HEALTH TALK: Obesity – Part III

TREATMENT

You may actually need to lose less weight than you think to improve your health. The first goal in dealing with obesity is to achieve and maintain a healthier weight. You should always keep a check on your BMI to determine your weight category.

Slow and steady weight loss of 1 to 4 pounds a week is considered the safest way to lose weight and the best way to keep it off. Eating a healthier diet, changing behaviors, and exercising can accomplish this. Other treatments include surgery and prescription medication.

DIETARY CHANGES

An important factor for successful weight loss is consuming fewer calories.

Now, crash diets to reduce calories are NOT recommended because this can cut so many calories and nutrients that they lead to other health problems, like vitamin deficiencies. Neither is fasting the answer. Most of the weight you initially lose is from water, and it’s not good for your body to go without food for extended periods.

Very low calorie liquid diets are sometimes prescribed for seriously obese people. Medifast or Optifast, for example, provide about 800 calories a day – most adults take in roughly 2,000 to 2,500 calories a day.  Although people are usually able to lose weight on these very low calorie diets, most people regain the weight as quickly when they stop following these diets.

Over-the-counter liquid meal replacements, such as Slim Fast, also cut calories. These plans suggest replacing one or two meals with their product – a low calorie shake – then eating snacks of vegetables and fruits, and a healthy, balanced third meal that is low in fat and calories. This can be as effective as a traditional calorie- controlled diet.

To lose weight and keep it off, eat moderate amounts of nutrient-rich, low-fat, low-calorie foods. The following fundamentals of healthy eating may help:

•    Choose healthy foods.  These include fruits, vegetables, grain and lean sources of protein including beans, fish, low-fat dairy and lean meats. Forget junk foods – you know what they are.

•    Cut back on sweets.  Limit candies, cakes, cookies, muffins, pies, doughnuts and frozen desserts.  They are high in calories. For dessert, better choices include vanilla wafers, low-fat frozen yogurt, sorbet, or sherbert, also angel food cake. Get a recipe book if you don’t know what I’m talking about.

•    Reduce fat.  Fat has more than twice the calories of carbohydrate and protein, ounce for ounce. So reducing fat is important in reducing calories. High-fat foods include most fast foods, pastries, red meat, full-fat dairy products, oils, margarine, salad dressings, and mayonnaise. 20-35 percent of your total calorie intake should come from fat. Less that 10 percent of your total calories should come from saturated fats. Read labels.

•    Count calories.  Read food labels. Foods that are low in fat can sometimes be very high in calories.  Processed foods – most that are not fresh – often have hidden fat and sugar. Cut back on sugary soft drinks. They’re high in calories.

•    Watch portion sizes.  This is especially important when eating out because many restaurants serve oversized portions.

•    Choose the right carbohydrates.  45 to 65% of your total daily calories should come from carbohydrates. But stay away from simple carbohydrates, such as table sugar, and other sweeteners. Try to eat plenty of complex high-fiber carbohydrates, like whole-grain bread and pasta, brown rice, and other grains, such as oatmeal.

•    Think ‘energy density’.  This is the number of calories in a given volume of food. Fat is energy dense, so you don’t need so much to get a certain amount of calories. Vegetables and fruits are low energy density, so you can consume a lot, feel full and get a relatively small amount of caloric energy. A tablespoon of butter has the same number of calories as 20 cups of leaf lettuce. Which do you think is better for you to consume?

GROUP WEIGHT-LOSS PROGRAMS

You don’t have to go it alone.  Commercial group programs can support your efforts, giving you eating plans and reinforcement from others on the same path. Some of these groups are as follows. Much won’t be said about them because they are not available in Dominica. Perhaps this will serve as an impetus for one or more persons to start one or more.

Overeaters Anonymous.   Just as Alcoholics Anonymous can help compulsive alcohol drinkers (alcoholics), this group can help compulsive overeaters.  The approach is identical, with meetings focusing on 12 steps and 12 traditions.

TOPS (Take Off Pounds Sensibly).  This is mainly a support group which does not tell you what foods to eat or how much to consume, nor does it watch over your exercise levels. They do recommend an exchange dietary plan and publishes a healthy lifestyle guide that includes a full description of how to use the plan.

Weight Watchers.  We’ve all heard or seen a bit about this on TV. One of the things you might like about it is that there are no forbidden foods. You must follow a prescribed program, however, to achieve a certain reduction in your weight. Eventually, you reach the proper, healthy weight, and the focus moves to maintenance.

INDIVIDUAL WEIGHT-LOSS PROGRAMS

Figuring out how you’re supposed to eat to lose weight can be difficult, even if you have a plan. Busy schedules can preclude involved meal preparation or trying new recipes.

In these cases, you might need to consider calling on companies that prepare everything for you. These suppliers will obviously be expensive. Remember that.

•    Jenny Craig.  There are Jenny Craig centers, and there is an at-home program for people who don’t live near one. They also encourage long term weight loss through exercise, stress reduction and individual support. You can even receive telephone consultations. Frozen meals containing the right portion of protein, fat and carbohydrate are provided. This is quite convenient.

•    Nutri System, also delivers frozen meals to you door for a set price per week. You select your meals, desserts and snacks. Meals are prepared in low-calorie portions that Nutri System deems optimal for vitamins, minerals and other nutrients. You can also choose from among other products they have, such as salad dressings, crackers, and beverages. You still need to shop for fresh produce, however.

POPULAR DIETS

•    The Atkins diet.  Everyone has al least heard about this diet and many have tried it. I would dare say that many or most, if not all, have been disappointed by it. Suffice it to say that the medical community by and large frowns upon it because the tenets on which it is based are not medically sound. The long term health effects of this diet are unknown and potentially risky.

•    The Zone
•    South Beach Diet
•    Sugar Busters
•    Grapefruit diet
•    Cabbage Soup diet

In the interest of space and just so I don’t have to go into a Part 4, I only mentioned these. You can always speak to your nutritionist or dietician about them. Fad diets like these and others promote quick-and-easy weight loss. You may lose weight, and relatively easily, but you’ll gain it back. Fad diets don’t offer a permanent, healthy solution to the problem of obesity.

INCREASED PHYSICAL ACTIVITY

This cannot be divorced from diet programs but doesn’t mean you have to wear a sweat suit everyday. Here are some simple ways to add more activity to your day.

•    Use stairs, even where elevators or escalators exist.
•    Where there are parking lots, park in the furthest spot.
•    Walk or bike to work or to the store. Dominicans, please take note!!
•    Walk during lunch hour.
•    Play with your children instead of watching them play.
•    Walk with your family after dinner.
•    Do weekend chores the physical way – use a push mower to mow the lawn or wash your car manually (yourself).
•    Buy an exercise bike and pedal during TV shows or while talking on the phone.

If you’re obese, particularly if you’re unfit and have health problems, always check with your doctor before starting an exercise program.

BEHAVIOR CHANGE

To lose weight and keep it off, you need to make lifestyle changes:

•    Motivate yourself.
•    Make lifestyle changes a priority.
•    Have a plan.
•    Set small goals.
•    Surround yourself with good examples.
•    Avoid food triggers.
•    Keep a record.
•    Focus on the positive.
•    Don’t give up.

There are medications for weight loss that I’ll just mention, the prescription ones. Over-the-counter ones are discouraged.

•    Sibutramine (Meridia)
•    Orlistat (Xenical)
•    At least one other has been recently approved by the FDA.

Talk to your doctor about these.

SURGERY

This is an option if you’ve tried diet and exercise, and are still seriously obese.

Two main categories of surgery are:

•    Stomach surgery.
•    Stomach surgery plus intestinal bypass.

Specific operations under these two categories:

•    Vertical banded gastroplasty (VBG)
•    Gastric bypass

Talk to your surgeon about these.

**Liposuction is NOT a weight-loss plan, not a treatment for obesity. It is a body-shaping procedure.

See how complex obesity is? Try not to get there. If you are there, please get to work.

See you next week.

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4 Comments

  1. April 6, 2012

    Thanks Doc, as always, very interesting and informative article. I look forward to next week’s topic. Kind regards

  2. neso
    April 5, 2012

    i love this article. thanks , i go walking every morning with my dog ,that’s a good company to exercise with they love to walk and run .

  3. tect nee cal lity
    April 4, 2012

    Man i just find your column always worth reading;
    you give more genuine information than most of them medical institutions, and they are so easy to digest, yet people will by pass that and jump on the political comments. well to each his or her own i am a follower of yours.
    good work Doc. you are a breath of fresh air.

  4. blessed
    April 4, 2012

    Great Article. Graet advice. I am not anyway near obese but I find this article very interesting

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