This post was written based on a presentation by Ryan Singerman, DO, PPG – Family Medicine, director, PPG – Weight Management & Bariatric Surgery, at the 2023 Men’s Health Expo.
Since 2008, no country on earth has seen a declining body mass index (BMI) rate. More people are sick worldwide from overweight diseases than ever before and, according to the World Health Organization (WHO), obesity has nearly tripled since 1975. Understanding the impact and nuances of this disease (yes, it’s a disease) can help develop strategies to address the risks of carrying excess weight.
Obesity redefined
While BMI has long been believed to be the best indicator of obesity, the view is shifting a bit.
Previously, a person was considered obese if they had a BMI greater than or equal to 30. Now, the Centers for Disease Control and Prevention (CDC) and WHO define obesity as, “excess body fat presenting a risk to one’s health.”
So, based on factors such as your age, sex and ethnicity, you could have a BMI that falls outside of the previous threshold and still be considered obese.
Why should we care about obesity?
There are many facets of life impacted by being overweight.
The financial impact of obesity comorbidities
Direct costs
- Health insurance
- Copays
- Medications
- Labs
- Imaging
- Surgeries
Indirect costs
- Lost productivity – More reduced work from short-term absences, long-term disability and premature death than those without the disease.
- Employers pay a higher life insurance premium and more workers’ compensation than those without the disease.
- Lower overall wages and household income.
Throughout a lifetime, per-person costs for obesity were comparable to those for chronic smoking.
The population impact of obesity
Obesity causes or worsens over 260 other diseases and raises the risk for every form of cancer.
Challenges to treating obesity
As a society, we have a lot of work to do to understand why we aren’t getting people the care needed to treat obesity, but we do know some of the challenges from a medical provider standpoint, including:
- A lack of education – Medical schools average 19.8 hours of nutritional education across four years. The national recommendation is 25 hours.
- Social prejudice – Before 2008, obesity was not recognized as a unique disease. People assumed those who were overweight were unmotivated, uneducated and just needed to “put down the fork.”
- Prevalence – The disease of obesity is so common we fail to recognize it.
- Fear – Providers are hesitant to broach the topic for fear of insulting the patient.
- Lack of information – Providers don’t always know how to treat obesity.
For patients, it’s no wonder weight loss is difficult. Socially, we use food to celebrate, to console and to show support. If we win the game, we go for ice cream. If we lose the game, we go for ice cream. It’s woven into the social fabric of our society. Some other common challenges include:
- Dismal nutritional knowledge.
- Average caloric needs are far surpassed by most.
- Inability to read/understand nutrition labels.
- Tremendous amount of “fad” diets and pseudoscience treatments online and on social media.
- An overabundance of calorie-dense, nutritionally poor food, especially sugar-sweetened beverages!
Additionally, many people who battle their weight also face psychological challenges, such as:
- Binge eating
- Depression
- Anxiety
- Stress eating
- Trauma
- Poor coping
- Emotional eating
- Anorexia
If you have concerns about any of the conditions mentioned above, ask for a referral immediately to seek help. Parkview Behavioral Health offers eating disorders support services. You can reach them at 260-481-2700 for more information.
Losing weight is more complicated than you think
The common cultural model of obesity is that if you eat too much and don’t move your body, you will gain weight, and inversely, if you eat less and move more, you will lose weight. This is a very simple formula, and it doesn’t work for everyone, because there are so many more factors at play.
The actual science of the disease state is more complicated. There are roughly 57 different subsets of obesity, so what affects one person’s weight one way, will affect another person differently.
The key factors at play are each individual’s:
- Genetics
- Psychology
- Physiology
- Nutrition
- Sociology
- Medications
So, while an individual influences their calorie intake and activity level, they may require medical assistance to influence things like their metabolism, hunger hormones and fullness hormones, which might fall outside of their control. When any of the factors mentioned above are out of balance, it can create a struggle for the individual.
We have over 400 hormones that regulate our weight and, to date, only 10 of them have been shown to help us lose weight. Our bodies are actually fighting our efforts to lose weight, which is why it’s important to seek assistance if you have concerns.
Treatment options for obesity
The list below begins at the most conservative approach and escalates to more aggressive strategies to treat obesity. Each level is additive, and the patient should not remain at one level for longer than six weeks to three months if they aren’t seeing an appropriate response.
- Level 1: Self-directed lifestyle change
- Level 2: Education, dietician, movement, counseling
- Level 3: Weight loss medication
- Level 4: Weight loss surgery
- Level 5: Post-surgical combinations
I can’t emphasize enough how important it is to seek help if you aren’t seeing change. The impact of poor weight is devastating to overall wellness, and should be addressed appropriately to avoid complications.
Diet and exercise
There are so many diets out there, it can make your head spin. From paleo to vegan to DASH, there are countless methods to adopt. But the most important things are:
- What will you stick to?
- What approach will allow you to eat within the calorie budget for your height and health?
Calories are just a method of measuring energy needed for the body to perform essential functions. Everything we do takes energy. If you eat too many calories, it gets stored as fat.
If you eat less than you need, you lose weight.
The problem is that generally speaking, calorie recommendations are way too high. The average American needs 1300 a day but gets 2100. These needs can vary based on age, height and activity level. An older, sedentary woman, for instance, needs far fewer calories than a six-foot moderately active male.
So, why can’t we just exercise to burn the excess? Simply put, it’s just not effective enough to make up the difference. If the average American has an 800-calorie gap, that will take approximately 3.4 hours of walking on the treadmill. And this has to be done consistently, every day. Working out is ideal for physical, mental and emotional health, but best if combined with an overall healthy lifestyle for optimal results.
How do I start if I want to lose weight?
This article is a great jumping-off point, but there is so much to learn about weight loss. I recommend learning the facts vs. the myths. Education is key to success. Additionally:
- Recognize that obesity is a disease.
- Ask your provider for help to achieve a healthy weight if you’re unable to achieve it on your own after six weeks of effort.
- Learn about healthy caloric intake.
- Learn to avoid calorie-dense, nutrient-poor foods.
- Push back against fad diets, supplements and diet culture.
- Use your local resources (physical therapy, dietitians, primary care provider, obesity certified providers).
- Find an accountability partner.
- Don’t give up on the journey! It will be hard, there will be setbacks, but you can do it.
To learn more about the resources available to you at PPG - Weight Management & Bariatric Surgery, including free seminars, call 260-425-6390 or fill out this form and one of our care team members will contact you with more information.
