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Obesity Management through diet and lifestyle

Obesity Management: How to reduce fat and maintain ideal weight 

 A study reported that out of 178 adult patients hospitalized with coronavirus disease 2019 (COVID-19), at least one underlying condition was found in 89.3%, the most common being hypertension (49.7%), obesity (48.3%), chronic lung disease (34.6%), diabetes mellitus (28.3%), and cardiovascular disease (27.8%)

https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm?s_cid=mm6915e3_w 

 

The most widely accepted classifications are those from the World Health Organization (WHO), based on body mass index (BMI). The WHO designations are as follows:

  • Grade 1 overweight (commonly and simply called overweight) - BMI of 25-29.9 kg/m2

  • Grade 2 overweight (commonly called obesity) - BMI of 30-39.9 kg/m2

  • Grade 3 overweight (commonly called severe or morbid obesity) - BMI ≥40 kg/m2

In muscular persons, BMIs that usually indicate overweight or mild obesity may be spurious, whereas in some persons (eg, elderly individuals and persons of Asian descent, particularly from South Asia), a typically normal BMI may conceal underlying excess adiposity characterized by an increased percentage of fat mass and reduced muscle mass. 

Intra-abdominal or visceral fat contains more blood supply / mitochondria and is metabolically active. When expanded, it releases more fatty acids to the liver which leads to insulin resistance and hyperinsulinemia. This also leads to a clinical picture of raised blood triglycerides and low HDL.


Obesity is an international epidemic and health crisis. A report from the National Center for Health Statistics stated that in US individuals aged 20 years or older, the prevalence of obesity rose steadily from 19.4% in 1997 to 31.4% for the period January-September 2017

The annual cost of managing obesity in the United States alone amounts to approximately $190.2 billion per year, or 20.6% of national health expenditures, according to a study. Compared with a nonobese person, an obese person incurs $2741 more in medical costs (in 2005 dollars) annually. In addition, the annual cost of lost productivity due to obesity is approximately $73.1 billion, and almost $121 billion is spent annually on weight-loss products and services. 


The thresholds used in the National Cholesterol Education Program Adult Treatment Panel III definition of metabolic syndrome state that significantly increased cardiovascular risk (metabolic central obesity) exists in men with waist circumferences of greater than 94 cm (37 in) and in women with waist circumferences of greater than 80 cm (31.5 in)

These thresholds are much lower in Asian populations. Tan and colleagues concluded that a waist circumference of greater than 90 cm in men and of more than 80 cm in women were more appropriate criteria for metabolic central obesity in these ethnic groups.

Obesity can be secondary to medical, genetic, behavioral, psychological disorders which will not be covered on this blog. 

 

Overweight and obese individuals are at increased risk for the following health conditions:

  • Metabolic syndrome

  • Type 2 diabetes

  • Hypertension

  • Dyslipidemia

  • Coronary heart disease

  • Osteoarthritis

  • Stroke

  • Depression

  • Non-alcoholic fatty liver disease (NAFLD)

  • Infertility (women) and erectile dysfunction (men)

  • Risk of stillbirth

  • Gall bladder disease

  • Obstructive sleep apnea

  • Gastroesophageal reflux disease (GERD)

  • Some cancers (eg, endometrial, breast, and colon)

  • Asthma

 

 Proinflammatory products of the adipocyte include the following

  • Tumor necrosis factor–alpha

  • Interleukin 6

  • Monocyte chemoattractant protein–1 (MCP-1)

 

Several gut hormones play significant roles in inducing satiety. Leptin and pancreatic amylin are potent satiety hormones. On the other hand, ghrelin, which is secreted from the stomach fundus, is a major hunger hormone.

The major role of leptin in body-weight regulation is to signal satiety to the hypothalamus and thus reduce dietary intake and fat storage while modulating energy expenditure and carbohydrate metabolism, preventing further weight gain. Potentially, leptin sensitizers may assist in changing feeding habits.

 

 In many genetically similar cohorts of high-risk ethnic and racial groups, the prevalence of obesity in their countries of origin is low but rises considerably when members of these groups emigrate to the affluent countries of the Northern Hemisphere, where they alter their dietary habits and activities. These findings form the core concept of the thrifty gene hypothesis espoused by Neel and colleagues. The thrifty gene hypothesis posits that human evolution favored individuals who were more efficient at storing energy during times of food shortage and that this historic evolutionary advantage is now a disadvantage during a time of abundant food availability.

https://academic.oup.com/nutritionreviews/article/57/5/2/2672568 

 

Overall, obesity is estimated to increase the cardiovascular mortality rate 4-fold and the cancer-related mortality rate 2-fold. As a group, people who are severely obese have a 6- to 12-fold increase in the all-cause mortality rate. Obesity is considered the greatest preventable health-related cause of mortality after cigarette smoking.For men with severe obesity (BMI ≥40), life expectancy is reduced by as much as 20 years and is also associated with increased risk of lifetime disability.  

 

A reasonable goal for weight loss in the setting of a medical treatment program is approximately 1-2 lb/wk. ( under 0.5 to 1 kg/wk ) . According to guidelines released by the American College of Cardiology (ACC), the American Heart Association (AHA), and The Obesity Society (TOS) in 2013, clinically meaningful health improvements can even be seen with weight loss in the range of 2%-5%.

10 % weight loss in Obese individuals has demonstrated the following health benefits:

  • mortality
    • 20-25% reduction in premature death
    • 30% reduction in the risk of dying from diabetes-related complications
    • 40% reduction in the risk of dying from cancer
  • Blood pressure
    • 10mmHg decrease in systolic blood pressure
    • 20mmHg decrease in diastolic blood pressure
  • Diabetes 50% fall in fasting blood glucose levels
  • Lipids
    • 10% fall in total cholesterol 15% fall in LDL cholesterol
    • 8% increase in HDL cholesterol

 

 Patterns associated with successful weight maintenance include the following:

  • Self-monitoring of weight

  • Consumption of a low-fat diet

  • Daily physical activity of approximately 60 minutes

  • Minimal sedentary “screen time”

  • Consumption of most meals at home

Achieving a caloric deficit is still the most important component in achieving sustained weight loss. However, the considerable variance in individual energy expenditure. Older individuals have less basal expenditure than younger individuals and basal expenditure also comes down as weight comes down making it more difficult for these individuals to maintain weight by calorie restriction alone.  

 

Types of Strategies for weight loss

-30-60 minutes of continuous aerobic exercise 5-7 times per week

-Catechin, a flavonoid found in green tea, may aid in preventing obesity. Green tea also contains anti-inflammatory and anti-viral ( zinc ionophore ) compound ECGC .

-Caffeine from tea and coffee can increase energy expenditure and promote weight loss ( often undone by addition of sugar and milk ) 


-Drinking full glass of cold water before meals 

-Vegetable margarines containing plant stanols and sterols have demonstrated reduction in total cholesterol by 10-15 % although weight loss was not seen. Example of these are Becel Pro-Activ in North America and Benecol in UK.   

- A healthy sleep pattern is important to harness weight loss benefits from other interventions. 7 to 8 hours of sleep are optimal. Any underlying obstructive sleep apnoea should be screened for and treated for optimal results. 

-reducing snacking and consider intermittent fasting 

-Low Calorie diet: Noom

-Low  Carb and high fat diet: Keto 

-Low Carb and high protein diet: Atkins

-Mediterranean Diet: Increased fresh vegetables, fruits, oils, nuts, olives, avocadoes, fish etc


-Low Carb natural unprocessed foods diet: Paleo

https://thepaleodiet.com/paleo-101/what-is-paleo 

https://thepaleodiet.com/paleo-vs-keto

 

Anti-obesity medication and surgery will not be covered in this blog.  



INFORMATION & DISCLAIMER: 

I obtained my primary medical education from India and post graduate MD in Family Medicine from the United Kingdom. After working in National Health Service, England for 15 years, I moved to  Canada five years ago.  As a Family Physician, I consider my speciality as engaging patients, interpreting medical information for them, guiding them through their health journey, promoting wise health choices and encouraging early detection and management of disease. 

The information on this blog is accurate as per time of publishing. Scientific information and evidence changes dynamically and my opinions would change accordingly. 

The recommendations on this blog are not prescriptions and any patients considering these should consult with a physician to check if these are applicable to their unique situation.
 
Physician websites I commonly use for reference include 

 
Patient reference websites I commonly recommend to patients include
 

 
 
https://patient.info/

Patient confidentiality must be upheld at all times and any patients wishing to discuss specific medical scenarios on social media are requested to do so anonymously in 'third party' sense. 

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