” Among those individuals, the following are perhaps the 2 most common bits of history that eventually find their way into our discussion.
- “My sleep is terrible.”
- “I’m not hungry in the morning.”
Sleep
Arguably, sleep may be the single most important factor in regard to weight loss. Sleep is critical for proper functioning of our nervous system, being required for a “reset” of sorts on a daily basis. While nutrition and physical activity are certainly top contenders, the effects of sleep deprivation basically wipe out any progress that you might achieve from all other efforts. Trying to lose weight without proper sleep is like trying to cut down a tree with a dull saw blade — a good saw and lots of saw movement are incredibly important, but only if the saw blade is sharp.
Inadequate sleep increases appetite via complex hormonal pathways, most notably leptin (the “satiety” hormone), ghrelin (the “hunger” hormone), and cortisol (the “stress” hormone). Leptin is produced by our white fat cells and signals our brain to feel full. Conversely, ghrelin stimulates our appetite and creates a sense of hunger. Sleep deprivation also drives us to choose less healthy food items, perhaps being connected to the reward system in our brains, as well as contributing to impaired focus and increased anxiety.
In a crossover study, compared to those who slept 8.5 hours per night, participants who slept only 5.5 hours per night lost 55% less body fat and 60% more lean-body mass (ref). Other studies show that total sleep time and sleep quality predicted fat loss (ref) and that better sleep quality and sleeping more than 7 hours per night increased the likelihood of successful weight loss by 33% (ref).
Poor sleep may also be a sign of other problems associated with resistance to weight loss. Alcohol use is notorious for disrupting the second half of sleep (ref). Of course, alcohol can be a useful tool to help with initiating sleep, but its utility runs out shortly thereafter.
Morning Appetite
It’s unclear if a lack of appetite in the morning is driving problems that make it difficult to lose weight or if there are other issues that manifest as low appetite in the morning.
There are several lines of evidence that point toward the benefit of front-loading food intake earlier in the day. Protein intake is best distributed multiple times daily, rather than being skewed towards the evening meal. Eating in the morning is also more favorable for one’s insulin response to food, as well as for digestion.
Eating late in the day increases daytime hunger and decreases leptin levels throughout the day (ref). Several studies show an association between late-night eating and weight gain.
A solid morning meal can set the tone for the day, with a generous serving of protein providing satiety for a long period of time. It’s easiest to do so at home, where you likely have more options than when you’re on-the-go. Skipping that morning meal may impart more pressure on individuals to scramble for a meal during the day when it’s more difficult to find reasonably healthy options.
