Obesity & Weight Loss
Time for a change
Throughout much of recorded history, people have struggled to get enough food. Today, many people in the world, even in the United States, remain undernourished. However, the many people now face another nutritional crisis: they are overweight. This is a major public health issue because being overweight can lead to serious health problems.
We cannot change our genetic make-up, but the good news is that we can do things to make a difference.
Whenever you decide to take action, your doctor can help. It is a good idea to also enlist the support of friends or family members. But remember that ultimately the responsibility for your health, your weight, and your activity rests squarely on your shoulders. Neither your doctor, your friends, or your family can make you do this.
Why is being obese or overweight a problem?
Being overweight (obese) greatly increases the risk for significant health problems, such as diabetes (high blood sugar), hypertension (high blood pressure), heart disease, hypercholesterolemia (high cholesterol), joint pains, sleep disorders (including sleep apnea), urinary incontinence, some cancers, menstrual irregularities, and other maladies. Every year in the United States, about 300,000 adults die from causes related to excess body weight.
Perhaps you don't have these problems now, but merely want to prevent them. Or, perhaps you already have problems, and want to know how to deal with them. Maybe you are on medications for these problems, but your problems are not very well controlled.
The good news is that getting control over your weight will lesson your risk and/or make these problems easier to manage. It is the cornerstone of treating these problems. Even if medications are required, these do not take the place of a proper diet and exercise. Reducing your weight may even enable you to reduce or eliminate some of the medications you might now require.
It is therefore extremely important that you lose weight if you are overweight. Your goal should be to reach your ideal body weight. While this goal may be too ambitious for many, ANY improvement you make in your weight can and will lower your risks.
How do I lose weight?
Weight control requires attention to both dieting and exercise. Quite simply, it is a matter of how many calories you consume, and how many you utilize. Extra calories are stored as fat. In order to lose weight, you must REGULARLY burn more calories than you consume.
DIETING
Food Choices
The following advice is sound for anyone to follow. Even if you are not overweight, it will help you to maintain your weight.
- Eat less sugar. Do not consume table sugar, regular soft drinks, syrup, honey, candy, jelly, or jam. Eat fruits if you want something sweet. If you like fruit juices and/or canned fruits, choose those that have no added sugar. Ice milk and frozen yogurt are ok in small amounts. Use a non-nutritive sweetener instead of sugar.
- Eat less fat. Avoid animal fat and fatty meats in general, such as hot dogs, bologna, untrimmed meats, skins, etc. Choose lean meats, such as skinless chicken and fish. Bake, broil, or grill your meats.
- Avoid fried foods, cream, regular ice cream, butter, and lots of salad oil. Choose low-fat milk and cottage cheese. Limit your use of cheese.
- Eat all you want of fresh fruit, celery, carrots, peppers, tomatoes, onions, sauerkraut, beets, turnips, okra, radishes, broccoli, green beans, lettuce, spinach, cucumbers, asparagus, cabbage, and all other green vegetables.
- Eat a moderate amount: whole grain bread, cereal, potatoes, brown rice, corn, and beans. These foods are not particularly fattening, but often are made fattening by what is added to them, like butter, sour cream, cheese, etc. Still, these foods are starches, and consuming too much of them may contribute to problems controlling your blood sugar.
- Fiber: You should eat some foods that are high in fiber, like whole wheat bread, bran cereals, and vegetables.
- Hidden calories: alcohol (beer, wine, liquor, many liquid medications), fried snack foods and things with added sugar.
Changing Habits
- Don't go grocery shopping when you're hungry.
- Learn to read the labels on food containers, and learn what they contain. Choose wisely!
- Eat only when you are hungry, not because you are bored, stressed, or tired.
- Eat only at the dining table.
- Don't go choose the large orders of fries, etc.
- Don't drive, watch television, or talk on the phone when you eat.
- Stop eating when you are no longer hungry. Don't continue to eat until you are completely full.
EXERCISE
If you try losing weight only by eating less, and do not exercise, you will still have trouble losing weight. Your metabolic rate will simply slow down to conserve energy. Only 9% of people lose weight by dieting alone.
You should do some form of vigorous exercise for 30 minutes each day. If vigorous activity isn't possible, walking for 1 hour a day will help. Not only will burn calories faster while exercising, exercising enables your body to use calories more efficiently for the rest of the day, effectively raising your metabolic rate.
Regular physical activity has been shown to help prevent heart disease, type 2 diabetes and osteoporosis, as well as other chronic conditions. It is important for maintaining good health in all adults and children, regardless of whether their weight is a problem or not. As the following suggestions make clear, lifestyle changes do not have to be drastic. Simple measures applied every day can make a significant difference over time.
- Increase whatever physical activity you are now doing by adding another 10 minutes a day, or increase the intensity of your exercise from low to moderate.
- Don't use a remote control when watching TV. Simply getting up to change the channel can make a difference in your activity level.
- Limit time spent online, watching TV, and playing video games to less than two hours per day.
- Take the stairs instead of the elevator or, get off one floor earlier and take the stairs to the last floor.
- Park at the far end of the parking lot and walk to your destination, rather than parking as close as possible. Get off the bus one stop earlier and walk the rest of the way.
- Do more household chores (e.g., dusting, vacuuming, weeding).
- Walk/run with the dog and/or the kids.
- Use an exercise machine (e.g., treadmill, bike) while watching TV.
- Take "active" vacations. Go hiking or ride bicycles.
- Walk to do errands (e.g., grocery store, post office, etc.) instead of driving.
- Consider buying a pedometer, which measures how many steps you take a day, and gradually increase the number of steps you take every day. (Pedometers can be purchased at sporting good stores.)
- Don't be embarrassed about exercising!
How Active Are You?
Moderate physical activity
Hard physical activity
Very hard physical activity
Walking a mile in 15-20 min (3-4 mph)
Walking or jogging (12 min/mile)
Jogging (<10 min/mile)
Treading water
Swimming laps (light effort)
Swimming laps (vigorous effort)
Bicycling (10 mph)
Bicycling (12 mph)
Bicycling (> 14 mph)
Dancing or tai chi
High impact aerobics
Step aerobics (6- to 8-in steps)
Yard work/gardening
Mowing lawn with hand mower
Digging a ditch
Hiking
Playing doubles tennis
Playing singles tennis
Vacuuming
Moving furniture
Playing basketball or soccer
Playing actively with children
Weight lifting
In-line skating
Formal Weight Loss Programs
Some commercial weight-loss programs, such as Weight Watchers, TOPS, Jennie Craig, and Slim for Life, combine good advice with support about nutrition and physical activity. This type of support from an organized group may help you achieve and maintain weight loss.
Tell your family physician if you are participating in a weight-loss program. If you have one or more serious conditions (in addition to being overweight or obese), or if you're taking multiple medications, you need to work with your doctor to choose a program that is safe and appropriate for you.
Weight Loss Medications
Some medicines can be effective in helping obese patients lose weight over short periods of time. The main problem is that no study has shown these medication to help in the long-run. People often gain the weight back as soon as they discontinue the medications.
The guidelines for people who are candidates for medical therapy for weight loss are those with a:
- BMI of 30 or more and no risk factors for additional conditions
- BMI of 27 or more (but less than 30) with one or more obesity-related conditions or other diseases.
Over-the-counter dietary supplements
OTC dietary supplements that contain ephedra or ephedrine and caffeine can enhance short-term weight loss, their safety is questionable. They can cause nausea and vomiting, anxiety and changes in mood, and palpitations. These medications have been linked to heart attacks, seizures, strokes, and death. Be sure to let your doctor know if you are taking these medications.
Conditions and Medications Preventing Weight Loss
Some medical conditions and medications can interfere with efforts to lose weight. The doctor can advise you about these situations.
Some Medical Conditions that May Make it Difficult to Lose Weight
- Hormonal: Polycystic ovarian disease, Cushing's disease, Diabetes, Hypothyroidism
- Cardiovascular: Congestive heart failure, Idiopathic hypertrophic cardiomyopathy, Heart valve disorders
- Sleep: Obstructive sleep apnea
- Eating Disorders: Bulimia
Medications that May Cause Weight Gain
- Antihistamines (Claritin, Allegra, etc.)
- High blood pressure: Alpha blockers (Hytrin, Cardura, etc), Beta blockers (such as Betapace, Blocadren, Tenormin), Methyldopa (Aldomet)
- Contraception: Progestins (in certain oral contraceptives)
- Diabetes: Insulin, Sulfonylureas (glyburide, glipizide, and others),
- Epilepsy: Valproate (Depakene),
- Depression: Tricyclic antidepressants (amitriptyline, nortriptyline, and others)
- Psychiatric: Lithium (Eskalith, Lithobid and others); Neuroleptics (Zyprexa, Risperdal, and others)
Final Thoughts
Someone starting a diet may lose several pounds in the first few days, causing great excitement. You might think this is diet going to be easy! However, this initial loss represents only a loss of water, or 'diuresis,' typically due to a reduced salt intake or higher consumption of plain water.
A goal of losing a pound a week is not difficult. At that rate you would lose 52 pounds in a year. You could do that by eliminating 2 regular soft drinks a day. You didn't become overweight overnight, so be patient!
Often people try to diet and lose weight, only to gain all the weight back and more. Their failure was due to the fact that they did not enjoy their food or the exercise. It is important to find healthy food choices that you actually like and physical activity that you genuinely enjoy.
Perhaps a more successful approach is not to 'go on a diet,' but chose to simply eat healthier food in healthier ways. And rather than deciding to 'exercise,' chose to start doing those activities that you really enjoy.
Adapted from American Academy of Family Physicians