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Despite our collective obsession with counting calories, we are now the fattest generation in history. Obesity levels in Canadian adults have increased from 3 per cent in 2003 to 18.5 per cent in 2012, according to Statistics Canada, with the greatest rate of increase seen in women.

These extra pounds aren't just about calories. A tidal wave of risk factors for obesity and metabolic problems is wreaking havoc on our physiology and contributing to the fat phenomenon.

Our evolving understanding of these risk factors is shedding light on the question of why calorie-restricted diets, regardless of regimen, don't work, or may seem to work only temporarily but are inevitably followed by rebound weight gain. This vicious cycle of weight loss and gain is hazardous to our health. Recent research suggests that yo-yo dieting redistributes toxins from fat tissue exposing the brain to their harmful effects.

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So if calorie counting doesn't work, what can we do about age-related weight gain? The first step is redefining the problem and moving away from a quantitative approach and toward a qualitative framework. I encourage focusing on food quality (not calories) and body composition (not simply pounds on the scale). There are no cookie-cutter solutions, but by understanding an individual's metabolic, inflammatory, hormonal and psychological status along with their habits and lifestyle a comprehensive plan may be born.

Preventing age-related weight gain requires an individualized, multifaceted approach as diets alone are doomed to fail. The following five steps target the metabolic, hormonal, psychological, environmental and lifestyle factors contributing to weight gain.

Reset insulin sensitivity

By the time we're 50, our ability to effectively metabolize dietary carbohydrates has plummeted to about 50 per cent of our level as teenagers. We acquire a varying degree of insulin resistance that makes us more prone to elevated insulin levels even in the setting of normal blood sugar. So while we are not yet diabetic, an unfavourable metabolic cascade is at play with faulty insulin signaling and inflammation. As a result, we become adept at converting the carbs we eat to deep stores of body fat, especially in the belly. Cutting back on grains and highly processed food along with increasing aerobic exercise can improve insulin sensitivity and stop the mid-waist drift.

Restore hormone balance

Declining estrogen and progesterone in women and testosterone in men produces changes in body composition with redistribution and accumulation of deep fat stores coupled with a loss of lean body tissues such as bone and muscle. The role of hormone therapy is well established for maintenance of lean body mass while its role in preventing weight gain is less clear. The decision to initiate hormone therapy must be a highly individualized one between a patient and their qualified physician that considers the total risk-reward profile. While hormone therapy may not be right for all, an easily accessible first step is to reduce harmful environmental exposures. Common household products like skin care and cleaning agents may contain hormone-disrupting or estrogenic chemicals known as "xenoestrogens" that can interfere with hormone balance and increase risk of breast cancer.

Repair the gut

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Overgrowth of unfavourable gut bacteria can adversely affect human health and metabolism. New science has shown that the typical Western diet fosters gut bacteria that are more efficient at harvesting energy from food. These gut bugs are much better able to convert the food we eat into calories – literally delivering an even faster version of fast food to our cells with the extra energy being stored as fat. To keep the microbiome thriving, a plant-based, high-fibre diet is preferred as it increases transit time and supports favourable flora. Fermented foods like kimchi and sauerkraut may have an edge on a store-bought probiotic pill as these traditional "germy" foods contain a naturally derived symbiotic blend of both the necessary pre-biotic substances and probiotic organisms. So at once we can live clean and eat dirty to better balance the gut.

Rethink calories

Be mindful of portion size but think mostly in terms of quality, not calories. An energy-equivalent portion of kale and processed fast foods are not equivalent in any other way, as the cruciferous kale is akin to a warehouse of nutrition with anti-inflammatory, anti-oxidative and anti-carcinogenic health benefits. Get more nutritional punch with each bite by loading up on cruciferous vegetables like kale and broccoli instead of starchy ones like potatoes and avoiding processed foods that often have hidden calories.

Reboost brain controls

Sleeplessness and stress are both strongly associated with weight gain and poor dietary choices. Chronic stress produces a state of elevated cortisol, which in turn can lead to insulin resistance. Psychological stress has been shown to alter levels of the satiety hormone, leptin, leading to overconsumption of comfort foods that are high in fat and sugar. Mindfulness-based interventions and stress-management techniques such as tai chi, yoga and deep breathing have been proven to be effective in keeping stress at bay and improving sleep.

Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging.

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Dr. Jennifer Pearlman is a physician focused on women's health and wellness and a staff physician at the Menopause Clinic at Mount Sinai Hospital in Toronto, and medical director of PearlMDRejuvenation, a women's health and wellness facility. You can follow her on Twitter @drjpearlman. Pearlman was recently named a 2014 International Enterprising Woman of the Year, given by Enterprising Women and @EWmagazine.

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