Obesity

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What is obesity?

Obesity is defined as being 20% or more over your ideal body weight, with an abnormally high proportion of body fat. (More than 100 pounds overweight is considered morbidly obese.) These numbers are growing markedly every year. Extra weight in adulthood dramatically increases your risk for high blood pressure, diabetes, cardiovascular disease, arthritis, and several kinds of cancer. The more pounds you gain, the higher your risk.

Who is at risk for obesity?

The major obesity culprit is lifestyle. Most of us spend hours sitting—at computers, in front of TVs, in our cars. Fast food and vending machines can’t be avoided. We’ve grown accustomed to “supersized” everything, from candy bars to restaurant meals. Genetics certainly plays a part: If your parents and grandparents were heavy people, you may well have inherited their body type. You could also have an underfunctioning thyroid or neurological problems. Maybe you’re gaining weight because you’re taking certain medications. Ask your doctor about these possibilities. Another conflicting factor: Some 30% to 40% of obese patients who seek help with weight are suffering from depression or another psychological disturbance.

Treatment for obesity

Weight loss choices depend on your medical profile and how many pounds you need to lose to lower your risk of disease. Experts use the Body Mass Index, a standard method to evaluate body weight, according to height. If you have a BMI of 25 to 29, you’re “moderately overweight.” If it’s between 30 and 40, you’re considered “severely overweight” or obese.

If you’re in the moderately overweight category, you should be able to lose sufficient weight with diet and exercise. However, if you’re severely overweight, lifestyle methods alone may not correct your problems. Medications and physical therapy may be required, possibly even surgery (although surgery is usually reserved for people who are at least 100 pounds overweight and at high risk for early death).

In working out any realistic obesity treatment plan with your doctor, consider whether you’re under lots of stress or often feel out of control when you’re around food. If so, ask your doctor about counseling or psychotherapy, which can help control binge eating.

Medications for obesity

Maybe you’ve tried and tried to lose weight and kept putting it back on. If so, ask your doctor whether a medication can help you succeed. There are several drugs available for short-term use. Since keeping the weight off is the point of weight loss, many doctors focus on the following two prescription drugs for long-term treatment:

• Orlistat (Xenical). Taken before, during, or after a meal, orlistat prevents the digestion of about 30% of the fat you eat. In clinical trials, it worked better than a placebo to help overweight people lose pounds—and keep them off—when combined with a healthy diet. The downside? Important fat-soluble nutrients can be lost. Not all of them can be replaced by supplements. Some patients report gas and frequent bathroom trips. Certain people develop high blood pressure while on the drug.
• Sibutramine (Meridia). This drug affects brain neurotransmitters that influence appetite and satiety (fullness) mechanisms. In clinical trials, those who took the drug and got advice on diet lost significantly more weight over one year than those who got diet advice alone. Side effects include dry mouth, insomnia, heart arrhythmia, and elevated blood pressure. Studies suggest that taking Meridia in 12-week on/off cycles minimizes side effects without affecting its ability to suppress appetite.

If taking either drug for obesity, you should be monitored closely by your doctor. Some people shouldn’t take diet drugs at all—including pregnant women and those who have a history of drug or alcohol abuse, or who have an eating disorder, severe depression, migraine headaches, or an unstable medical condition. The bottom line on drugs: There is no magic bullet, and diet and exercise still count.

Lifestyle Changes

Whether you are overweight or obese, the principle of weight loss is maddeningly simple: Burn more calories than you take in and you’ll lose weight. But if it were that easy, there wouldn’t be so many best-selling diet books or quick-fix over-the-counter weight loss products. As you’re undoubtedly aware, beating obesity requires an ongoing commitment to change.

To start, many experts recommend that you keep a food diary to record not only what you eat, but your hunger levels and emotions when you eat. After a couple of weeks you’ll have a good idea of your eating habits. You can then talk with your doctor (or a dietitian) about a specific low-calorie eating plan and how you might modify your diet. You might also want to discuss finding a support system beyond family and friends. Weight-loss support groups offered by university or hospital clinics typically meet weekly for 16 to 26 weeks and have led to average reductions of 8% to 10% of initial weight. Many people find such groups—and commercial programs like Weight Watchers—extremely helpful. They provide social support along with sound advice on diet and nutrition. Some have online services.

Weight loss plans that work for most people encourage eating a wide variety of foods—in smaller amounts. The focus is on lowering your fat intake (especially saturated fat) and eating more whole grains, legumes, fruits, and vegetables. Many of these foods are high in fibre, which makes you feel satisfied sooner. Make it your goal to get the greatest “bang for the buck” with every calorie.

If you’re in the moderately overweight category, your goal will probably be to lose one to two pounds a week. This can usually be accomplished by creating a daily “deficit” of 500 calories through eating less and exercising more. Most overweight women will lose about a pound a week by consuming 1,200 to 1,500 calories daily; men, by eating 1,500 to 1,800 calories. Getting fewer calories is usually not recommended, because it’s difficult to get a good nutritional balance.

Why does exercise work so well? Because it burns calories while you’re doing it, and because regular exercise increases the rate at which you burn calories even when you’re just sitting around. Exercise is also a great mood elevator, and seeing quick results helps people stick to their eating plans.

Before you begin any sort of exercise program, your doctor may recommend a stress test to record your heart’s performance while you work out. Once you get the medical go-ahead, begin to increase your daily activity. If you’re not used to exercise, this could mean starting with five-minute walks, plus some strengthening exercises. Your goal is to work up to 30 minutes of aerobic exercise daily (brisk walking, jogging, swimming, biking); 30 minutes of strengthening exercises two to three times a week; and regular stretching to gain flexibility.

Related Procedures for Obesity

Advances in stomach-shrinking (bariatric) surgery offer some hope for the severely obese. You could be a candidate for an operation that blocks off part of your stomach if you are more than 100 pounds overweight, have a BMI of 35 to 40, and perhaps a related medical condition such as diabetes or high blood pressure. Dramatic weight-loss results occur because, after surgery, you feel full even if you eat only a small amount of food.

There are a number of variations on bariatric surgery. The most popular method is Roux-en-Y gastric bypass surgery (RNY). In this procedure, the surgeon creates a small pouch (which holds a maximum of about four tablespoons of food at a time) by stapling the upper end of your stomach and completely blocking off the lower part. A section of the small intestine is attached to the new stomach pouch to create the bypass. In another method, called vertical banded gastroplasty (VBG), both staples and a polypropylene band are used to create an even smaller pouch, which holds only about one tablespoon of food at a time.

Although there seem to be fewer complications and better weight loss with RNY, some surgeons prefer VBG because any necessary band adjustments can be made more easily. Exciting advances in laparoscopy (use of a tiny video camera to guide the surgeon) are making stomach-shrinking surgery less taxing on the patient. The surgery carries risks, of course—including infection, bleeding, hernia, ulcers, and vitamin deficiencies—but fatal complications are rare. Compared with the risks of extreme obesity, they may seem slight indeed.

If you’re moderately overweight, bariatric surgery isn’t for you. However, many overweight women and men are turning to a type of cosmetic surgery called liposuction (also known as lipoplasty or suction-assisted lipectomy) to get rid of unsightly fat ripples. Not a substitute for conventional weight loss, liposuction is most successful at improving body image. Even if you have it, you’ll still be encouraged to eat right and exercise to maintain your new look.

Alternative Therapies for Obesity

Most experts don’t recommend herbal supplements as part of a weight loss program, yet people continue to buy them. Do any of them work? Maybe. Studies show mixed results (and some dangers) with certain herbs. A recent review of weight loss supplements by an independent laboratory found that many brands do not contain the amount of active ingredients the labels proclaim. Despite these drawbacks, a number of supplements can prove a beneficial addition to a weight-loss program:

• Green tea is good for you because of its antioxidants. One Swiss study showed that three daily doses of green tea extract helped burn more calories than similar doses of caffeine.
• Psyllium, the soluble fiber from the husk of psyllium seeds, absorbs water in the stomach and may create a feeling of fullness.
• Chromium picolinate supplements can help those with diabetes who have mild glucose intolerance and may help lower cholesterol, but most studies don’t support claims that chromium increases weight loss or changes body composition. Still, some dieters report that the supplement reduces sugar cravings.

Questions for Your Doctor

• Could I be overweight due to a metabolic disorder? Can you test my thyroid levels?
• With so much extra weight, is it safe for me to exercise?
• Am I a candidate for a weight-loss drug?
• If I get my stomach stapled, will it affect other medical problems I have?

Living with Obesity

When you change your diet, you need to develop new habits. Here are some that have been found to work well for gradual weight loss:

• Don’t skip meals. Your body goes into deprivation mode, and this leads you to eat more at the next opportunity. Eat often enough to keep your energy level steady—maybe as often as every three to four hours.
• Drink lots of water. Eight glasses daily is good for your overall health and helps stave off hunger. One good tip: Drink a glass right before eating.
• Watch serving size. That means measuring your morning cereal until your eye knows how a portion looks in a bowl. A serving of chicken or lean meat should be no bigger than a pack of cards. Use smaller plates and bowls to help you adjust.
• Follow the 20-minute rule. If you’re tempted to go for second helpings, wait. It takes 15 to 20 minutes for your stomach to signal your brain that it’s full.
• Think volume. Research has shown that a bowl of low-fat, low-calorie soup or plain popcorn helps assuage hunger. Make your own healthy soup with low-fat broth and onions, carrots, greens, or other vegetables; eat it before lunch or dinner.
• Reward yourself regularly. If you stick to your eating plan, buy a book, some flowers, a new CD, or take time off from work. We often “reward” ourselves with food; it’s good to remember there are noncaloric treats as well.