Thursday, September 26, 2013

Overweight, Obesity, and Weight Loss

Overweight, Obesity, and Weight Loss

How many women in the United States are overweight or obese?
Sixty percent or more of women in the United States are overweight, according to 2007 estimates from the National Center for Health Statistics of the Center for Disease Control and Prevention. Just over one-third of overweight adult women are obese.
How do I know if I’m overweight or obese?
Have a doctor find your body mass index (BMI). BMI is a measure of body fat based on height and weight. People with a BMI of 25 to 29.9 are considered overweight. People with a BMI of 30 or more are considered obese.
What causes someone to become overweight or obese?
You can become overweight or obese when you eat more calories (KAL-oh-rees) than you use. The unit of energy in the food you eat is called a calorie. Your body needs this energy to function and to be active. But if you take in more energy than your body uses, you will gain weight.
Many factors can play a role in becoming overweight or obese. These factors include:
  • Behaviors, such as eating too many calories or not getting enough physical activity
  • Culture and environment
  • Genes
Overweight and obesity problems keep getting worse in the United States. Some cultural reasons for this include:
  • Larger portions
  • Little time to exercise or cook healthy meals
  • Not walking or biking, but using cars
What are the health effects of being overweight or obese?
Being overweight or obese can increase your risk of:
  • Heart disease
  • Stroke
  • Type 2 diabetes
  • High blood pressure
  • Problems breathing
  • Arthritis
  • Gallbladder disease
  • Some kinds of cancer
Your only risk isn’t excess body weight, though. The places where you store your body fat also affect your health. Women with a “pear” shape tend to store fat in their hips and buttocks. Women with an “apple” shape store fat around their waists. If your waist is more than 35 inches, you may have a higher risk of weight-related health problems.
What is the best way for me to lose weight?
If you use more calories, then you will lose weight. You can do this by following a healthy eating plan and being more active. Before you start a weight-loss program, talk to your doctor.
Safe weight-loss programs that work well:
  • set a goal of slow and steady weight loss — 1 to 2 pounds per week
  • Eating plans that are low calorie
  • encourage you to be more physically active
  • teach you about healthy eating and physical activity
  • adapt to your likes and dislikes and cultural background
  • Keep your weight off after losing it
How can I make healthier food choices?
The U.S. Department of Health and Human Services (HHS) and Department of Agriculture (USDA) offer tips for healthy eating in Dietary Guidelines for All Americans.
  • Focus on fruits. Eat a variety of fruits — fresh, frozen, canned, or dried — rather than fruit juice for most of your fruit choices. For a 2,000-calorie diet, you will need 2 cups of fruit each day. One banana, one large orange, and one-quarter cup of dried apricots is two cups.
  • Vary your veggies.Eat more:
    • dark green veggies, such as broccoli, kale, and other dark leafy greens
    • orange veggies, such as carrots, sweet potatoes, pumpkin, and winter squash
    • beans and peas, such as pinto beans, kidney beans, black beans, garbanzo beans, split peas, and lentils
  • Get your calcium-rich foods. Drink three cups of milk each day. Or, you can get an equivalent amount of low-fat yogurt and/or low-fat cheese each day. 1.5 ounces of cheese equals 1 cup of milk. If you don’t or can’t consume milk, choose lactose-free milk products and/or calcium-fortified foods and drinks.
  • Make half your grains whole. You should eat three ounces of whole grain cereals, breads, crackers, rice, or pasta each day. One ounce is about 1 slice of bread, 1 cup of breakfast cereal, or 1/2 cup of cooked rice or pasta. Look to see that grains such as wheat, rice, oats, or corn are referred to as “whole” in the list of ingredients.
  • Go lean with protein. Choose lean meats and poultry. Bake it, broil it, or grill it. Vary your protein choices with more fish, beans, peas, nuts, and seeds.
  • Limit saturated fats. Saturated fatty acids should account for ten percent of your calories. Most fats should come from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. When choosing and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free.
  • Limit salt. Get less than 2,300 mg of sodium (about 1 teaspoon of salt) each day.
How can physical activity help?
The new 2008 Physical Activity Guidelines for Americans state that an active lifestyle can lower your risk of early death from a variety of causes. There is strong evidence that regular physical activity can also lower your risk of:
  • Heart disease
  • Stroke
  • High blood pressure
  • Bad cholesterol levels
  • Type 2 diabetes
  • Metabolic syndrome
  • Colon and breast cancer
  • Falls
  • Depression
When combined with lower calorie intake, regular exercise ca help prevent unhealthy weight gain.. If you are overweight or obese, losing weight can lower your risk for many diseases. Being overweight or obese increases your risk of heart disease, high blood pressure, stroke, type 2 diabetes, breathing problems, osteoarthritis, gallbladder disease, sleep apnea (breathing problems while sleeping), and some cancers.
Regular physical activity can also improve your cardiorespiratory (heart, lungs, and blood vessels) and muscular fitness. Exercise can improve mental function for older adults.
Physical activity may also help:
  • Improve functional health for older adults
  • Reduce waistline size
  • Lower risk of hip fracture
  • Reduce risk of lung cancer
  • Lower risk of endometrial cancer
  • Maintain weight after weight loss
  • Increase bone density
  • Improve sleep quality
Your health will improve if you do the following:
    • Moderate Activity
      During moderate-intensity activities you should notice an increase in your heart rate, but you should still be able to talk comfortably. An example of a moderate-intensity activity is walking on a level surface at a brisk pace (about 3 to 4 miles per hour). Other examples include ballroom dancing, leisurely bicycling, moderate housework, and waiting tables.

      Two and one-half hours of aerobic physical exercise
    • 1 hour and 15 minutes of vigorous-intensity aerobic physical activity
    • Combining moderate and vigorous aerobic physical exercise.
  • Muscle-strengthening activities on 2 or more days
Vigorous Activity
If your heart rate increases a lot and you are breathing so hard that it is difficult to carry on a conversation, you are probably doing vigorous-intensity activity. Examples of vigorous-intensity activities include jogging, bicycling fast or uphill, singles tennis, and pushing a hand mower.

Physical activity should be in addition to your routine activities, such as walking or cleaning.
If you want to lose a substantial (more than five percent of body weight) amount of weight, you need a high amount of physical activity unless you also lower calorie intake. This is also the case if you are trying to keep the weight off. Many people need to do more than 300 minutes of moderate-intensity activity a week to meet weight-control goals.
How You Can Increase Your Physical Activity
If you normally…
Try this instead!
park as close as possible to the store
park farther away
let the dog out back
take the dog for a walk
take the elevator
take the stairs
have lunch delivered
walk to pick up lunch
relax while the kids play
get involved in their activity
What drugs are approved for long-term treatment of obesity?
The Food and Drug Administration has approved two drugs for long-term treatment of obesity:
  • Sibutramine (si-BYOO-tra-meen) suppresses your appetite.
  • Orlistat (OR-li-stat) keeps your body from absorbing fat from the food you eat.
These medicines are for people who:
  • Have a BMI of 30 or higher
  • Have a BMI of 27 or higher and weight-related health problems or health risks
If you take these medicines, you will need to follow healthy eating and physical activity plans at the same time.
Prior to taking these medications, talk with your doctor about the benefits and the side effects.
  • Sibutramine can raise your blood pressure and heart rate. If you have a personal history of high blood pressure, heart problems, and stroke. Other side effects include dry mouth, headache, constipation, anxiety, and trouble sleeping.
  • Orlistat may cause diarrhea, cramping, gas, and leakage of oily stool. Eating a low-fat diet can help prevent these side effects. This medicine may also prevent your body from absorbing some vitamins. Your doctor will know if you should take vitamin supplements.
What surgical options are available to treat weight loss?
Weight loss surgeries — also called bariatric (bair-ee-AT-rik) surgeries — can help treat obesity. Surgical treatment for weight loss is recommended only if:
  • Have a BMI of 40 or higher
  • Have a BMI of 35 or higher and weight-related health problems
  • Other weight loss methods don’t work.
Common types of weight loss surgeries are:
  • Roux-en-Y (ROO-en-WEYE) gastric bypass. A stomach pouch is created by a surgeon using surgical staples. This limits the amount of food you can eat. The pouch is attached to the middle part of the small intestine. Food bypasses the upper part of the small intestine and stomach, reducing the amount of calories and nutrients your body absorbs.
  • Laparoscopic (LAP-uh-ruh-SKAWP-ik) gastric banding. A band is placed around the upper stomach to create a small pouch and narrow passage into the rest of the stomach. The amount of food you ingest is limited and the size of the band can be adjusted. A surgeon can remove the band if needed.
  • Biliopancreatic (bil-ee-oh-pan-kree-at-ik) diversion (BPD) or BPD with duodenal (doo-AW-duh-nul) switch (BPD/DS). In BPD, a large part of the stomach is removed, leaving a small pouch. The surgeon connects the pouch to the end of the small intestine, bypassing other parts of the small intestine. In BPD/DS, less of the stomach and small intestine are removed. This surgery reduces the amount of food you can eat and the amount of calories and nutrients your body absorbs from food. This surgery is used less often than other types of surgery because of the high risk of malnutrition.
Your doctor will let you know beforehand of the changes you need to make after surgery. You will need to:
  • Follow your doctor’s directions as you heal
  • Make lasting changes in the way you eat
  • Follow a healthy eating plan and be physically active
  • Take vitamins and minerals if needed
You should also talk to your doctor about risks and side effects of weight loss surgery. Side effects may include:
  • Infection
  • Leaking from around the staples
  • Hernia
  • Blood clots in the leg veins that travel to your lungs (pulmonary embolism)
  • Dumping syndrome, in which food moves from your stomach to your intestines too quickly
  • Getting too few vitamins from food
Is liposuction a treatment for obesity?
Liposuction (LY-poh-suhk-shuhn) is not a treatment for obesity. In this procedure, a surgeon removes fat from under the skin. Liposuction can be used to reshape parts of your body. There is no promise of weight loss with this surgery.
I’m concerned about my children’s eating and physical activity levels. How can I help improve their habits?
When a child learns to do something, it is hard to modify when they are older This is true for their eating and physical activity habits. Many children have a poor diet and are not very active. They may eat foods high in calories and fat and not eat enough fruits and vegetables. They also may watch TV, play video games, or use the computer instead of being active.
Kids who are overweight have a greater chance of becoming obese adults. Overweight children may develop weight-related health problems like high blood pressure and diabetes at a young age. The body mass index (BMI) can help you determine if your child is overweight.
For Children and Teens
You can help your child build healthy eating and activity habits.
  • Watch less TV and play fewer video games.
  • Make sure your child is physically active for 1 hour each day.
  • Find out about activity programs in your community.
  • Ask your children what they like to do and what they’d like to try, like Little League Baseball or a swim team.
  • Plan active family activities.
  • Help your children eat healthy foods.
  • Make your children cook healthy meals with the family.
  • Don’t do other things while you eat, like watch TV.
  • Give your kids healthy snacks, like fruits, whole-grain crackers, and vegetables.
  • Stop going to fast-food restaurants.
  • Involve the whole family in healthy eating. Don’t single out your children by their weight.
We know children do what they see — not always what they are told. Set a good example for your children. Your kids will learn to eat right and be active by watching you. Setting a good example can mean a lifetime of good habits for you and your kids.

Compliments of Kshamica Nimalasuriya MD, MPH
Preventive Medicine & Public Health

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