Help For Those Who Chose to Lose Weight and Improve their Health!

More than 80 million adults in the United States are obese.  Obesity raises the risk of morbidity from hypertension, hyperlipidemia, type 2 diabetes, coronary artery disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems and some cancers, such as: gastrointestinal, breast, uterine, and ovarian.  Obesity is associated with an increased risk of all cause cardiovascular disease mortality.  The medical, psychosocial and economic consequences of obesity have known implications for the health and well-being of our population.  Recently, the national clinical guidelines have been updated to improve the quality of our guidance.  These guidelines have been put forth by an Expert Panel of Physicians representing many specialties including cardiology, endocrinology, internal medicine, gastroenterology, bariatric surgery and obesity medicine.

    The term Body Mass Index or BMI is a measure of body fat based on height and weight in kilograms/meter squared. Overweight is defined as 25-29.9 kg/m2. Another way to express this is a 5 foot 5 inch person weighing 150-178 pounds.  Class 1 Obesity is a BMI of 30-34.9 kg/m2. ( A 5 foot 5 inch person weighing 180-205 pounds)  Class 2 Obesity is 35-39.9kg/m2.( A 5 foot 5 inch person weighing 210-235 pounds) Class 3 Obesity (Extreme) is over 40 kg/m2. ( A 5 foot 5 inch person weighing 240 ounds.) Waist Circumference is also used to determine obesity.  A waist circumference in a White, Black or Hispanic man over 40 inches is considered obese.  A waist circumference higher than 35 inches in a White, Black or Hispanic woman is considered obese.  A waist measurement over 35 inches in an Asian man is thought to be obese and over 31 inches in an Asian woman is thought to be obese.

    Assessing a patient with a weight problem requires attention to their specific risk factors including hypertension, hyperlipidemia, diabetes, kidney disease, sleep apnea and chronic pain issues.  Often, they are taking medications that are aggravating their weight problem such as antidepressants, steroids, progesterone, insulin, beta blockers, antihistamines and sleep aids.  It is also important to get a history about what the patient has tried in the past to lose weight.  It is important to know what works and what doesn’t.  It is also important to know when the weight problem started. Pregnancy, menopause, a change to a sedentary job, stressful life events can all impact a person’s weight.

    A weight loss counselor can help a patient decide if they can self-direct a lifestyle change to lose weight or if they require professional direction including a trainer or nutritionist. The counselor can also be an Obesity Specialist Physician who is able to prescribe helpful medications to help with eating disorders contributing to the obesity. Other lifestyle factors that affect weight gain include a high carbohydrate diet, lack of adequate physical activity and too much stress, less than 7 hours of sleep a day. A disruption in circadian rhythms such as frequent shift change can also cause weight gain. Frequent awakenings to urinate during the night can also affect sleep quality and should be addressed. 

     The diet to be used is the one that the patient will follow.  There are many options and include Paleo, Low Carbohydrate (20 gram), Mediterranean, DASH, Vegetarian, Calorie Restricted. Intermittent Fasting has also become popular, but is not advised for everyone.  Night eating, skipping meals and snacking all need to be addressed for a diet to be successful. The portions should be the size of your palm. Commercial programs are also available, but not always needed.

    150 minutes of moderate intensity exercise per week is recommended along with 30 minutes of weight training at least 3 times a week. Exercise is best, however, if it is done as a daily routine such as a 30-60 minute power walk daily. Patients with limitations can also have their regimens adjusted to fit their disability.

    The object of treating obesity aggressively is not only to help the patient live longer, but also to live better with fewer co-morbidities and complications. Consultations are available at our Clinic with an Obesity Specialist.  You can also consult your Primary Care Provider for Guidance.

Janice H. Alexander, R.N.,M.D.