Treat obesity like all other ailments....meaning directly!

The HealthGal Health Guide
  • What are the current statistics on obesity?


    Currently there are about 155 million Americans who are overweight or obese.  A BMI over 30 is considered obese.   Once you carry about 35 pounds or more of excess weight, you are considered significantly overweight.  Being overweight or obese is linked to an elevated risk of developing type 2 diabetes, heart disease, stroke, many types of cancer, osteoarthritis, and a number or other diseases and health conditions.


    What are the guidelines for treating and managing obesity?


    One of the biggest recent changes to hit the health sector was the determination and classification of obesity as a disease.  This shift suggests that doctors and other health professionals should abandon the hesitation that often accompanies a conversation about excess fat.  It means that any office visits with the doctor should include addressing a patient’s excess weight.  It also means that insurance companies should begin to cover office visits and dietary counseling sessions that specifically target the treatment of obesity.  Despite the reticence of patients, who may be in denial about their size and the concomitant risk factors that their extra weight presents, the new guidelines specifically instruct health professionals to treat obesity like any other disease.  Ideally, doctors should “aggressively intervene just like they would if the patient had full blown hypertension or heart disease or cancer."  This is, of course, more easily said than done, because of the emotional and self-esteem issues that surround a patient’s weight.

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    There is no single perfect diet for weight loss, which is why health professionals really need to personalize the eating and exercise program, and determine the number of sessions that the obesity treatment plan initially requires, for that patient.   In general, a template of about 2 or 3 meetings in-person, every month for about six months, allows for significant behavior modification, adjustments to the diet or exercise recommendations to address elements that are not working, and to provide support, an under-valued and important part of any obesity treatment plan.  The diet should aim for an overall reduction of about 500 calories daily, plus some daily goal of fitness.  These new recommendations actually go hand-in-hand with very recent modifications of cholesterol management.  The new guidelines were based on a review of a significant number of prior research studies.


    Is there a specific initial goal for weight loss?


    The initial recommendation is to help patients to lose 5% to 10% of their weight, which can immediately improve certain health parameters, and to then create a food plan that allows the patient to continue to lose weight, while engaging in physical activity, and behavior and habit changes.  The gold standard according to certain experts would be an intensive 14 session program over 6 months with trained obesity interventionists.  Next best would be working with your doctor and a dietician or nutritionist or using a web-based or commercial diet and support program.  Ultimately, you need calorie deficit in order to shed pounds, and it's not unusual to see dramatic weight loss in the first weeks (which includes water loss) and then a slower but steady rate of weight loss.  Of course, the secondary goal of weight loss is to reduce the risk or presence of other diseases, like heart disease, diabetes, hypertension.


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    Are there any other new findings or recommendations?


    New research and guideline determinations are now being presented at the annual meeting of The Obesity Society.  One very new study just presented at the conference (but not fully vetted) suggests that binge eating, even in the absence of excess weight, could fuel a heightened risk of diabetes type 2.  So experts may decide to recommend that individuals avoid eating extremely large meals regularly, even if the total number of daily calories is within dietary recommendations.  A lot of dieters like to “store their calories till nighttime,” to help with the urge of nighttime snacking that is typical of someone struggling with food issues.  If you regularly eat only 400 or 500 total calories at breakfast and lunch, and save 1500 calories for dinner, you may be causing serious insulin spikes on a regular basis, and exhausting your pancreas.  This new information would discourage excessively big single meals, and support a diet consisting of three balanced meals daily, plus one or two snacks, or an effort to balance calories within a day’s worth of eating.


    In general, the new obesity management guidelines recommend diet plus exercise.  Many patients who struggle with weight issues do not want to do both.  This reticence may continue to be one of the biggest hurdles to overcome in the treatment of obesity.  The guidelines also recommend an assessment of weight and ongoing health issues, including a screening for bariatric surgery.  The surgery is now considered a reasonable tool for the treatment of obesity, especially when diabetes is present.


    Amy Hendel is a Physician Assistant and Health Coach, journalist and host of Food Rescue, Simple Smoothies and What’s for Lunch?  Author of Fat Families, Thin Families and The 4 Habits of Healthy Families, she tweets health headlines daily @HealthGal1103.  Catch her guest appearances on local and national news and talk shows, and check out her website.  Follow her blogs.

Published On: November 16, 2013