Treatment of Obesity

Obesity should be treated when the BMI is above 25 if there are two or more of the following risk factors:

• Large Waist Circumference
• High Blood Pressure
• High Cholesterol
• Family History of Heart Disease

If the BMI is greater than 30 then treatment should be started regardless of number of risk factors. Everyone should be encouraged to live a healthy lifestyle.


 

Ideally a gradual reduction in body weight that can be maintained over the long-term is ideal. One to two pounds of weight loss per week should be the goal.

Treatment options are to increase exercise, dietary changes, behavior therapy, medications, surgery or a combination of these techniques.

To lose weight one must expend more calories than they consume. Weight loss is often not accomplished because people do not comply with this strategy over the long haul. Many fad diets are effective, as long as they stick to the principle of fewer calories in and more calories out.

Dietary changes are a critical part of an effective weight loss program. Reducing the number of calories to less than the number of calories expended, creates a negative calorie balance and will lead to weight loss. While it goes against the norm in American culture, where people want immediate gradification, the ideal weight loss program involves eating a healthy diet that results in a slow and steady weight loss while improving the nutritional content of the diet.



Many diets are available for weight loss. Low-calorie diets contain between 800-1200 calories per day while normal-calorie diets are greater than 1200 calories. General dietary recommendations include selecting a diet that incorporates between 1000 and 1200 calories per day for women and 1200 to 1600 calories per day for men.  Normal calorie diets will not result in a rapid weight loss but allow the patient to learn a healthy eating pattern while losing weight. Very-low calorie diets - less than 800 calories per day - involve specialized foods or drinks that do not teach skills necessary for the maintenance stage of the weight loss.

The ideal diet should incorporate variety and are composed of lots of fruits and vegetables, whole grains and lean meats. A proper balance of carbohydrates, proteins and fats is a key factor to a healthy diet.

The Dietary Guidelines for Americans (2005) have suggestions for weight loss. This guideline recommended eating a variety of fresh fruits and vegetables, whole grains, low-fat proteins and healthy fats. For weight loss they recommend aiming for a reduction in total energy intake while maintaining nutrient intake and increasing physical activity.




Carbohydrates should make up 45-65 percent of total calories. Not all carbohydrates are the same. Foods that are high in simple carbohydrates including white bread, white rice, ice cream, candy, soda and jellies, are absorbed fast and cause a spike in blood sugar. Simple carbohydrates are not packed with essential vitamins, minerals and healthy chemicals like complex carbohydrates. Complex carbohydrates include whole grain cereals, beans and many vegetables are more densely packed with vitamins, minerals and fibers. The bulk of the diet should be  from complex carbohydrates including fruits, vegetables and whole grains.

Fiber, another carbohydrate, is an essential food element to prevent disease. Twenty to 30 grams of fiber is recommended every day. Fiber is found in fresh fruits and vegetables, bran cereals, and beans. Eating a diet high in fiber prevents constipation, possibly reducing the risk of colon cancer, helps with weight loss, improves cholesterol readings and slowing the absorption of sugars.

Protein should make up 10-35 percent of the diet.  High protein diets do not result in any greater weight loss than a moderate protein level. Some experts suggest that a diet high in protein results in more satiety and leads to increased compliance with a low calorie diet. High levels of protein have the potential to put extra strain on the kidneys. Patients with chronic diseases should talk to their healthcare provider before starting a high protein diet.

Fat should make up 20-35 percent of the diet and a small percentage should be saturated fat. Partially hydrogenated fats, as found in margarine, crackers, cookies, doughnuts, and chips are particularly harmful to the body’s cholesterol. Monounsaturated fats, polyunsaturated fats and omega-3 fats should be substituted for saturated fats. Monounsaturated fats are found in avocado, olive, canola and peanut oil. Polyunsaturated fats are not as healthy as monounsaturated fats but are better than saturated fats and are prevalent in soybean and corn oil. Omega-3 fats are found in certain fish including mackerel, salmon, and albacore tuna.

Bad food is not necessarily harmful but it should not be consumed in large quantities. This includes: foods high in sugar and empty in calories, high in trans fat and high in saturated fat. Foods high in sugar and empty in calories include candy and regular soft drinks. Trans fat is found in processed foods like chips, cookies, and crackers. Saturated fats are found in fatty red meats, butter and fried food such as most French fries.