July 5, 2020 - Sunday

Obesity: Current Medical Knowledge – Part Two

By Suheil Khuri M.D. –
ObesityIV. Health Consequences of Obesity:
Obese individuals are at a much higher risk of developing many diseases and health issues that can affect their lives negatively. In 57 studies in 4 continents mortality was noted to begin to increase modestly with a BMI > 25. With a BMI of 30 or above mortality rates increase 50% – 100%.
The following are common medical complications of obesity:
• Cardiac: coronary artery disease and congestive heart failure: For each 1unit increase in BMI, risk of congestive heart failure increases 5% in men and 7% in women.
• Hypertension
• Diabetes Mellitus
• Stroke: For each1 unit increase in BMI stroke risk increases 4% – 6%
• Impaired Respiratory Function: Asthma is noted to show an increased risk with higher BMI’s especially with BMI’s above 30.
• Sleep apnea: Occurs in 50% of severely obese individuals. More common in males. Associated with snoring. Neck circumference over 17 inches in men and more than 16 inches in women increases the risk for sleep apnea. Those patients have increased risk of coronary artery (cardiac) events, increased risk of stroke and hypertension. However, 10% weight reduction can im-
prove the severity of the sleep apnea problem by more
than 50%.
• Osteoarthritis: in multiple joints.
• Dyslipidemia: increased cholesterol, triglycerides,..
• Vascular disease and thrombophlebitis: (blood clots)
•  Liver (non-alcoholic fatty liver disease) and gallbladder disease: As BMI increases gallstone risk increases from 9% to 25% in     women and from 5% to 11% in men.
• Alzheimer’s Dementia: Overweight increases the risk for Alzheimer’s Dementia in elderly women. For every one-unit increase in BMI at age 70 Alzheimer’s Dementia risk increased by 36%. This association was not found in elderly men.
• Various cancers: breast, esophagus, stomach and others. Two large chemoprevention trials revealed that there is a 70% increased risk of premenopausal breast cancer in obese vs. normal weight women.
• Many other complications: gout, pancreatitis, polycystic ovarian syndrome, urinary stress incontinence, and infertility.
It is important to recognize that a mere 10% weight loss will significantly improve all above conditions. It will also significantly decrease the need for the use of medications associated with diabetes, hypertension, and hypercholesterolemia.
V. Treatment:
Many factors need to be considered in the treatment of obesity. To achieve a successful weight loss goal, a weight loss program needs to address four categories (diet, behavior/habits, physical activity, & pharmacotherapy/
medications):
1. Diet
There are some controversies as to what is the best weight reduction diet. The composition of the healthiest diet is not known, however, ingested calories are the critical factor for weight loss.
The main food components are:
• Macronutrients: those are the carbohydrates (have a 4 Calorie/gm. value) , proteins (have a 4 Calorie/gm. value) and fats (have a 9 Calorie/gm. value) and are important as energy sources.
• Micronutrients: those are the vitamins, minerals, and electrolytes that are vital for various chemical reactions.
• Water: the adult body averages ~ 53% (varies from 45% in the obese – 75% in the infant) water.
• Other non-nutritive substances.
Factors that determine the quality of weight loss:
• The energy content. Lower calorie diet tends to cause greater loss of fat mass. However, excessive low calorie intake is not healthy and is not advised.
• The Macronutrient composition. The higher intake of proteins results in a greater retention of fat-free body mass (muscle sparing).
• The individual’s body composition: there is a greater fat loss in more obese individuals using the same calorie diets as less obese individuals.
Dietary Strategies:
• Calorie restricted / Balanced Deficit Diets.
• Macronutrient specific diets:
1. Low Fat diets.
2. Low Carbohydrate (carbohydrate restricted) diets.
• Protein sparing modified fast/very low calorie diet
• Meal replacements.
Classification of diets by calories:
• 0-400 Starvation type and not recommended
• 400-800 VLCD (Very low calorie diet)
• 800-1500 LCD (Low calorie diet)
• Above 1500 BDD (Balanced deficit diet)
• Self directed programs: Atkins, South Beach, Weight
Watchers,…
Regardless of nutrient composition VLCD and LCD should include physician education and patient monitoring to ensure safety and obtain the optimal effect. They are effective diets for weight loss. However, one needs to set realistic goals.
Both low fat diets and low carbohydrate diets lead to significant weight reduction but recent research has focused more on carbohydrate diets. Dietary adherence is shown to be a more important factor than the type of diet itself.  Low fat diets tend to reduce LDL cholesterol, while low carbohydrate diets tend to target triglycerides/
HDL cholesterol.
Typical weight loss has been shown to be 75% fat and 25% lean body mass (muscle). Thus one needs to increase protein requirements above recommended levels to compensate for that loss. Use 1 to 1.5 gms of protein per kg of initial body weight daily as a guideline.
Meal Replacement can be very helpful especially when the individual tends to crave sugars or other non-healthy foods. Meal replacements can be used as a full meal replacement, as a part of a meal, or a snack to avoid non-healthy food cravings.
Maintaining weight loss is more important than larger weight loss.
Diets should be tailored to the individual and the best diets are those that an individual can adhere to and follow regularly.
Weight loss goals: typically there is a wide discrepancy between the physician’s goal and the patient expectation. One should set more realistic goals and achieve them. A 5% – 10% decrease in baseline weight that is maintained is a more realistic approach and is proven to improve triglycerides, HDL, fasting blood sugar as well as most of the obesity-associated diseases.
Call us at: 561-427-2232 or e-mail us at Jupiter.florida@drgsweightloss.com for a free consultation at Dr. G’s WeightLoss and
Wellness Center of Jupiter
Next month:
Obesity Current Medical Knowledge – Part Three

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