“New year, new you.” That’s the saying, and for many, this means it’s time to lose weight.

A couple of methods are especially popular in January:

• January is often a month for fasting since it is viewed as a cleansing and detox ritual.
• Calorie-cutting fad diets are another popular method.

Yet, have you ever cut your calorie consumption only to get on the scale and find that you’ve gained weight? How could that be? Fewer calories should automatically lead to weight loss, right?

We reached out to WakeMed Medical Weight Loss provider Deepti Sharma, MD, to learn more about the relationship between calories and weight loss.

Before we dig in, let’s take a moment to get to know her.

1. Why did you go into medical weight loss?

I am board certified in family medicine, obesity medicine and lifestyle medicine. I decided to practice medical weight loss to make a meaningful impact on the health and quality of life of my patients. It has been incredibly fulfilling. I believe in treating the root cause of chronic diseases and am passionate about this field because I want to address the stigma as well as health care disparities related to obesity. Educating everyone about this chronic, progressive, multifactorial, and relapsing condition is important since it is associated with over 200 comorbid conditions.

I joined WakeMed Medical Weight Loss in October 2022 for its mission, values, excellent leadership and culture of inclusivity. I appreciate that my colleagues and I collaborate to address obesity — a condition worthy of empathy, treatment and longitudinal care.

2. Why do you think there is an obesity epidemic in the United States?

Stress is at all-time high, so people reach for comfort food to cope. Since we live in a very obesogenic environment of food abundance, it is easy to access processed, fast food.

Family dynamics have also changed. Since both parents are in the workforce, fewer nutritious meals are being prepared and children are spending more of their free time on screens. More screen time typically leads to less physical activity and fewer meaningful connections. Isolation that is the outspring of this cultural norm, encourages mindless overeating.

3. Let’s discuss fad diets that involve extreme food deprivation.

Since so many Americans are overweight and obese, they are seeking a quick fix, and eating less is a commonsense approach. Yet, when done to the extreme, it can eventually lead to weight gain and have detrimental health affects.

Starvation is defined as long-term, severe deprivation of nutrition. Most Americans trying to lose weight aren’t necessarily intentionally starving themselves, but they may try fad diets that involve fewer than 1,200 calories a day for women and under 1,800 calories a day for men — which can lead to starvation mode symptoms.

Here are a few symptoms:

• Amenorrhea
• Cold sensations
• Constipation
• Depression, irritiability, mood swings
• Hair loss
• Hunger
• Lethargy
• Sleep issues

When trying to lose five to 10 pounds in a pinch, people may turn to starvation diets, including these:

• Extended fasts
• Extreme intermittent fasts
• Human chorionic gonadotropin (HCG) diets
• Low-calorie diets
• Water fasts

Starvation can be very detrimental. It is not safe and is a major stressor on the body. Serum cortisol (a stress hormone) goes up when the body is deprived of food, making weight loss unsustainable long term.

4. How can starvation diets lead to weight gain?

Starvation diets cause slowing of metabolism, slowing of bodily functions, impaired cognitive function, dehydration, weakened immune system, heart problems, fatigue and in severe cases, organ damage.

The body slows down to help store energy. The slowed metabolism along with other bodily systems, increases the likelihood of weight gain when normal eating is resumed because the body is trying to conserve energy.

Additionally, starvation does not initially lead to weight loss. A smaller number on the scale is merely water weight in the first week. Thereafter, if starvation continues, the body will begin to pull on fat stores and lean muscle mass. The body starts breaking down fat and protein after liver glycogen stores are used. This process is called catabolism.

When the serum cortisol goes up, it can start retaining water, which could result in weight gain.

5. January is a prime fasting season. What happens if people fast (starve the body) for too long?

People fast at the start of the new year for various reasons. Some people do it to reset their systems and detox for the new year. Others do so for religious purposes to draw near to their spiritual higher power.

Fasting (starving) for too long can involve endogenous ‘stress’ mediators, such as cortisol, catecholamines, growth hormone (GH), glucagon and cytokines to go up. This also results in the heightened stress response — catabolism.

6. What’s the relationship between starvation diets and high carb food?

The body recognizes starvation as scarcity, so this will increase the desire for all energy dense foods. It is a protective mechanism of our primitive brain to shield us from starvation.

Carbohydrates are the most readily available source of energy for the body — specifically the brain —and it will ramp up hunger hormones.

7. If a person wants to fast, what do you propose?

I do not recommend prolonged fasts.

Resets can instead involve the following:

• Eliminating processed foods
• Eliminating alcohol
• Eating a diet rich in vegetables/fruits only

The body does not need detoxes or resets. And, weight loss from a week of fasting, isn’t really weight loss at all. It is water loss. Pounds will ramp up quickly once a person starts back eating. That in mind, an absolute fast should be less than 24 hours with a snack in hand in case one feels faint or dizzy.

8. What are your top recommendations for weight loss and weight management?

Addressing underlying pathophysiology with a physician trained in managing obesity is key. Sustainable lifestyle changes include planned healthy eating, optimizing physical activity, managing stress, getting restorative sleep, fostering healthy relationships and avoiding substance abuse. These are fundamental to a weight loss journey.

Medications and bariatric surgery are additional evidence-based tools to help with achieving and maintaining weight loss. A consult with the bariatrics team can help patients navigate this complex disease, so they can choose the treatment that’s right for them.

9. At what point should a person consider WakeMed Medical Weight Loss?

Anyone who wants to lose weight should contact our team. It’s an honor for us to be part of this journey with our patients, and it’s humbling to make a difference in their health.

Evidence shows that weight loss of five to 10 percent can significantly improve health.

Please don’t wait. Come see us! We will partner with you to help you achieve your weight goals.

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About Deepti Sharma, MD

Dr. Deepti Sharma is board certified in family medicine. She is also board certified in obesity and lifestyle medicine with over a decade of clinical experience. Dr. Sharma’s clinical interests include weight management, prevention and cure of disease using evidence-based lifestyle changes centered on nutrition, physical activity, sleep, and mental health. Dr. Sharma received her medical degree from Government Medical College, Amritsar, and completed her family medicine residency at St. Joseph Mercy Hospital in Ypsilanti, Michigan. While practicing in Eastern North Carolina, she saw the burden of chronic diseases, health care disparities and the role of preventive medicine. As she delved more into lifestyle aspects of disease, Dr. Sharma completed her plant-based nutrition certificate from T. Colin Campbell’s Center for Nutrition Studies. To further her expertise in treatment of chronic diseases, she became certified in obesity medicine and lifestyle medicine.

Dr. Sharma is passionate about treating the root cause of disease and exploring the connection of our daily habits with how we feel. Through a personalized approach, her philosophy is to partner with her patients to connect them to their best possible health and the life they want to live. Outside of work, Dr. Sharma enjoys reading, walking and yoga.