Getting Weight Under Control for Better Health
Maintaining Your Health
on Mackinac
By Yvan Silva, M.D.

You really should lose weight, if you need to for your health. Get it down to optimal levels and then maintain it at a healthy level. This is the advice given by doctors to a substantial proportion of our population and really, a lot of people try. It is advice we give each other as our conscience nags in the background of our daily lives. And so we try and try, again and again.

Beyond just looking good and beyond weight loss as a display of personal strength and discipline in the social milieu, the negative impact of obesity on personal health is inarguable. Given the unrequited promises made by one diet after another, the special programs, medications, and products, we all know how hard it is to lose weight. It’s harder to keep it off and the recurrent rebound to more weight gain is a constant and looming threat. The weight control business is bigger than big.

We spend more than $30 billion a year in the United States on weight control services and products. Yet, we’re losing the battle in spite of progress in all related areas of scientific research, the direct and indirect cost, the emotional travails and dashed hopes, to an epidemic of inexorable and increasing obesity. We seem to have lost sight of the basics: eating too much food in an unbalanced diet and not being sufficiently active is the cause, in most cases, of obesity.

Sixty-five percent of Americans are overweight or obese. More than 350,000 deaths are considered to be obesity-related annually, and more than $115 billion is expended in the economy in health care costs in management of problems arising from obesity.

The overall focus seems to be on weight loss to improve appearance, instead of a goal of weight management to maintain good health. For people who are overweight, losing weight will reduce the risks of cardiovascular disease, blood pressure, diabetes, musculo-skeletal deterioration, and a host of other physical and mental problems. Obviously, there are many programs and methods to achieve success. A combination of basic principles with continued adherence to a time frame is important. The quick fix never has and will never work for the long term.

Just what is “ideal” weight? Today it is best defined by the Body Mass Index, or BMI. This applies to all and removes the variable parameters used in previous definitions. The BMI, besides being universally applicable, relates body weight to health risks from being overweight. The BMI is calculated as follows: Multiply your height (in inches) by your height (in inches) = height squared. Divide your weight (in pounds) by this number. Multiply the answer by 703. For example, an individual who is 5 feet, 10 inches in height and 165 pounds in weight will have a BMI of 23.7. A BMI of 18.5 to 24.9 is considered healthy. There are minor variations in BMI depending on an individual’s proportionate composition of muscle and bone tissues. A BMI more than 40 is a measure of obesity associated with serious medical risks.

The health effects of obesity are being clarified with research. The human body contains 30 to 40 billion fat cells and there is an unlimited capacity to increase body fat by storage in these cells, which expand as they accumulate fat from extra calories. Healthy levels of body fat composition range from 18 to 23 percent in men and 25 to 30 percent in women. Clearly, a regular weight scale does not tell you your own fat composition. Small differences in body weight occur frequently depending on fluid shifts influenced by salt intake, exercise intensity, or changes in the weather. Fluid losses also result from caffeine and other substances that act as diuretics. The most accurate measurements of body fat composition are reliable when done in a professional laboratory designed for this purpose. Biometric impedance analysis is another method, more widely available, but less accurate.

A healthy weight that accommodates indices of body fat composition to total body weight to determine health risk has been described by the National Institutes of Health in a combination of three components - the BMI, circumference at the waist, and personal medical history.

The BMI is the better indicator of body fat than weight per se. The waist measurement and shape analysis is an overall indicator of where most of the fat is deposited in the body. For example, abdominal waist measurements at the upper limit of normal are 40 inches for men and 35 inches for women. Increased waist measurements do relate to increased health risks. The reason for this is that deposits of fat in and around the abdomen and the abdominal organs are associated with greater risk. Here, fat accumulation, when it breaks down, enters blood more rapidly, contributing to cardiovascular deterioration. There is greater risk for diabetes, coronary artery disease, high blood pressure, strokes, and perhaps, certain types of cancer. The common description of this shape is the pot belly, or “apple.” The “pear” shape describes accumulation of fat around the hips, buttocks, and thighs and is thought to be associated with fewer health risks. The level to measure your waist is just above the highest point of both hip bones. Loss of fat within the abdomen is the most important factor in reducing the waist size.

A review of your personal and family medical history would include conditions such as diabetes, high blood pressure, high cholesterol, osteoarthritis, and cancer. Calculate your BMI. You can lower your health risk by bringing your BMI toward the acceptable range.

Review the age when your weight gain started and the rate at which it continued. Men who gained 22 pounds since the age of 22 or women since the age of 18 have a higher risk than those that did not. The proportion of carbohydrate, protein, and fat in the diet is important. Reduction of fat in the diet is key if it’s high. A combination of overeating, excess intake of alcohol, and smoking is detrimental. It is really true that modest weight losses will bring health benefits. A loss of five to 10 percent may improve cholesterol and triglyceride levels, blood pressure, reduce joint problems, and sleep apnea. Besides looking good, feeling good is another decided advantage.

There are many factors that come together to determine body composition and weight. A family history of obesity increases the possibility of being obese by about 30 percent. Over the long term, eating excess calories and a sedentary lifestyle both combine to weight gain. Alcohol, high sugar foods and beverages, candy, and desserts contain so-called “empty” calories that provide energy, but do not contain other nutrients. Excesses are stored as fat. A sedentary lifestyle results in lower caloric expenditure and a continuing balance toward weight gain. Aging is associated with weight gain from a combination of less activity, loss of muscle mass, increase in body fat, and a lower metabolic rate.

Although there is usually a weight gain with cessation of smoking, the benefits far outweigh the health risks from the gain.

Psychological factors play an important role in obesity. Binge eating to cope with stress and emotional problems, and a recurring personal loss of control and feeling of guilt over binge eating, leads to weight gain. Medications, like hormones, antidepressant drugs, and anticonvulsants, contribute to weight gain. Some women gain more weight than needed during pregnancy and retain the weight.

A sincere motivation to lose weight for better health is a start. The goals should be realistic. It is well known that a healthy weight loss should be slow and steady. Loss of one to two pounds per week with goals set for weeks and months is good. A steady diet of healthy foods and attention to total calories in the diet, especially fats to below 20 to 30 percent of daily calories, will work. Foods rich in nutrients and low in calories like whole grains, fruits, and vegetables will help you eat more food with fewer calories. Regular physical exercise will increase weight loss, especially aerobic exercise, which will burn fat. Weight training, even in modest settings, will counter loss of muscle mass and tone muscles, which burn calories even in the resting state.

Getting back to the basics is surely the way to success.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.