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OVERCOMING THE OBESITY OBSTACLE

Posted on July 20, 2015 by Patrick Zeemer, PA- C

Most Americans are aware of the growing dilemma we face in our country. With so many fast food choices, sugary beverages, large portions and carbohydrate rich options laid at our disposal, it seems easier to maintain a higher weight than a normal one.  Add to this an increased demand on our time, reliance on technology that promotes a sedentary life style, and changing public perception of what normal weight should be - we get the perfect recipe for a rising waistline! 

The scope of the problem is greater than most Americans appreciate. The BMI scale and waist circumference are both used to quantify problem weight gain. Overweight is defined as a BMI >25, obesity as a BMI >30, and morbid obesity as a BMI >40. Calculators are available online for home assessment. A large study in 2012 identified a 35% obesity rate overall in both adults and children in the United States! This is also a global trend. Obesity is now considered by the CDC to be a global epidemic, much the way infectious diseases are classified (1).  In another large study that followed participants for 30yrs, 50% of men and women became overweight by the end of the study period (5). Interestingly, despite an increase in prevalence, our opinions may be changing regarding excess weight. A 2007 British study showed a decrease in those who identified themselves as overweight, despite a clear increase in the prevalence of overweight/obesity (2).  Could we be in denial?

Why are we packing on the pounds? Secondary causes of obesity include thyroid and other glandular disorders, eating disorders, certain sleep disorders, poor education, some types of depression, certain medications (diabetes, epilepsy, psychiatric medicines), and genetic defects. Though important to identify, these contribute very little to the epidemic as a whole. The vast majority of our pesky pounds result from too much energy input (dietary indiscretion) and not enough energy output (lack of exercise). Technologies are often aimed at simplifying our lives at the expense of physical effort. An American study suggested a link between an increase in the use of energy sparing devices at work and home and rising rates of obesity (6). Television and media may be the biggest culprits. Researchers have found that for every 2 hours of television watched daily the risk of obesity is increased by 23%! (7). For many, life balance may play an important role. For example, eating breakfast (the most commonly skipped meal) has been clearly linked to a lower risk of being overweight (3). Data also suggest that sleep deprivation reduces the effectiveness of dietary restriction (4). Thus we may undermine our efforts to lose weight through dieting if we don’t get the sleep our bodies need.

Why do we care about “a few extra pounds”?  The effects of unchecked obesity wreak havoc on both cardiovascular and overall health. A large analysis published in 2009 combined data from many different studies to explore how overweight/obesity relates to overall death rates. The studies included over 900,000 participants and the findings were astonishing: For every 5 point increase in BMI, there was a 30% increase in mortality (8). These findings were similarly seen in another large survey that suggested the effect was independent of gender and ethnicity (9). The causes of death identified in these studies include all forms of cardiovascular disease including heart attack and stroke, diabetes, respiratory diseases, and even cancers of the breast, liver, kidney, prostate and colon. Looking at the issue along the lifespan, the Framingham study examined life expectancy in obese vs. normal weight individuals. Researchers found that those who were obese at age 40 died an average of 6-7 years sooner than normal weight counterparts (9). These studies confirm that obesity is more than just an issue of aesthetics, it is deadly business.

If you are battling the scale you are not alone as we have seen. It may be best to address the problem clinically, with a formal approach to diet, exercise and possibly medical or surgical options. The market for weight loss medications has expanded rapidly over the past decade and many are effective for some patients. Your doctor will be able to tell you more about which approaches to diet, exercise and medication will be most effective, based on your needs and problem areas. The annual physical is an ideal time to screen for problem weight gain, as well as other for other cardiovascular risk factors.

Patrick Zeemer, PA-C 

References

1.     Prevalence of childhood and adult obesity in the United States, 2011-2012. Ogden CL, Carroll MD, Kit BK, Flegal KM - JAMA. 2014 Feb;311(8):806-14

2.     Changing perceptions of weight in Great Britain: comparison of two population surveys. Johnson F, Cooke L, Croker H, Wardle J - BMJ. 2008;337:a494.

3.     Breakfast frequency and development of metabolic risk. Odegaard AO, Jacobs DR Jr, Steffen LM, Van Horn L, Ludwig DS, Pereira A. Diabetes Care. 2013 Oct;36(10):3100-6. Epub 2013 Jun 17.

4.     Insufficient sleep undermines dietary efforts to reduce adiposity. Nedeltcheva AV, Kilkus JM, Imperial J, Schoeller DA, Penev PD - Ann Intern Med. 2010;153(7):435.

5.     Estimated risks for developing obesity in the Framingham Heart Study. Vasan RS, Pencina MJ, Cobain M, Freiberg MS, D'Agostino RB - Ann Intern Med. 2005;143(7):473.

6.     Trends over 5 decades in U.S. occupation-related physical activity and their associations with obesity.

Church TS, Thomas DM, Tudor-Locke C, Katzmarzyk PT, Earnest CP, Rodarte RQ, Martin CK, Blair SN, Bouchard C PLoS One. 2011;6(5):e19657.

7.     Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. Hu FB, Li TY, Colditz GA, Willett WC, Manson JE - JAMA. 2003;289(14):1785.

8.     Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373:1083.

9.     Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L, NEDCOM, the Netherlands Epidemiology and Demography Compression of Morbidity Research Group . Ann Intern Med. 2003;138(1):24.

 

 

 

 

 

 

 

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