Have you had enough?

Participants at a burger-eating competition organised by Hilton Hotel in New Delhi. Pic/Getty Images

Like most of us who have ever battled the bulge, 42-year-old Lokhandwala resident Pooja Shah admits that the problem began with a big appetite. A meal of three rotis, sabji, dal and salad was the norm, with snacks ranging from a full bar of a Dairy Milk to even samosas. And this was not even stress eating. If pav bhaji was on the menu, it would come with four pavs. Today, the pavs are replaced with two slices of brown bread, dinner is made up of soup and salad and, if temptation strikes at night, it's dealt with a glass of haldi doodh.

Her weight, which had climbed up to 74 kg, was brought down to 62 and now, three years on, she maintains an average of 65-67 kg. In that perhaps is the success story, to face your appetite head on and win the battle.

Yet, is it really all about mind and willpower?

Not entirely, it seems.

The medical journal Cell published a study in April titled Human Gain-of-Function MC4R Variants Show Signaling Bias and Protect against Obesity. It was the work of 19 researchers including Dr Sadaf Farooqi, a professor of Metabolism and Medicine at the University of Cambridge and a consultant physician at Addenbrooke's Hospital in Cambridge. The study established that a gene called MC4R is responsible for signalling to the brain when the body has had enough food. The mutations destroy satiety, the feeling of fullness after a meal, Dr Farooqi and her colleagues found. As a New York Times report on the study put it, "There are biological reasons that some struggle mightily with their weight and others do not, and the biological impacts often are seen on appetite, not metabolism. People who gain too much weight or fight to stay thin feel hungrier than naturally thin people."

Pooja Shah, 43, has dropped 12 kg in the last three years. She says, the initial weeks of the diet were tough. But, as Mahawar points out, hunger reduces within a few days of a low-calorie diet. Pics/Atul Kamble

Breaking down Sut-I-Tea
UK-based bariatric surgeon Dr Kamal Mahawar, whose latest book, Fight with Fat: Battling India's Obesity Crisis, looks into the subject of hunger, satiety and balanced meals, discusses the role of the hunger hormone ghrelin in making the human body crave food. A very studied hormone, says Mahawar who consults at the Sunderland Royal Hospital, it is produced by the stomach and goes to the head where it stimulates hunger. In fact, in bariatric patients, ghrelin levels are reduced through surgery, making them feel less hungry. "Yet, everything that's involved in this process is not entirely known yet," says Mahawar.

There are other ways of reducing appetite.

In 2016, Shah consulted Vile Parle based fitness and nutrition expert Tulip Rodrigues, who in the first week cut down her daily calorie intake, concentrating on making her diet wholesome. "The first week was tough. While I ate normal food - idli and upma, for instance - the portions were cut down. Instead of fried snacks, I'd eat a fruit or nuts or a protein bar," says Shah. By and large, says Mahawar, the principle of consumption is that once you lower your calories, after a few days, hunger will go away.

Dr Kamal Mahawar, bariatric surgeon

Getting there

And, anybody who has lost the weight and gained it back, will tell you that once you start eating normal portion sizes, appetite, like the devil waiting for an invitation, returns. How then do you play this game?

With lifestyle change, argue experts. If satiety is a feeling of fullness in the stomach, understanding what leads to that feeling plays an important role. There is of course, the all-important fibre (from fruits and veggies), which brings volume to the stomach, letting us know that we are full. Which is basic math. Why then does protein also help us stay fuller for longer, even if in mass it occupies lesser space than say a full bowl of kale and quinoa salad? Rodrigues explains that protein-rich food, by nature, when sent into the system, sits heavy in the stomach and allows for a slower release of energy allowing you to feel dated for longer.

Time cures all

If a sedentary lifestyle has made our bodies require less energy, why is it that we are still eating all the time? While social eating and constant access to food - we can after all, tap our phones and access ice-cream in the dead of the night within pizza-delivery time without even moving from a binge-watching session - is one factor, Mahawar points out that another is that our body mechanisms which would otherwise let us know that we are not hungry, are failing.

So then, can we cheat our way through?

Yes. Eating slowly is one major change that we need to make, says Rodrigues. Satiety comes when you allow the brain and body to understand how much food is going inside and that happens when we let them do their job in the time that is required. "Chew on each bite at least 6-8 times, let the flavours explode in your mouth and then swallow. This lets the digestive juices do their job," says Rodrigues, adding that we should spend a minimum of 15-20 minutes on each meal in a concentrated form, not blindly watching a screen while doing so. "When you are not doing this, you are probably eating more."

Fibre in it's best form, raw veggies, need to be had before a meal. Give it 10 minutes to settle in, before moving on to the main course. Add a lime or vinegar to the salad, she adds. This cuts the glycemic index on the food, increasing the time food is digested and ensuring a steady release of glucose, which again means fewer hunger pangs.

But, what if you are still feeling hungry?

Rodrigues' simplest hack is to wait for 30 minutes post a meal. If the urge to eat still remains, chew on flax, fennel or chia seeds. These take a long time to chew and digest, thus increasing satiety.

Genes vs Will power

"If we talk about obesity in India," says Mahawar, "will power will have some role to play. But a very small one. In India, if five crore people suffer from obesity we can't say they are all lacking in will power. Food, lifestyle and availability of healthy foods will have some role to play. For instance, if you stock your fridge with soft drinks and cake, even the most disciplined person will give in once in a fortnight. So, the fight against obesity needs a multi-pronged approach."

Understanding why hunger fails us when we need it the most - for instance when battling illnesses like cancer and tuberculosis - might be a question, feels Mahawar, that will help us combat it to stay healthy and at desired fitness levels. "There are many factors at play when we talk hunger and satiety. Right from hormones to genes and much needs to be researched. Until then we have to do what we are doing."

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