This post was written based on a presentation by Brian LaMar, MD, and Laura Silver, NP, PPG – Weight Management & Bariatric Surgery, Noble County.
Obesity has become such a prevalent health concern, that most of us think we have a general understanding of what it means. But truly understanding why we carry excess weight, and what we can do to get rid of it, is more complicated than you think.
Defining obesity
The Obesity Medicine Association defines the condition as “a chronic, relapsing, multifactorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.” The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) keep it a bit simpler, categorizing obesity as "excess body fat presenting a risk to health."
As a physician who specializes in weight management, I would say that the big takeaways when defining obesity and understanding all it involves are:
- Obesity is not a lifestyle choice
- Excess calorie intake leads to increased fat mass and fat cell dysfunction
- Genetic abnormalities contribute to excess weight
- Certain medical co-morbidities contribute to excess weight
- Side effects of certain medications (obesogenic medications) can be an increase in weight
- Hormones play a role
- Environmental factors play a role
How common is obesity in the United States?
Nearly two-thirds of Americans have obesity, and it’s estimated that, by 2030, 60% of Americans will have a BMI higher than 30, and 86% will have a BMI higher than 25. To break it down differently, 1 in 5 children and more than 1 in 3 adults struggle with obesity in our country. Indiana ranks 5th in states impacted by obesity. No country on earth has a declining obesity rate right now.
Why is obesity dangerous?
Adults with obesity have a higher risk of developing heart disease, Type 2 diabetes and some types of cancer. Carrying excess weight also worsens 260 other diseases, including osteoarthritis, hyperlipidemia, generalized anxiety, neuropathy, polycystic ovarian syndrome (POS) and Alzheimer’s disease, to name a handful. The cost of managing this from a financial standpoint isn’t light. Obesity currently costs the U.S. healthcare system nearly $173 billion a year.
What measurements categorize someone as obese?
Body mass index (BMI) is probably one of the most common measurements used to define obesity, likely because it is easy, reproduceable and doesn’t come with a high price tag. The disadvantage with BMI, however, is that it doesn’t account for frame size, muscle mass, gender or ethnicity.
Abdominal circumference and body fat percentage are two other measurements worth considering. Abdominal circumference takes ethnic differences into account. For example:
- Caucasian males with a waist circumference greater than or equal to 40 inches correlates with obesity
- Caucasian females with a waist circumference greater than or equal to 35 inches correlates with obesity
- Asian males with a waist circumference greater than or equal to 35 inches correlates with obesity
- Asian females with a waist circumference greater than or equal to 31 inches correlates with obesity
When measuring body fat percentage, obesity is defined as:
- Greater than or equal to 25% in males
- Greater than or equal to 32% in females
What are the factors contributing to our high obesity rate?
There are many things leading to our high instances of excess weight, but the biggest are:
- Calorie-dense, nutritionally poor food, which is more affordable, easily accessible and highly rewarding
- Food insecurity
- Stress
- Sedentary lifestyles
- Poor sleep
What is the equation for weight gain and weight loss?
Like many medical scenarios, and just like other chronic diseases, obesity can be managed but not cured. It starts with understanding why we put weight on, and the things we can change to take it off.
We’ve all been taught that if we take in more calories than we need, and don’t burn them off through movement, then our weight will go up. Thus, eating less and moving more should conversely result in weight loss. Unfortunately, it’s just not that simple.
There are actually 57 different types of obesity, each comprised of complications from different combinations of the following elements:
- Genetics
- Physiology
- Psychology
- Nutrition
- Sociology
- Medications
Knowing this, the equation is actually: Individual influence plus medical influence equals a person’s weight. Individual influence would be food and exercise, and medical influence refers to a person’s metabolism, hunger hormones and fullness hormones.
What works for weight loss?
There are options for tackling obesity, and these include:
- Modifying diet and calorie intake
- Behavior modifications
- Educating individuals and families
- Increased activity/exercise
- Medical interventions
o Optimizing current medications
o Medications to assist with weight loss or behaviors contributing to weight gain
o Bariatric surgery
I would encourage obese individuals to work with a professional and develop a medically directed, supervised plan for weight loss. If we think about it like steps, with each step up being a slightly more aggressive approach, the steps might look like this:
Step one – Self-directed lifestyle change
Step two – Education and counseling, working with a dietitian and movement
Step three – Weight loss medication
Step four – Weight loss surgery
Step five – post-surgical combinations of lifestyle management
How many calories should I consume?
Recommendations will vary by factors such as height, activity level and circumstances such as pregnancy, but the majority of us are consuming well above the number of calories we need. If we’re tracking, we’re likely overestimating how many we should have for a healthy weight.
The average American needs 1,300 calories per day but gets approximately 2,100 calories per day. For those who eat out frequently or don’t track their intake, it would be easy to get more than the daily intake requirement in just one meal.
If you’re trying to figure out how many calories you should be eating in a day, you can start by finding your basal metabolic rate (BMR) using one of the many calculators online. Your BMR is the number of calories you burn as your body performs life-sustaining daily functions, such as digestion and standing. Once you know your BMR, you can use a calorie calculator to find a goal based on your activity level.
Calorie tracking is key to discovering how much you are currently eating, and how much you eat in a day in relation to your weight loss goals. There are a number of free calorie-tracking apps, such as Lose It!, fitbit and myfitnesspal, that can make it easy to keep tabs on your daily intake. Meal planning is another helpful tool for monitoring calorie intake. I recommend the app eatthismuch for taking the guesswork out of the menu.
Aside from food, what changes lead to weight loss success?
When we talk about other adjustments that can have a positive impact for weight loss, I can break it up into three categories.
Behavior modifications
Forming new habits is a proven tool for achieving the results you desire. Here are some that are helpful for obese individuals:
- Mindset is the key to success. Believe in your ability to change habits!
- Use small plates and bowls to help with portion control.
- Eat your food slowly and chew thoroughly.
- Make a meal last 20 minutes and stop when satisfied.
- Eat protein first at every meal.
- Keep a food log for awareness and accountability.
- Avoid liquid calories (juice, soda, milk, flavored coffee, alcohol, etc.).
- Avoid highly processed foods (crackers, chips, cookies, etc.).
- Create a weekly meal plan that coincides with your calorie goals.
Physical activity and exercise
When it comes to movement, it all adds up. Here are some simple shifts to increase your activity:
- The goal is to reduce sedentary time–move more and sit less.
- For substantial health benefits, the recommendation is at least 150-300 minutes of moderate intensity aerobic activity per week.
- It’s also recommended that adults do muscle strengthening two or more days a week.
- Combining dietary changes and physical activity is proven to be more beneficial than either of these efforts alone.
- It’s important to discuss physical activity with your provider before beginning a program as there are certain conditions which prohibit activity or warrant close supervision.
Medical intervention
Most obese individuals underestimate the benefits of working with a medical provider for weight loss. These are the big considerations when discussing medical options:
- It’s not a one-size-fits-all approach.
- A provider will take into consideration other medical conditions, medication use, health history, etc.
- Treatment may be indefinite, as we are treating a chronic medical condition.
- The goals of FDA-approved medication use are to:
o Combat plateaus
o Reduce hunger signals
o Support lifestyle changes
Where can someone turn if they are struggling with obesity and don’t want to do it alone?
The PPG – Weight Management & Bariatric Surgery team is a tremendous resource for those in the area that are feeling overwhelmed by weight concerns. Our specialized programs offer appointments with medical providers, during which they can discuss medication optimization and assistance, mental health counseling, dietary training and, when appropriate, bariatric surgery. We take an unidealized approach, based on each patient’s unique circumstances.
To learn more about the resources available to you at PPG - Weight Management & Bariatric Surgery, including our free seminars, contact our office at 260-425-6390 or fill out this form and one of our care team members will contact you with more information.
Sources
Bays, Harold Edward, et al. “Thirty Obesity Myths, Misunderstandings, and/or Oversimplifications: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022.” Obesity Pillars, vol. 3, 2022, p. 100034.
Bays HE, McCarthy W, Burridge K, Tondt J, Karjoo S, Christensen S, Ng J, Golden A, Davisson L, Richardson L. Obesity Algorithm eBook, presented by the Obesity Medicine Association. www.obesityalgorithm.org. 2021. https://obesitymedicine.org/obesity-algorithm/ (03/13/2023)
Bray, George A. Medical Consequences of Obesity, The Journal of Clinical Endocrinology & Metabolism, Volume 89, Issue 6, 1 June 2004, Pages 2583–2589
