Author’s note: For those of you who missed Part 1, this article begins with a brief review. But if you have a minute, try and read Part 1 in its entirety.
Our country is facing an obesity crisis. Obesity rates in adults have almost tripled in the past 30 years. Kids have fared even worse, tripling their rates of obesity in just 20 years.
Approximately 1 in 3 adults is now overweight.
Obesity has a tremendously negative impact on our health, adding to our chances of everything from cancer to heart disease to diabetes. If you think the price of oil is high, wait and see what happens to the price of health care as our obese generation ages.
Obesity is defined as a body mass index (BMI) reading greater than 30 (“overweight” is a reading of 25-30; normal is under 25). Obesity is caused when we take in more calories than we burn off.
We burn calories primarily in two ways: 1) the basal metabolic rate (the energy the body expends to run its basic functions like pumping blood, breathing, filtering blood, and so on), and 2) the extra activities of motion and exertion (running, jumping, and so on).
Our generation is taking in more calories because of the bad foods we are eating, and because we are choosing larger sizes. Our generation is burning off fewer calories because of our sedentary life style (cars and TVs and desk jobs).
Here are some recommendations for a healthier diet, which will help you lose weight:
1. Cut out soda pop. If you must imbibe, switch to sugar free soda. Best of all, drink water instead.2. Reduce or eliminate fruit drinks. They are loaded with sugar. Most of them have had the fiber removed. Their nutritional value is limited and their calorie content high.2. Eat out less often; eat at home more often. Studies consistently show you get less saturated fat, more fiber, and fewer calories when you cook and eat at home.3. Try and eliminate snacking between meals. If you must snack because you are starving, eat something healthy like a handful of nuts (almonds are best) or a piece of fruit. One trick I have tried: get some Fiber Choice Sugar- Free Fiber tablets and munch on them. They swell in your stomach, provide great fiber, and make you feel full (and no calories).4. Use fewer saturated fats in cooking (fats that harden, such as butter and lard); use more mono-unsaturated fats (olive or canola oils). Watch you trans-fatty acid (“trans fat”) intake.
Let’s look at some new ideas on the subject of obesity.
Calories and the Glycemic Index
Different foods have different caloric values. Fats have the highest value (9 Kcal/gram); proteins and carbohydrates (sugars) are about equal in value (about 4 Kcal/gram). However, fats and proteins take a much longer time to digest and therefore make you feel full longer. Many carbohydrates, on the other hand, are rapidly digested and leave you feeling hungrier sooner.
Carbohydrate foods are composed of different types of sugars. This is where that term “glycemic index” comes in. Generally speaking, it means that foods with a high glycemic index are very high in simple sugars like sucrose (table sugar), fructose (fruits sugars), or galactose. Simple sugars are rapidly digested (and thus you get hungrier earlier) and are converted into fat by the body very easily.
Conversely, many other carbohydrates are starches (a type of sugar), but starches are complex carbohydrates, which means they are higher in undigestible fibers and thus take longer to digest, and therefore have a low glycemic index. As I pointed out before, brown starches are even better than white starches because they usually have even more fiber in them.
One of the current theories of dieting that I really like suggests you eat more proteins, more low-glycemic carbohydrates, and moderate amounts of mono- or poly-unsaturated fats. This of course shuns the high glycemic carbs that have a lot of sugar in them. These types of diets (e.g. South Beach Diet) seem to be effective and very healthy.
Pills
OK. You have waited ling enough. You finally get to hear about pills that help with weight loss. No matter how much I talk about healthy diets and exercise, most people want to hear about “pills” for weight loss. This is unfortunate, because the prescription medications we have for weight loss are only mildly to moderately effective, and, in the end, can only effect long term results when one makes a total commitment to the other lifestyle changes we have been discussing. But, human nature being what it is, people want a pill to take, so here goes.
Let me first begin by telling you there are no magic pills. Those ads you hear on TV that tell you that you can take a pill and burn off calories while you sleep are pure nonsense. Many companies go even further by telling you that you don’t even have to diet or exercise at all – just pop their magic pill and you will melt of the pounds. It just isn’t so.
Losing weight takes work (no exaggeration – in physics work is the result of energy being expended to move an object against gravity or other resistance, which means calories burned, gasoline consumed, electricity used). Pills can definitely aid in this work, but they cannot do it for you.
Types of Medications Available
We currently have several medications approved for weight loss in this country, with two being the newest and most safe and effective over the long term: Sibutramine (Meridia) and Orlistat (Xenical).
Other popular weight loss medications, which are derivatives of the amphetamine class of drugs, have been around for years and are effective only for the short term (we are talking about a few weeks). You may have heard of these meds: Fastin, Preludin, Ionomin, and others. They have side effects related to amphetamines: insomnia, nervousness, rapid pulse, elevated blood pressure, and the like. They work by suppressing the appetite center in the brain – but the effect wears off within two to three weeks. These medications are not without some helpfulness – they may be used to get an obese patient headed in the right direction. But they are a short term “crutch” and not intended for long-term use.
On the other hand, Meridia and Xenical have been approved for long-term use (up to two years now). Meridia is in a class of drugs similar to the serotonin anti-depressants. It increases the amount of serotonin, dopamine, and norepinephrine in the brain, which leads to appetite suppression. The effect is mild – it is not earthshaking. But it can be effective. Side effects are usually mild, except for high blood pressure, which can be seen in those so predisposed, so watch out for it. Average weight loss over a year is about 10 lbs.
The other agent, which is safe and effective, is Xenical. This drug works by partially blocking the digestive enzyme lipase in the intestine. Lipase is needed to absorb fats from the gut into the bloodstream. Xenical blocks some of the lipase but not all of it, so it is effective in weight loss, but only mildly so. The average weight loss is about 8-10 lbs over a year. Side effects are related to the malabsorption of fats in the gut, like greasy stools and increased gas and are not considered serious.
Surgery
Surgery is usually considered a last resort, and rightfully so when one considers the cost and risks. There are several types of surgery available for weight loss but they primarily fall into two categories: gastric surgeries, which attempt to limit the size of the stomach reservoir, and intestinal bypass or shortening procedures, which decrease the ability of the small intestine to absorb food. The most aggressive (and successful) surgery employs gastric reduction and intestinal bypass. It carries a mortality rate of around 1% and has some unpleasant side effects like diarrhea and intestinal bloating and gas. It is highly effective, however. This is the surgery that weatherman Al Roker had.
The least aggressive surgery is the new lap band, which adds a stricture to the stomach to limit its size. It is safer and more tolerable than the bigger surgery, but not quite as effective. It has side effects of gastric regurgitation (acid reflux, vomiting). It should be understood that approximately 20% of these procedures will need to be converted to the bigger surgery because the effect was not great enough.
Before you even contemplate weight loss surgery get several opinions from various doctors (not just a 2nd opinion, but a 3rd, 4th, etc).
Final Thoughts:
Obesity kills people. Even worse, however, it makes life insufferable for so many people (the stigma of being overweight, the medical complications such as diabetes, heart disease, joint pain – you name it). Weight loss is hard work and requires a long-term commitment to lifestyle changes. A psychologist may even be required to help one get a handle on overeating.
Medications can help but must be considered mildly efficacious at best. Surgery is highly successful but is a big step, both financially and risk-wise.
Losing weight is a long journey, but like every journey, it begins with the first step forward. Let’s get moving! Good luck to you.
