Weight Control and Obesity

What is weight control?

Weight control is a term used to discuss managing and maintaining a healthy body weight. Having a healthy body weight can mean different things for different people. The traditional way this weight is calculated is with the body mass index (BMI). Your BMI uses your height and weight to figure out your ideal weight range. This number can vary, but typically, you are considered obese if your BMI is over 30.

Your waist line can also be a sign of obesity. For a woman, a healthy waist measurement should fall below 35 inches. For a man, it should be less than 40 inches. This measurement is called your waist circumference.

When talking about waist circumference, it’s also good to discuss body shapes. People have all different body shapes. Some are an hourglass, with shoulders and hips around the same size but a smaller waist. Some are pear-shaped, with smaller measurements on the top and larger on the bottom. If you have an apple-shape — also nicknamed ‘potbelly,’ ‘spare tire’ or ‘muffin-top’ — you carry more fat in and around your abdominal organs. Having this extra fat in your abdomen can increase your risk of many serious medical conditions that are linked to obesity.

What’s the difference between being overweight and being obese?

Both terms mean that you have excess body fat, but they are two different levels of a similar thing. Being overweight means that you have some extra fat. Although you are higher than your goal weight, you don’t have as much body fat as the next level — obesity. When you have high levels of body fat, it’s considered obesity. This is typically determined by your primary care physician during an appointment. Talk to your physician about the differences between being overweight and obese and what that means for your body type.

Why does obesity happen?

Obesity happens when your calorie intake is higher than the amount of energy you burn off each day. Think of the food you eat as fuel. This fuel is meant to power you and as you move throughout your day, you burn off this fuel. However, if you take in too much fuel, it isn’t burned off. This just sits in your body, not serving its purpose.

There can be many reasons why weight gain happens, and often it’s more than one reason at a time. Some of the factors that can add to weight control issues include:

• Environmental factors: Lifestyle behaviors, like what you eat and how active you are on an average day, can impact your weight.
• Psychological factors: Eating can be linked to your emotions. We eat to celebrate something good and we eat to grieve something sad. The emotional side of food can lead to things like eating due to depression, anxiety, boredom and binge eating. Binge eating is when you eat a large amount of food at one time, while often feeling out of control of how much you eat.
• Genetic and Environmental factors: Obesity can run in your family. This means that if you have family members who are overweight or obese, you might have an increased risk. It’s unclear if this is from your genetic code, or lifestyle behaviors (diet and exercise) that are passed down through generations. However, many people with family members who are overweight are not themselves overweight.
• Medical conditions: Sometimes, a medical condition or medication can actually lower your metabolism (ability to burn calories into energy), which can cause obesity. Medications like steroids and antidepressants can cause weight gain. Medical conditions can include:
  • Hypothyroidism.
  • Cushing’s syndrome.
  • Depression.
  • Certain neurologic problems.

Can being overweight lead to medical problems in the future?

Your weight can play a large role in your health over time. Being overweight is linked to several health problems, including:

• Heart disease and stroke.
• High blood pressure (hypertension).
• Diabetes.
• Certain cancers.
• Gallbladder issues and gallstones.
• Osteoarthritis.
• Gout.
• Breathing problems, such as sleep apnea (when you stop breathing for a short amount of time during sleep).

Generally, the more obese a person is, the higher the risk of developing a medical condition. A person who is 40% overweight is twice as likely to die prematurely as an average-weight person. This typically happens over a number of years with a higher weight (10 to 30 years). Losing the weight can really benefit your health, both now and in the long term.

Many physicians who specialize in obesity believe that people who are less than 20% above their healthy weight should try to lose weight if they have any of the following risk factors:

• A family history of certain chronic diseases: These can include conditions like heart disease and diabetes.
• A pre-existing medical condition: Health conditions like high blood pressure (hypertension), high cholesterol and high blood sugar levels are all warning signs of some obesity-associated diseases.
• Having a body shape that’s considered apple-shaped: If you carry excess weight around your abdomen, you could be at a higher risk of developing heart disease, diabetes or cancer than people of the same weight who are pear-shaped.

The good news is that even a modest weight loss of 10 to 20 pounds can bring significant health improvements, including lower blood pressure and cholesterol levels.

How can I control my weight?

Controlling your weight isn’t a short-term thing — you need to think long-term about ways to control your weight and make changes to your lifestyle. Weight loss should be gradual, and careful follow-up is needed to keep you from rebound weight gain. Changing your nutrition, behavior and lifestyle are the only ways to make long-lasting changes in your weight. These changes focus on changes to your eating and exercise habits.

A few ways you can change your behavior and lifestyle that will help you control your weight include:

• Learning about nutrition.
• Changing your eating habits.
• Increasing your physical activity.
• Changing your mindset about eating.
• Joining a weight loss program.
• Building up support systems.
• Following any drug therapies ordered by your physician.

The keys to weight control include making lifestyle changes, such as increasing your exercise and activity level. Find a physical activity or kind of exercise that you enjoy. Whether this is a dance class or long walks, having fun will help you stay motivated over the long-haul.

Can prescription weight loss medications help me control my weight?

In some cases, your physician may recommend using a prescription drug to treat obesity. Medication isn’t a replacement for changing your diet and exercise routine, but should be used along with a program of diet and exercise to help you get to your goal weight.

The medications that may be recommended work by suppressing your appetite. They raise specific hormones, such as noradrenalin or serotonin in the nervous system, creating a feeling of fullness. But these medications will not work alone — you simultaneously need to change your lifestyle (diet and exercise).

Weight loss medications may be considered if you:

• Have a BMI that’s greater than 30 with no obesity-related conditions.
• Have a BMI that’s greater than 27 with two or more obesity-related conditions.

Most available weight-loss medications are approved by the FDA for short-term use, meaning a few weeks or months. Talk to your physician about whether or not weight-loss medications could be an option for controlling your weight.

Is weight loss surgery a good way to control my weight?

Weight loss (bariatric) surgery can also be an option for some people. Surgery should only be considered after other attempts to lose weight have been unsuccessful, or if you have an obesity-related disease.

There are two main types of weight-loss surgery. These include:

• Roux-en-Y gastric bypass: In this procedure, the size of the stomach is decreased, and part of your small intestine, where some foods are absorbed, is bypassed. This is done by creating a pouch at the top of the stomach and the bottom of the pouch is connected to a part of the small intestine. Limiting the physical space in your stomach is meant to make you feel full faster — limiting the amount you eat at each meal. By skipping part of the intestine, your body doesn’t absorb as many calories from the food.
• Sleeve gastrectomy: This procedure simply limits the size of the stomach and makes it into the shape of a slender sleeve. This limits the quantity of food that can be eaten at one time, and the food that enters the sleeve-shaped stomach passes straight through to the small intestines.

Surgery should be done at centers committed to long-term follow-up in addition to patient education, monitoring of vitamin and mineral levels, and exercise and behavior modification programs. In most cases, candidates for these surgeries have to be:

• Severely obese (a BMI greater than 35).
• Well-informed and educated about the surgery; and committed to the lifestyle changes that will be needed.
• Assessed by a dietitian, psychologist, endocrinologist and other specialists before being considered for the procedure.

These types of surgeries are typically successful, but the success can be lost and weight regain can occur over time if changes to nutrition and lifestyle are not maintained.

How much exercise should I do to control my weight?

Activity and movement can greatly help your health. By introducing exercise into your routine, you can gain significant health benefits. It’s recommended that you try to work in about 30 minutes of moderate to intensity aerobic (low to high-intensity activity where your breathing and heart rate increase) exercise daily.

Some types of aerobic exercises can include:

• Jogging.
• Walking.
• Swimming.
• Bicycling.
• Rowing.
• Aerobics (such as with an exercise class or video).

What are fad diets and how do I spot one

Fad diets are nutrition plans that are typically popular for a short amount of time — sometimes promoted by celebrities — that often eliminate entire food groups from the diet. These diets may or may not promote healthy eating and weight loss. Unfortunately, these popular diets are not always the best option for many people and don’t end with long-term weight control. You should generally avoid fad diets and focus instead on portion control, cutting down on empty calories (like sweets and sugary drinks) and increasing exercise. While there’s no set approach to identifying a fad diet, many have the following characteristics:

• Recommendations that promise a quick fix.
• Dire warnings of dangers from a single product or regimen.
• Claims that sound too good to be true.
• Simplistic conclusions drawn from a complex study.
• Recommendations based on a single study.
• Lists of “good” and “bad” foods.
• Recommendations made to help sell a product.
• Elimination of one or more of the main food groups.

How can I lose weight and keep it from coming back?

When you are working to lose weight and keep the weight off, there are a few tips you can keep in mind, including:

• Setting realistic weight loss goals, such as a one- to two-pound weight loss per week. Those who lose weight slowly, by eating less and exercising more, tend to keep their lost weight off. Even a half pound weight loss per week would result in a 25-pound loss over one year.
• Eating fewer calories by cutting down on portion sizes. An easy way to portion a plate is to put fruits and vegetables on half, starch on one quarter of the plate and protein on the other quarter of the plate.
• Aiming for at least five small handfuls of fruits and vegetables per day.
• Not skipping meals. This slows down metabolism and can lead to increased hunger and binging.
• Choosing foods high in fiber, such as whole grain breads, cereals, pasta, rice, fruits and vegetables. These foods will give you more chewing satisfaction, while the higher fiber content may make you feel fuller on fewer calories.
• To ensure that you are eating healthy, keep an accurate food journal. Write down everything you eat or drink. Be honest and accurate. The food journal will help you learn about your eating habits and help you assess the food choices you are making.
• Eating a variety of foods. Include all food groups to get all the nutrients you need.
• Limit eating out and especially fast food.

Planning ahead. Plan meals for the week, create a grocery list, and keep healthy foods available to you in your kitchen and pantry, while avoid purchasing foods that are less healthy.