OBESITY
W. G. Franklin, M.D.
- Formerly defined as being 10-20% above ideal body weight
- Now defined as having a body-mass index (BMI) > 30
- Body mass index is calculated by dividing your weight in kilograms by the square of your height in meters
- Overweight is defined as BMI from 25 to 30
- 27% of Americans are obese; 34% are overweight
- obesity affects risk of diabetes and hypertension and thus heart attack and stroke
- osteoarthritis, gallstones (which are 99% cholesterol), back pain, hernias, sleep apnea, narcolepsy, etc. are also affected
- contributes to a state of dependency by adversely affecting mobility
Treatment
- no treatment works if the patient is unwilling to participate
- motivation is critical!!
- a loss of 10 lbs. May reduce the BP and cholesterol 10 points and thus reduce the risk of heart attack and stroke 20%
- quality of life improves with an increase in energy and sense of well being
- be clear about the goal: to be healthier, not to look better
- Changing habits results in improved health
- reaching a certain weight by starving and then reverting to old bad habits is not healthy
- temporary changes are by definition not long-lasting
- the goal is to change habits permanently
- there should be no target weight which when reached tells you to stop practicing healthful habits
- a slow steady weight loss of 1 lb. per week (1/7 lb./day) is achievable by 90% of people without experiencing hunger!
Techniques:
- Counting Calories
- counting calories is more important than counting other things such as fats
- patients who keep track of what they eat and drink in a notebook lose weight 99% of the time
- keep a small notebook with you wherever you go
- each day record the date and the items consumed on the left side of the page
- record the calories on the right side; add the total at the end of the day
- record the total number of minutes of continuous exercise on the upper left of the page
- use a new page each day
- on the back page create a table with 4 columns
- column 1 is for the date each Sunday AM
- column 2 is for the weight on Sunday AM
- column 3 is for the average number of calories per day that week (add calories total for the previous 7 days and then divide by 7)
- column 4 is for the total number of minutes of exercise that week
- the notebook acts as a tool to promote focusing on choices
- obtain a calorie book from the grocery store, book store, or drug store
- this process takes no more than 5 minutes per day
- if the weight does not go down by 1 lb. in 1 week then one can usually reduce the calorie intake by 100 calories per day and see a drop
- 100 calories is not a large amount of calories and should not result in hunger
- most people drink 6 oz. of juice (100 calories) per day
- 12 oz. of soda has 150-200 calories and a glass of wine or beer has180-250 calories
- many people can lose weight simply by drinking beverages with few calories (water, tea, diet soda, crystal light)
- Exercise is very useful
- daily exercise for 25 minutes is healthier than 1 hour three times per week
- most people would require 30 minutes of vigorous exercise such as walking 2 miles in 30 minutes to burn 150 calories
- one can undo this effort in 5 minutes with certain beverages
- Simplify the exercise process to remove barriers
- it is usually preferable to create a routine to be performed at home, perhaps in front of the television
- running in place, calisthenics, stationary bicycle, or treadmill would all work
- even simple activities such as walking in the hall for 15 minutes, chewing gum, and squeezing a rubber ball are helpful and burn calories
- Medications have generally been found to be of minor help, to have risks, and have reversal of gains when they are stopped
- thyroid replacement is necessary if thyroid function is underactive
- siburtramine (Meridia) is an inhibitor of norepinephrine and serotinin uptake
- orlistat (Xenical) reduces intestinal absorption of fats
- 120 mg per day with meals
- possible side effects include flatulence (gas), frequency of stool, urgency and incontinence of stool, spotting
- bupropion (Wellbutrin): an anti-depressant
- metformin (Glucophage) for type II diabetes may cause lactic acidosis
- contra-indicated in renal failure, heart failure, lung or liver disease
- Surgery , including gastric stapling and intestinal bypass
- generally reserved for those unable to focus on any program
- gastric stapling or bypass can reduce the size of the stomach or bypass loops of intestine
- benefits may be overcome by increased consumption of food
- benefits may be overcome by increased consumption of food
- vitamin deficiency may develop
- possible side effect may be frequent stool
Literature Cited
Yamovski, Susan et al.: Obesity, NEJM 346 #8 (2/21/02) pages 591-601.