Obesity
Question: What is Obesity?
Answer: Do you weigh more than you
should? If so, you're like more than 97 million other Americans who are
overweight or seriously overweight (obese). In the United States, obesity has
reached epidemic proportions. One in four adults are considered obese. And
childhood obesity is at an all-time high.
Obesity involves having an abnormally high proportion of
body fat. Doctors define obesity as having a body mass index (BMI) of 30 or
higher.
Obesity is more than a cosmetic concern. Being over-fat puts
you at greater risk of developing such serious health risks as high blood
pressure, diabetes, cardiovascular disease, stroke and cancer.
The human body, with its 30 billion to 40 billion fat cells,
can support some extra fat. Fat is important for storing energy and insulating
the body, among other functions. But after a certain point, body fat can begin
to interfere with your health. Ultimately, obesity can even be
life-threatening.
The good news is that even a modest weight loss of 10 to 20
pounds can bring significant health improvements. In many cases this can be
accomplished by committing to eating a healthier diet, exercising and changing
behaviors.
For those who don't respond to lifestyle changes,
prescription medications and surgical techniques are available to enhance the
weight-loss process.
With a positive attitude, you can lose weight. Yet, before
pursuing any plan to take off excess weight, consult your doctor. Crash diets
or other quick fixes can be dangerous to your health.
Question:
When is surgery appropriate for obesity?
Answer: It's
a stunning statistic: According to recent federal guidelines, more than half of
American adults are overweight or obese.
Surgery to reroute the digestive system or limit the amount
of food that can be eaten at one sitting is not for everyone who's overweight.
But it can be effective for those who are severely obese.
Not only can it promote significant weight loss, but it
often results in a reversal of weight-related chronic health conditions.
Defining the problem
Weight-reduction surgery is
not cosmetic surgery. Rather, it's intended for severely obese people who have
weight-related chronic health conditions.
Essentially, individuals who are 100 percent or more over
their ideal weight or at least 100 pounds overweight are considered severely
obese. Weight-related health conditions, including high blood pressure, heart
disease, diabetes, arthritis and sleep apnea, are important indicators as well.
Such chronic health conditions associated with severe
obesity increase chances for early death. As a result, these conditions may
signal a need to consider a surgical route to weight reduction.
Surgery can be an important aspect in treatment. But success
also depends on a person's determination to change his or her eating behavior
and a commitment to lifelong follow-up. Surgery doesn't replace the importance
of diet and exercise in weight management.
Vertical banded gastroplasty and the Roux-en-Y are two
common types of weight-reduction surgery.
Types of surgery
The most common types of
weight-reduction surgery promote weight loss by either:
- Restricting food
intake
— Restrictive procedures create a small pouch at the top of the stomach
and narrow opening to the stomach so you can't eat as much or as quickly.
The outlet is only about the diameter of a dime.
Unless very small amounts of food are eaten and chewed well,
vomiting is a common side effect.
The most frequently used gastroplasty technique is called
vertical banded gastroplasty (see illustration). The small pouch only holds
about 1 ounce, eventually expanding to 2 to 3 ounces over time (compared to the
usual stomach capacity of about 3 pints).
- Bypassing the normal
digestive process — Gastric bypass procedures create an extremely small
pouch for food entering the stomach and connect that pouch directly to the
small intestine. The connection bypasses most of the stomach and the first
portion of the intestinal tract.
These procedures not only restrict food intake but limit the
absorption of nutrients. For that reason, some vitamin and mineral supplements
may be required.
This type of surgery — as compared to gastroplasty — usually
results in greater weight loss and more success in maintaining a satisfactory
weight loss. However, gastric bypass may cause "dumping syndrome" —
nausea, cramping and diarrhea — especially if high-calorie sweets are eaten.
The most common gastric bypass procedure is the Roux-en-Y
(roo-en-why).
There are several other surgical procedures for weight
reduction, but they're either used infrequently or are still being studied.
Measuring success
Weight-loss surgery isn't for everyone. But when appropriate, it can
result in dramatic improvements in weight and health.
In the first 12 to 24 months, most people lose 50 to 60
percent of their excess weight. Generally, those who follow dietary and
exercise recommendations keep most of that weight off long-term.
The effect on chronic health conditions related to severe
obesity can also be significant. For example, people who are severely obese and
have type II diabetes (adult-onset) nearly always see a major improvement after
surgery.
In addition, high blood pressure disappears in about
two-thirds of people who have weight-reduction surgery, and many with sleep
apnea enjoy marked improvement.
Question: What
works for weight control and why?
Answer: If
you need to lose weight, here's what to do to improve your chances of losing
weight safely and keeping it off permanently:
- Make a commitment. Lose
weight because you want to, not to please someone else. You must be internally
motivated to lose weight because it's what you want to do.
- Get your priorities
straight. Don't try to improve your lifestyle if you're distracted by
other major problems. You're setting yourself up for failure. It takes
considerable mental and physical energy to change habits. If you're having
marital or financial problems or if you're unhappy with other major aspects of
your life, you may be less likely to follow through on your good intentions.
Timing is critical.
- Set a realistic goal. Try achieving the
weight you maintained easily as a young adult. If you've always been
overweight, reaching a weight at which levels of triglycerides, blood
sugar, blood pressure and energy improve may be a realistic goal.
Accept that healthy weight
loss is slow and steady. Aim to lose no more than 1 to 2 pounds a week. If you
lose as little as 1/2 pound a week, that's still good.
Learn to enjoy more healthy foods. Liquid meals, diet pills
and special combinations of foods aren't the key answer to long-term weight
control and better health. Instead, learn how to eat.
Surveys show that most people try to lose weight by eating
1,000 to 1,500 calories a day. But cutting calories to fewer than 1,200 (if
you're a woman) or 1,400 (if you're a man) usually doesn't allow enough food
for you to be satisfied in the long term.
Eating fewer than 1,200 calories often makes it difficult to
get enough of certain nutrients, such as folic acid, magnesium and zinc. And it
promotes temporary loss of fluids rather than permanent loss of fat.
Even small weight losses can bring health benefits
You don't have to lose a
lot of weight to enjoy health benefits from weight loss. Even modest losses can
bring major returns, particularly if you have health problems related to your
weight.
Losses of just 5 percent to 10 percent may help reduce your
blood pressure, improve triglyceride and cholesterol levels, reduce sleep apnea
symptoms, and cut your risk of joint problems, such as osteoarthritis. And, a
small weight loss can improve your self-esteem. Setting realistic, small goals
can provide a good start to a weight-loss program and can provide positive
reinforcement when you succeed. If you lose 3 pounds and your goal is 10, you
are 30 percent toward your goal.
Cutting calories is easier if you focus on limiting fat to
less than 30 percent of daily calories.
Cutting back on calories from fat allows you to eat more
nutrient-rich foods like whole grains, fruits and vegetables. You can also eat
more food for fewer calories.
Get and stay active
Dieting alone can help you
lose weight. Cutting 250 calories from your daily diet can help you lose half a
pound a week — 3,500 calories = 1 pound of fat. But add a 30-minute brisk walk
4 days a week, and you can double your rate of weight loss.
The goal of exercise for weight loss is to burn calories,
although there are many other benefits as well. Burning calories is a function
of frequency, duration and intensity of your activities. For many people it's
easier to keep a routine of longer-duration, lower-intensity aerobic exercises.
One of the best ways to lose body fat is through steady aerobic exercise, such
as walking, lasting more than 30 minutes.
Strength training exercises, such as weight training, are
also important since they help counteract muscle loss due to aging. And since
calories are burned in muscle, muscle mass is a key factor in helping maintain
a healthy weight. The more lean muscle mass you can preserve, the bigger
"engine" in which to burn calories.
Exercise sensibly by starting out slowly. Then gradually
increase duration and intensity. Walking is an ideal choice. Other options for
aerobic activities are swimming, bicycling, jogging and dancing. Decide, too,
if you like to exercise alone or with someone. Often, having a buddy helps you
stick to your schedule.
Even though regularly scheduled aerobic exercise is best for
losing fat, any extra movement helps burn calories. Start to park at the far
end of the lot or make several trips up and down stairs instead of using the
elevator.
Change your life
It's not enough to eat healthy foods and exercise for
a few weeks or even several months. You have to incorporate these behaviors
into your life.
To do that, you have to change the behaviors that made you
overweight in the first place. Lifestyle changes involve taking a good look at
your eating habits and daily routine.
Were you taught to clean your plate? If so, do you still
feel compelled to eat everything, even when you're full?
Assess your eating style. Do you eat fast? Do you take big
bites? When do you eat? While watching TV? All the time? Assess your shopping
and cooking techniques.
Then try working out a strategy to gradually change the
habits and attitudes that may have sabotaged your past efforts.
Make a healthier lifestyle — not the number of pounds you
shed — your primary motivation.
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