Obesity

In 2004, obesity was reclassified by Medicare as a chronic disease. Obesity is characterized by an excess of body fat and is most often defined in terms of body mass index (BMI). The BMI is measured by taking weight in kilograms divided by height in meters squared (kg/m2). Worldwide, adults with a BMI of 25 to 30 are categorized as overweight. BMI can sometimes be inaccurate because it does not distinguish between fat and muscle, nor does it predict body fat distribution. On a population level however, BMI does seem to track trends in adiposity as opposed to muscularity.

In a clinical setting, the most valuable measurement strategy for classifying weight other than the BMI is waist circumference. The presence of extreme abdominal fat has been shown to be an independent risk factor for diabetes, high blood pressure, and cardiovascular disease.1 Waist circumference is obtained by placing a measuring tape in a horizontal plane around the waist at the level of the umbilicus (“belly-button”) and the superior iliac crests (“hip bones”).

Evidence shows that obesity is a proinflammatory state that increases risk of several chronic diseases, including hypertension, dyslipidemia, diabetes, cardiovascular disease, asthma, sleep apnea, osteoarthritis, and several cancers.2

All calories are not created the same, and can translate into differing amounts of energy burned by the body over a fixed period of time. Consumed calories are absorbed at different rates depending on their source — fiber, carbohydrates, protein, fat — and this translates into different metabolic signals in the body.3 Consequently, calorie type may influence energy balance as much as amount of intake. A study from the Harvard School of Public Health supports this hypothesis; overweight patients fed 300 more calories per day actually lost more weight than did their counterparts who were eating food of a different composition but equivalent caloric content.4

A regular visit schedule should be proposed and agreed on by the client and management team. The more contact between the two, the longer clients will remain in a program and the greater potential they have to achieve and maintain their weight loss goals.

When consulting with someone who is interested in using exercise as a weight management tool, assessment is essential to setting attainable goals and creating an action plan. For sedentary individuals who are starting an exercise program, the initial goal is simply to start moving. Creating a habit of exercise or movement that emphasizes enjoyment and adherence is an important first step. During this phase, the intensity of exercise is not of paramount importance, but adherence to a modest volume of movement is. Even with modest amounts of movement, one can experience favorable functional changes in strength and endurance that can be a positive and encouraging first step. After a pattern of regular movement has been established and exercise tolerance has improved, the notion of increasing the frequency, duration, and intensity of activity becomes more realistic.

Preloading with 500 mL of water 30 minutes before a meal was reported to be associated with a mean weight loss of 2.4 kg after 12 weeks. Those who used this method three times a day instead of just once daily, lost even more, 4.5 kg (∼10 lbs).5 One could also add soluble fiber to the 500 mL of water. The fiber has the added benefit of soaking up water and expanding in the stomach, enhancing the effects of satiety. Other notable supplements include: Omega-3 fatty acids6, green tea and its extract7, and probiotics.8

As is evident above, obesity is a challenging but not impossible problem. The solutions we offer at Rocky Mountain Regenerative Medicine are simple, actionable, effective, and more importantly, sustainable.

  1. J.P. Despres: Is visceral obesity the cause of the metabolic syndrome?.Ann Med. 38:52-63 2006
  2. National Task Force on the Prevention and Treatment of Obesity: Overweight, obesity, and health risk. Arch Intern Med. 160:898-904
  3. M. Hyman: The calorie myth. Ultrametabolism. 2006 Scribner New York19-27
  4. P. Greene: Pilot 12-week feeding weight loss comparison: low fat vs. low carbohydrate diets. 2003 presented at the annual meeting of the North American association for the study of obesity abstract 95
  5. H.M. Parretti, P. Aveyard, A. Blannin, et al.: Efficacy of water preloading before main meals as a strategy for weight loss in primary care patients with obesity: RCT. Obesity. 23:1785-1791 2015
  6. R.C. Oh, J.B. Lanier: Management of hypertriglyceridemia. Am Fam Physician. 75:1365-1371 2007
  7. T. Nagao, Y. Komine, S. Soga, et al.: Ingestion of a tea rich in catechins leads to a reduction in body fat and malondialdehyde-modified LDL in men. Am J Clin Nutr. 81:122-129 2005
  8. A. Saari, et al.: Antibiotic exposure in infancy and risk of being overweight in the first 24 months of life. Pediatrics. 135 (4):617-626