First, we must define obesity to better understand it and then discuss what can be done outside of medication and surgery to control or manage this disorder. Obesity is defined as a chronic
condition resulting from the interaction between a person’s genetic makeup and the environment (phenotype). There are a lot of factors to include social, behavioral, cultural, psychological, and
hormonal or metabolic that impact this disease. Despite the overwhelming number of people who suffer this disorder, it is still poorly understood. One is considered obese when their Body Mass
Index (BMI) calculated by using weight and height is elevated. A person with a BMI of greater than 30% is by definition obese.
In 1999, the National Health & Nutrition Exam Survey (NHANES) found that 61% of Americans are obese. This is a 5% increase over the 1988 – 1994 period and a 14% increase over the 1976 – 1980 period. This is a sad state of affairs. Something has gone terribly wrong here.
The relative risks for several other diseases are significant. Diabetes type II, Coronary Artery Disease, Hypertension, Cancer, Dyslipidemia, and Sleep Apnea are all disorders that arise in part
due to obesity. For better quality of life, it is essential to avoid obesity and all its sequelae. That is why in anti-aging medicine, nutrition, diet and exercise is as important as any other medication
or hormone we prescribe.
Simply put, if one is to reduce caloric intake in conjunction with increased caloric expenditure, the result is weight loss (a loss of stored fat as opposed to muscle should really be the choice of
words here.) Unfortunately, there is no magic pill or procedure that is safer than eating right and exercising. But it takes will power and compliance and many Americans are not willing to be this
disciplined. The alternatives can be costly. Do nothing and you subject yourself to an early death and increased morbidity from the other illnesses mentioned above. Pick a weight loss medication
and you can suffer the consequences of many untoward and dangerous side effects. Remember the problems with Redux and Fen-phen. Also, who wants to suffer from the gastric discomfort of
Orlistat (Xenical), or the danger of sudden death with over-the-counter Ephedra infused products.
Others consider surgical procedures such as gastric bypass or gastric stapling with its relatively high morbidity and mortality rate and malabsorption problems. The removal of adipose tissue
surgically (liposuction) is not without risks of infection and sensory nerve damage. Sometimes, with the morbidly obese surgical intervention is a must. But for those mildly obese or heading
that way, remember diet and exercise first.
From a nutrition recommendation, I could go on for hours, but by simply avoiding “fad” diets and sticking with a reasonable / sensible plan, you will not yo-yo or spin your wheels. After an
exhaustive review of the plethora of dietary recommendations out there, I counsel my patients quite simply. A protein weighted diet with ratios of 40% Carbs, 30% Protein and 30% Fats
(Good fats mind you, from such sources as olive oil and fish mostly). This comes very close to the dietary recommendations of Dr. Barry Sears of the “Zone” fame. Required reading for my
patients, by the way, is Dr. Sears’ “A Week in the Zone.” Remember, one pound (0.45 kg) is equal to 3,500 calories. Therefore, a person consuming 500 calories more than he or she expends
daily will gain 1 lb. a week. I will leave the topic of diet at that for now.
Exercise is essential for effective weight loss according to the conclusion of a 1996 Surgeon General’s Report on Physical Activity & Health, the AMA’s 1998 Executive Summary, and the
2001 American College of Sports Medicine position. While good diet, surgery or even those “fad diets” may take pounds off, exercise cannot be ignored. There are too many benefits in exercise not to take it seriously, from maintaining health bone and muscle mass, to the positive effects on the cardiovascular system, to the effects on mental health.
How much and at what intensity should one exercise to lose weight? This is a very good question and one where there is much misunderstanding and confusion. Some ill informed exercise
instructors and exercise equipment manufacturers advise that a low intensity workout burns more fat than carbohydrates. Burning fat and carbohydrates, and protein for that matter, is called
substrate utilization and this can be measured by calorimetric instrumentation in an exercise physiology lab. Carbohydrates provide 7% more energy per unit of O2 consumed during exercise, thus the body relies on carbs more than fat as exercise intensity increases. From a physiological perspective, the “fat burning zone” refers to maintaining an exercise intensity of 50
– 60 percent of aerobic capacity as calculated or measured as VO2max.
When one increases the intensity of exercise to say 70% of VO2max (attaining a higher heart rate) then the substrate shifts to “burning” more carbohydrate than fat. However, the important
concept to remember here is the “total calories burned.” For example, while the ratios of calories from fat and from carbohydrates may change with intensity, the total number of calories burned at the end of the workout is where weight loss is achieved. Let us take a typical person on day one:
he exercise for one hour at 50% VO2max and burn 240 kcal (50%) from Carbs and 240 kcal (50%) from Fat, for a total of 480 Calories. The following day the same person exercises at 80%
VO2max for an hour and burns 264 kcal (40%) from Fat while 396 kcal (60%) are burned using carbohydrates. While the ratio of Fat:Carbs is lower with the higher intensity he is still burning
more fat at the higher intensity and the total Calories add up to 660 kcal.
For those people with less time to exercise, a higher intensity regiment makes more sense. The caveat here is that with high intensity exercise there is more risk for overuse injury, especially in
the unconditioned. So, to keep someone compliant with exercise (if they injure themselves, they are more likely to quit all together) mix it up a bit. Three days a week at higher intensity and two
days at a lower intensity. Cross train and mix up the type of exercises you do (treadmill, stationary bike, elliptical, lap swimming, …)
One does not have to become a super-elite athlete to loose weight. Take a 200-lb. man who walks briskly for one hour each day. His caloric expenditure would amount to 2100 kcal above
rest per week and that represents a fat loss of 0.6 lbs. After 12 months that is a 30-lb. loss of weight and that is significant. If that person chose to run (6.0 mph) instead of walk, then he
would burn 14.6 kcal per minute above resting metabolism and achieve the same 0.6 lbs. of weight loss in only 30 minutes. Another point to remember is that overdoing it is counter productive. Very high intensity workouts greater than 40 minutes will cause the adrenal glands to secrete the stress hormone cortisol which has a negative impact on muscle. Cortisol can actually melt muscle mass away. Still another important point to consider is the fact that added muscle mass makes burning fat much easier and efficient. Loss of muscle mass will hinder fat loss. So it is crucial to limit high intensity aerobic workouts to less than one hour and combine with a resistance-training program as well. For those seeking a safe and well-designed exercise program, I would recommend finding a certified personal trainer for assistance. For weight loss and weight management programs, we offer may different solutions for individuals at Wellness One, including the famous hCG protocol, use of agents such as Metformin and Topamax and modalities such as Far-Infrared Sauna sessions.
JP Saleeby, MD is medical director of WellnessOne, an integrative preventive and anti-aging medicine center Health & Beauty Spa in Myrtle Beach. He can be reached for comment at jpsaleeby@aol.com or (843) 444-WELL.