Help Patients Get the Link Between Sleep Loss and Obesity

Medscape

4 days ago

When patients share their struggles with falling asleep or staying asleep, physicians should try to assess whether obesity is playing a role. During discussions with your patients, acknowledge those concerns about sleep deprivation, help them understand possible causes and discuss ways to help them get better sleep.
Often, conditions like obesity play a role, and discussing weight issues with patients can be tricky. There are strategies to lean in gently to discussions. Here's how to get started.
Explaining the Connection
Obesity and sleep loss are two separate but often interconnected health concerns, each with its own set of risks.
'It is well-known that obesity increases the risk of heart disease, type 2 diabetes, and high blood pressure, but obesity can also lead to structural changes in the body that make breathing more difficult and therefore contribute to sleep disorders such as obstructive sleep apnea,' explained Fariha Abbasi-Feinberg, MD, medical director of sleep medicine at Millennium Physician Group in Fort Myers, Florida. 'In fact, even a 10% weight gain can increase [sleep apnea] risk by up to sixfold.'
Fariha Abbasi-Feinberg, MD
In addition, she noted how the relationship is bidirectional: Obstructive sleep apnea 'can impair sleep quality, affect metabolism and hormone levels, making it harder to maintain or lose weight.' Sleep loss may also interfere with the body's natural hunger and satiety signals.
'We all have experienced cravings for certain foods after a night of poor sleep; this can lead to weight gain and the increased body weight over time increases the risk of OSA and other medical issues,' she said. 'To help your patients, there's a need to address both in order to improve health.'
Sharing Information With a Sensitive Approach
The goal here isn't to shame patients or make them feel bad about their body image but to provide information and guidance to live healthier and sleep better. The course of discussion should be how losing weight could achieve better outcomes.
'Weight loss can improve certain sleep disorders such as obstructive sleep apnea by decreasing the amount of tissue around the upper airway and making it less likely to collapse,' said Abbasi-Feinberg. 'Better sleep also supports hormone balance and appetite control, making it easier to maintain a healthy lifestyle.'
Ways That You Can Communicate With Patients
Patients trust primary care providers. Abbasi-Feinberg offered some action steps:
Start the conversation by mentioning how a number of factors contribute to sleep apnea and weight can be one piece of the puzzle.
Ask if they are open to discussing it further before making recommendations.
Emphasize that even a modest change in weight can make a real difference in their sleep and energy levels.
Encourage patients that this is a common challenge and there are options to help with weight loss.
Consider referral to a dietitian and/or endocrine or bariatric clinic to discuss further interventions that might help promote weight loss.
Explaining the Link Between Bad Sleep and Poor Choices
Lack of sleep often triggers strong cravings, especially for high‑fat, high‑sugar snacks, Abbasi-Feinberg explained. 'It ramps up brain reward systems and endocannabinoids, making junk food even more appealing while weakening self-control,' she said,
In one study, sleep‑deprived participants ate nearly twice as much fatty food than when well-rested. 'This shift in food preference can directly lead to poor eating choices and weight gain,' Abbasi-Feinberg said.
Indira Gurubhagavatula, MD
In addition, insufficient sleep can reduce physical activity and slow metabolism. When you're tired, you're less likely to move and burn calories. Research shows that sleep deprivation also disrupts basal energy expenditure and fuel use, lowering resting metabolic rate and fat oxidation.
Here is additional information for patients to understand how sleep deprivation intersects with gaining weight. Abbasi-Feinberg provided talking points that are easy for patients to understand.
Sleep deprivation messes with your hunger hormones.
Sleep deprivation makes you crave unhealthy foods.
Sleep deprivation makes you too tired to move.
This combination of factors can affect your weight.
What Patients Should Also Know About Snoring
Weight gain can make snoring worse. It can also affect your partner's quality of sleep. 'Sometimes people wake themselves up from snoring or disturb their bedpartner, who then wakes them up to have them turn over,' said Indira Gurubhagavatula, MD, professor of medicine, Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
Gurubhagavatula offered some suggestions for patients for better sleep
Keep a regular schedule. Encourage patients to try and wake up and go to bed at roughly the same time every day.
Eat at predictable times. Suggest they avoid eating close to bedtime or during the night when they should be sleeping.
Encourage exercise. Overall, people tend to sleep better when their lifestyle includes some physical activity.
Choose nutritious foods. The research around food choices and sleep quality continues to grow. High quantities of sugar have been shown to lead to poorer sleep quality.
Maintain a bedroom environment that promotes sleep. Ideally, the bedroom should be cool, dark, quiet, and comfortable.
Manage stress. Chronic stress may lead to poor sleep and weight gain in several ways, including eating or drinking alcohol or drugs to cope with negative emotions, she asserted.
Limit the use of caffeine. Caffeine blocks adenosine, which is a sleep-promoting neurotransmitter therefore keeping you more alert, said Gurubhagavatula. 'The effects of caffeine can last for many hours after consumption and can disrupt sleep,' she explained.
Reduce alcohol. Alcohol makes people fall asleep faster but lowers the quality of sleep later in the night, she noted, and it can lead to awakening or lighter stages of sleep in the second half of the night, leading the person to wake up feeling unrefreshed.
See a sleep specialist. A referral to a sleep specialist could be helpful. 'Sleep is a foundational pillar of health,' said Gurubhagavatula. 'Investing in sleep can have large payoffs in the long run, leading to better overall physical and mental health and quality of life.'