Obesity is a Disease
In June 2013, the American Medical Association (AMA) classified obesity as a disease. According to the Centers for Disease Control and Prevention (CDC), the obesity rate in the United States has increased 50% from 1997 to 2012. It is well established that obese patients are at a higher risk for diabetes mellitus, heart disease, and even cancer. Physicians are now empowered to ask about weight, to identify any metabolic, mechanical, mental, and monetary problems associated with obesity, and prescribe lifestyle changes, medications, counseling, and possibly surgery. Currently, medical insurance does not cover treatments for obesity and this is expected to change. It is anticipated that with proper diagnosis of obesity and adequate treatment, the prevalence of diabetes and heart disease will decline.
Obesity is not simple to diagnose. Physicians need to examine the patient carefully and conduct a battery of tests before reaching a diagnosis. Typically, Americans view obesity as a consequence of overeating and lack of exercise. This is true for a majority of Americans, including adolescents. However, a small subset of patients appear heavier because they have a higher muscle mass (e.g., football players and wrestlers), pregnancy, certain medications (e.g., antipsychotic medications, steroids), Cushing’s syndrome, and polycystic ovary syndrome.
Once the physician diagnosis obesity secondary to lack of exercise and poor diet, they will recommend (1) exercise and (2) eating better. The advice is superb but has a half-life of 5 seconds: five-seconds in one ear and five-seconds out the other ear.
Start Exercising for 30 minutes a day, five days per week
For those who do not normally exercise, it is best to start slow. Start with a daily 30-minute walk or use an exercise machine (treadmill, stationary bike, elliptical machine, etc.) for 30 minutes at low intensity. Eventually, you want to increase your stamina up to your exercise goal. For most patients, the goal is cardiovascular exercise (cardio) for 30 minutes a day, five days a week. Ask your physician what your goal is and what type of exercise is acceptable. It may be different secondary to your own body’s limitations such as physical ability, heart, and lung condition. To avoid injury to muscles and joints, take any two days of the week for resting.
If your physician does not exclude any activities, then the type of exercise will depend on your preference. One of the most popular exercises is Zumba, which is essentially dancing. Zumba attracts many people because you get to listen to dance music, and scream and shout during the routine. According to Clarisa Eng, a fitness instructor based in Southern California, participants can burn as much as 800 calories in one hour. If you choose not to take up Zumba, you can select either the treadmill, stationary bike, stair master, elliptical machine, or swimming to get your cardio exercise. The key to a successful workout is reaching your target heart rate for 20 to 30 minutes. To calculate your target heart rate, do the following math:
There are many products on the market that will help identify when you have reached your target heart rate. Consider investing in a sport watch that will display your current heart rate (with or without a chest strap), your target heart rate, time, and calories burned. Always stop and rest if you feel faint or dizzy. Feeling faint, lightheaded, and dizzy are symptoms of overexertion or dehydration. Drink plenty of water or Gatorade ( or other sport drinks) during and after your exercise to avoid these symptoms. Notify your physician if symptoms do not subside or worsen.
Eating Better-A New Lifestyle Change
When it comes to eating healthier and better meals, it is best to incorporate two principles: (1) portion control and (2) portion plate. Portion control refers to knowing what makes up one serving of any food group. At restaurants, patrons mistakenly assume that their waiters are serving them a meal for one person. Although they are priced for one person, the meal usually has 2 to 3 servings of carbohydrates, up to 3 servings of meat, and only 1 serving of vegetables (probably as a garnish). It is no longer necessary to be a “plate killer," eating everything on the plate. You may take home half of your meal for another day or share your meal with a friend.
To create a healthy meal, you need to know its basic components or food groups. Each food group has a recommended portion (of a plate). Imagine that your food plate is divided into three parts: ½ of the plate is vegetables and fruit, ¼ of the plate is protein and meat, and ¼ of the plate is carbohydrates (preferably whole grains).
Making Sense of the Portion Plate: A Breakfast Example
If you want to eat breakfast, ensure that your plate is filled with the three food groups with the correct portions. If you are still hungry after eating one slice of wheat toast (whole grains), one boiled egg (protein), and a bowl of strawberries (fruit), then increase the amount of vegetables and fruits until you feel satiated. Try eating a medium-sized banana or apple.
Whole grains are preferred over refined grains for carbohydrate consumption. Whole grains are listed as “dietary fiber” on every food nutrition label. Avoid foods that have little dietary fiber and/or high amounts of sugar or total carbohydrates.
To lose one pound of weight per week, you need to eliminate 3,500 calories per week which is 500 calories per day. There are two ways to achieve this:
(1) Decrease caloric intake of 500 calories of day by following these steps.
Consider your daily intake of food and record it in a food journal. By recording your food consumption, you’ll know exactly what you have been eating. Many patients are unknowingly consuming an excess amount of junk food, which is revealed by the food journal.
As an alternative to a food journal, you can download a free app from MyFitnessPal.com. The app is called the Calorie Counter and Diet Tracker. On your smartphone or computer, you can record your food intake and activities. It will provide a breakdown of calories, carbohydrates, protein, and fat consumed. The program also gives you an estimate of how many calories were burned from your recorded activities.
To decrease your caloric intake, stop eating a high-calorie snack or substitute the sugar filled drink with a glass of water or low-calorie iced tea.
(2) Burn 500 calories during exercise per day. Exercise and monitor your caloric burn on your watch or machine. The amount of calories burned is dependent on two factors: the length of time exercised and the level of intensity.
If you combine exercise and eliminating calories, weight loss will occur more quickly. The recommended weight loss is 1-2 pounds per week. In the beginning, you will shed weight very easily with exercise and better eating habits. After the first significant weight loss, your weight will plateau regardless of your regimen. This is your body signaling that you need to increase your exercise time and intensity (burn more calories) or decrease your caloric intake even more (eat less calories).
Every patient is different; your physician will establish an adequate and unique weight loss goal for you. Embarking on a new healthy lifestyle is not easy. Do not feel angry or depressed because you overindulged on your vacation or succumbed to a whole pint of vanilla ice cream. Just remember, tomorrow is a new day and a new day is a great day to start living better.
About the Author
Dr. Karine Wong has a 10 year history of working in hospital management and 2 years as a hospital pharmacist and outpatient pharmacist. She recently published a children's book called Don't Sit on Her.
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