Obesity and Overweight
The latest statistics describe that over 60 % of the population over age 20 are overweight. Those that are obese ( body mass index over 30) comprise nearly 30% of the population. This is both a staggering and horrendous statement. These disorders are on the rise, and are significant contributors to other conditions, including heart disease, stroke, heart attack, hypertension, gout, musculoskeletal damage, liver and kidney disease, diabetes and cancer. It is therefore imperative that we change the course of this constellation of problems. As we try to unravel all of the contributing factors we must be comprehensive in nature in order to achieve optimal results. This holds true for any medical or nutritional concern. A more clear understanding of all of the causes of disorder can enable our best results.
Over the years it has been described that weight problems have to do with hormone abnormality, excess fat intake, inactivity and or laziness. The typical approach to the disorder has involved fasting, purging, stimulants , appetite suppressants , prescription of thyroid medication,( sometimes in excess) and a variety of loosely organized diet plans. History has shown us that these rarely work, and can be more dangerous than the disease itself. The approach that consistently offers the best results involves understanding and controlling a few variables, hormone levels, exercise and carbohydrate intake.
First, we need to understand the chemistry of the body. It is essential to evaluate hormone levels, including thyroid, testosterone, dhea estrogen, progesterone and growth hormone. As these decline over time usually after age 25 to 30 it becomes more difficult to burn fat. Typically patients describe that they are doing more exercise and not getting any further results. They might see changes in hair, skin, nails, energy, memory, concentration and sexual drive or response. Correcting deficiency here may make a significant improvement, but it may not be long lasting if the other areas are not corrected.
Second, we need to maintain a mechanism to burn calories, fat and to increase aerobic/anaerobic capacity. Exercise should be done daily. For most patients I recommend 30 to 45 min of walking daily. This can be replaced by bicycling, stair climbing, eliptical machines as persons improve. Weight training should also be done with appropriate supervision to enhance muscle strength, bone stability and coordination. The more we do , the better the results.
Third, and possibly the most interesting, are the nutritional considerations. For many years people have thought that fat was the major culprit in overweight and obesity. It was thought that if you eat fat you become fat. With a better understanding of physiology we know that this is not necessarily so. This is evidenced by the emergence and persistence of the low carb diet. This has become the biggest and most popular diet of all . It has continued to surpass all other diet plans because it not only works well but people tend to feel much better on it. It also can allow for an excellent long term result. In all of the patients that I’ve seen over the past seventeen or so years I have recommended a supervised low carb diet. Here I can learn about their specific causes , test for and treat them.
The low carb concept follows a very interesting path. As our bodies ingest excess carbohydrate, and sometimes with excess fat and or protein, we are taking in far too many calories. It becomes difficult to burn fat with excess carbohydrate in the way. The body seems to need to burr, carb first then fat. We also become trained to produce extra insulin to help control blood sugar and in turn create a drop in sugar. This decline can present as hypoglycemia, which in turn can make us feel exhausted, irritable, depressed, panicky and craving of more carbohydrate. The recurrent intake of excess carb can allow a repetition of the previous cycle. People tend to continue to crave carb and sugar and can’t get out of the process. With extra carb intake it becomes impossible to have energy, exercise, and burn fat. Cholesterol, Triglycerides, Blood sugar, and Blood pressure begin and continue to rise. Therefore the continued rise and fall of blood sugar, and the overproduction of insulin keep us in this terrible spiral. Hence, the weight gain. This concept is extremely important in the control of Heart disease and risk factors. Controlling appetite begins with decreasing insulin release. This is accomplished best with a restriction in carb and sugar. Exercise, Hormone correction and Nutritional optimization will also maximize results. All of the typical low fat, low calorie diets can’t effectively decrease insulin response and that is why we see those diets fail and people gain most of their weight back. People, as they wean off of those diets begin the craving process all over again
As we incorporate all of these techniques, our results become significant. Younger individuals can lose weight more rapidly, generally because their hormone (fat burning potential) levels are much higher than those past age 35 or so. Some may need to eat a vegetable or protein snack every 2 – 3 hours or so in the beginning to compensate for feeling a little hungry. As the process continues , so do our results. A physician supervised program enables far more accuracy with the diet parameters , as well as with routine testing, and a little bit of friendly encouragement.