Obesity

Saddle River Magazine

Its terrible to be fat.  Most people are trying to lose weight, at least the patients that I see. There are a few individuals that aresvelte, but they are in the minority. Forty percent of adults and 19 % of children are now obese and with these numbers more than 50% of today’s children will be obese by the time they are 35 years of age. This is very striking data and the major reason that diabetes type 2 is on the rise. It is of course genetic in many families, but also the result of obesity and our bad diets. 

Let’s look at diets, some 55% of the typical American diet is carbohydrates even though there are an array of diets that can allow you to lose some weight. I will cover some of them below. However, its difficult to lose weight simply because for most the adaptive physiology of the body eventually brings you back to your original weight. Diet induced loss of weight results in “an increase of hunger, a decrease of your metabolic rate, and the tendency to restore fat.” (David Ludwig, Harvard Medical School). 

A recent article in the Journal of the American Medical Association (JAMA 319, no 3, 2018) showed that there is again interest in the so called ketogenic diet. You might recall the Atkins diet of the 80’s wherein a person ate mostly no carbohydrates, no fat and loads of protein. People lost weight, but readily gained it back once they began to eat fat and sugar again. Today, the ketogenic diet advocated by some experts suggests ingestion of as much fat and protein as you wish, which results in satiation (fullness) and weight loss. The ketones are a metabolic by-product of the ingestion of protein and goodly amounts of fat.  It seems counterintuitive, but it really works. The low carbohydrate diet results in a reduction of your body’s insulin, and fat starts to burn within a week. This state is called nutritional ketosis in which the liver converts fatty acids into compounds called ketone bodies that can even provide the brain with nutrients while you lose weight. Moreover, diabetes tends to abate in patients that continue with this diet. Its really a bit complicated for the layman to understand, but it works. Just how much weight you lose depends on how many calories you spontaneously reduce, as well as how fat you were to begin with, your age and sex, ethnicity and –of course whether you exercise. The most common side effects of this diet is something called the “keto flu”, which includes light headedness, dizziness, fatigue, difficulty exercising, poor sleep and some constipation that passes within days or weeks of starting the diet. (Interest in the Ketogenic Diet Grows for Weight Loss and type 2 diabetes. JAMA 319:3, 215-217)

I cannot talk about losing weight without telling you about body mass index and exercise. In Medicine we routinely use body mass index or BMI when we speak of a patient’s size. This is a combination of your height in inches and your weight in pounds. This will tell you if you are overweight, heavy or normal. We keep the table in the gym routinely and you can get the table by googling BMI.

Half of US adults meet the recommendations for physical activity. Inactivity accounts for 11% of all health expenditures in the USA as well as 6-10% of the world’s burden of chronic disease (Medscape, Can Walking Reduce the Risk of Death? 2018). One hundred twenty minutes or less of weekly moderate intensity walking is a boon to one’s life span. Any is better than none.

Everyone should try to exercise daily or at least 5 out of seven days per week. You can set goals for yourself. Physical inactivity will lead you to poor health. Doctors rarely advise patients on physical exercise (only 34% of primary care doctors ever talk to their patients about physical activity). One out of every five adults are a slug and does nothing but eat, sleep and sit. Exercise positively affects all systems of the body: cardio, brain, musculoskeletal, respiratory and metabolic. 

Obviously, if you have been a couch potato, I do not advise getting outside in 20-degree weather and running 3 miles, but you can start with modest physical activity and work your way up to be a svelte, sexy individual at any age. In fact, the more you exercise the longer you will live. And like buying a home, you must suffer a little when you embark on something new. If there is no pain, there is no gain. If you can afford it, go to a gym and hire a trainer for a fixed period (6 months) and learn how to exercise aerobically. You are never too old for this since my best athletic patients are in their late 70s and early 80s. My second point is to have your primary care physician measure your blood pressure, pulse, and Electrocardiogram before you begin a program, so you are in great shape to begin a new aspect of your life. I guarantee better appetite, better sleep, better brain function and even better intimacy. All this for a good diet and a little exercise? Wow.