Nutrition and Obesity
Joyce R. Mills, M.S., M.Ed.
Risks of obesity include: coronary artery disease (CAD), heart attack, heart
failure, angina, abnormal heartbeat, high blood pressure, elevated cholesterol and triglycerides levels, lowered beneficial
HDL cholesterol levels, stroke, type 2 diabetes, and certain cancers such as prostate, gallbladder, colorectal, breast, endometrial
and kidney. In addition, obesity increases the risk of developing gallstones (in women), liver problems such as an enlarged
liver, cirrhosis, or a fatty liver, gastroesophageal reflux disease (GERD), sleep apnea, asthma, shallow breathing (Pickwickian
syndrome) which can lead to heart disease, and arthritis. Obesity also increases the risk of reproductive problems such as
irregular periods, an increased risk of birth defects, especially neural tube defects, and an increased risk of death of the
mother and baby.
The risk of developing type 2 diabetes increases as a person gets heavier.
This is very unfortunate as diabetes is a major risk factor for the development of heart disease. While obese individuals
are more at risk for arthritis than normal weight individuals, each additional few pounds of weight gain increases the risk
for developing this potentially debilitating condition. Finally, recent research suggests that being obese can increase the
risk of lowered mental ability, especially in memory and learning, in men over time.
The location of body fat is also important in assessing risk. If the fat accumulates
disproportionably around the abdomen, it is an independent predictor of increased risk and morbidity. Thus individuals whose
fat accumulates around the abdomen are at greater risk than individuals whose fat accumulates around the hips and thighs.
A man with a waist measurement of more than 40 inches or a woman with a waist measurement greater than 35 inches is considered
at increased risk for type 2 diabetes, high blood pressure, high cholesterol, and coronary artery disease than normal weight
individuals or those whose fat accumulates around the hips.
Psychological consequences of being
overweight
It is ironic in a society that regards slender, well-toned bodies as the ideal
that an epidemic of obesity is threatening an increasing number of lives. Psychological consequences of being overweight or
obese include lowered self-esteem, anxiety, depression, and eating disorders. Unfortunately each of these problems may also
increase the risk of overeating and additional weight gain. It becomes a vicious cycle.
Gain a few pounds and many people, especially women, feel less valuable as
a person. A sad, miserable person may turn to food and/or substances for comfort. These self-comfort efforts result in additional
weight gain which exacerbates the problem. Positive life changes, such as adopting an exercise program, become more unlikely
and the loss of lean body mass through inactivity lowers the metabolism making additional weight gain more likely. It is a
sad spiral downward.
Loss of energy and joy for life
Overweight and inactivity are co-conspirators in murdering a sense of joy for
life.
As an individual gains weight they have less energy and the tendency is to
slow down and do less rather than more because it takes more effort to be active. Even the ordinary tasks of daily life seem
to make a person feel exhausted. A reduction in activity results in the susceptibility to health risks associated with being
sedentary. A sedentary lifestyle increases the probability of developing osteoporosis and arthritis, elevated cholesterol
and triglyceride levels, high blood pressure and the probability of additional weight gain. It also reduces a person’s
problem solving ability, speed of thinking, short and long-term memory, and reaction time. Sleep may be impaired and drug
and alcohol use may increase. Life stresses seem more overwhelming as exercise is avoided and a major opportunity for the
reduction of muscle tension, stress and anxiety is lost. Exercise can help with mood elevation only if it is pursued. Meanwhile
the less active a person becomes the greater the risk of gaining more weight, and the more weight gained the less likely the
individual is to become more active.
More calories in than needed for daily
energy expenditures
We gain weight because we eat more calories than our body needs to meet daily
demands. This is an adaptive response inherited from times when food was less abundant available and energy demands greater.
Individuals who were able to eat and store food (as fat) when it was available were more likely to survive when it was not.
Thus it is not unnatural to want to eat, and eat a lot, if tasty food is before us. The problem is that the practice is detrimental
to our survival because most Americans are blessed with the resources to obtain a continuous source of nourishment. At this
juncture we are required to use our intellect to understand our bodies’ instincts and to develop a more twenty-first
century appropriate relationship with food. The catalyst in making this change
is activity.
Genetics and age play a part but lifestyle
choices can have a major impact
The amount of fuel we need depends on genetics and what we do. The human body needs energy to maintain vital functions and maintain body temperature (resting metabolic
rate), energy to eat, digest and store food, and energy to perform physical activities in addition to these activities essential
for the continuation of life. Genetics helps determine the amount of energy a specific person needs to perform vital functions
and digest and utilize food. However the amount of energy expended in physical activity is under our control. We CAN choose
to be more active, which can, ironically, elevate our resting metabolic rate.
Muscles are very metabolically active which is why a loss of muscle mass will
reduce the resting metabolic rate. With strength training muscle mass can be maintained or increased which makes weight management
easier. In addition a person looks firmer and slimmer because muscle takes up less space than fat. Strength training reduces
the risk of injury, improves bone density, helps speed food through the digestive track, and assists in lowering blood pressure,
cholesterol and triglyceride levels.
Nutrition
Food provides the energy and nutrients to build and maintain body cells. Of
particular importance are life-sustaining essential nutrients that the body cannot make or make in sufficient quantity for
survival. Before we decide to eliminate categories of foodstuffs via a reducing diet we need to understand what is essential
for good health. Two websites provided by the U.S. government that can provide health and nutrition information
are http://www.healthfinder.gov and http://www.nutrition.gov.
The difference between nutritional
food choices and being on a diet
If one is on a reducing diet then presumably one will no longer be “on
a diet” when weight goals are achieved. While a drastic reduction in calories, especially carbohydrates, can result
in weight loss, maintaining the weight loss after going “off” the diet is more complicated. The ultimate goal
is to reach and maintain a reasonable body weight suitable for a particular individual. Unfortunately changing eating patterns
in a manner that is unsustainable or unhealthy is not the solution over time.
The lowest weight we have been able to maintain since reaching the age of 21
gives us an idea of the lowest weight that we might be able to maintain over time. Past history also provides us with personal
information about how easy it is for us to gain and lose weight. A look at immediate family members, and an evaluation to
determine bone size (small boned, medium boned, large boned) can also give us information to determine what might be an ideal
weight for us. All this information can help us determine a range of healthy weights for us.
Carbs, fat and protein
Carbohydrates, fats, protein, vitamins, minerals plus water make up the six
classes of nutrients found in food. Nutrients have three basic jobs: providing energy; promoting growth, development and maintenance;
and regulating bodily processes. Carbohydrates, fats and proteins work together to provide us with energy. Proteins, fats,
vitamins, minerals and water promote growth, development and maintenance. Proteins, fats, vitamins, minerals and water are
necessary to regulate bodily processes.
Since all classes of nutrients are necessary to provide a healthy diet, the
wisdom of severely limiting or eliminating any category is questionable. Rather it would seem preferable to include plenty
of fruits and vegetables, whole grain bread and cereals, lean meats, fish, and poultry, low or nonfat dairy products as well
as healthy fats in an effort to supply needed nutrients through a healthy eating plan.
Some of the current ideas underlying what sorts of weight loss plans would
work most effectively were derived from the fact that carbohydrates and proteins provide only 4 calories per gram while fat
provides 9 calories per gram.
Eating a diet high is saturated fat is known to increase LDL (bad) cholesterol
levels and increase the risk for cardiovascular disease. Trans fatty acids are believed to operate in the same way as saturated
fats. On the other hand, monounsaturated and polyunsaturated fats help to lower LDL cholesterol. The addition of soluble fiber
to the diet also helps reduce LDL in the bloodstream.
Carbohydrates are not all equal. Foods rich in simple sugars and refined flour
provide primarily calories but little nutritional value. Complex, unrefined carbohydrates such as those found in whole grain
products, whole fruits and vegetables provide calories for energy but also essential nutrients as well as fiber. Complex carbohydrates provide both insoluble fiber which help keep the digestive tract functioning properly
as well as soluble fiber which helps keep the arteries clean.
In summary, carbohydrates, fats and proteins are all essential for life. All
should be part of a healthy diet. Optimally food choices should involve the selection of the healthier forms of each category
of nutrient—with the less nutritious ones being selected on a more occasional basis.
In other words, if you want an occasional steak or piece of cake, or premium ice cream cone, go for it, enjoy the treat
and then go back to more healthy choices the next day.
Food pyramid
The Food Guide Pyramid, the most recent released in 2000, is a reference guide
for selecting a healthy diet. The serving suggestions provide for diets ranging from about 1600 to 2800 calories per day based
on the number of servings of each food group selected. The current food pyramid has as its base the bread, cereal, rice and
pasta food category, followed by the fruit and vegetable categories, followed by the milk, yogurt and cheese group which occupies
the same level as the meat, poultry, fish, dry beans, eggs, and nuts group. The top of the pyramid is composed of the fats,
oils and sweets category.
Soon a new food pyramid will be released. News releases indicate that the new
food pyramid will shift the focus from maintaining a healthy diet to losing weight. More fish and fiber will be recommended
than the current pyramid, and fewer refined grains. Portion control is quite important, as will be counting calories instead
of carbohydrate or fat grams. People will also be encouraged to exercise more—optimally in the range of 30-60 minutes
a day. Twenty minutes a day is still considered beneficial for improving health risks and helping maintain weight, but longer
periods of exercise are considered appropriate for those attempting to lose weight.
Junk food vs. whole, minimally processed
food
The major problem with the consumption of “junk” food, usually
foods containing an overabundant amount of sugar and fat, is that these foods provide little but calories. If these empty
calories replace more important nutrient-dense foods such as fruits and vegetables and low-fat dairy products, the end result
is a poorer quality diet. In children and adolescents these deficits can impede growth and development.
Eating a diet rich in fruits, vegetables, grains and legumes that retain their
beneficial fiber not only provide more nutrients than highly processed foods, these foods may also reduce the risk for cardiovascular
disease and certain cancers. Minimally processed foods, which contain fiber, also help moderate blood glucose levels, aid
elimination, assist in lowering blood cholesterol, and make weight management easier.
Low fat vs. very low fat diets
A low-fat diet has been recommended for some time as a weight reduction tool
and is the plan recommended for healthy living by the current food pyramid. The reason that a low fat diet often fails is
because of the misconception that since carbohydrates have fewer calories than fats per gram that unlimited amounts of carbohydrates
may be eaten. All carbohydrates are not created equal. There is a world of difference between complex carbohydrates and highly
refined ones which pack little nutritional value but plenty of calories. To add to the confusion, a food label describing
a food as low-fat does not mean that a food is necessarily low calorie. All calories count.
In addition to diets that recommend limiting fat to no more than 30% of the
diet (only 10% saturated fat) there are several diets that recommend a very low fat consumption (5-10% of calories from fat).
The Dr. Dean Ornish plan is one such diet. A diet this low in fat tends to be
very high in carbohydrates. While these diets are not harmful for most adults, this type of diet may not be suitable for those
with diabetes or insulin resistance. A very low fat diet may provide cardiac benefits, but it is very hard to follow over
the long term. People get tired of the diet because they can eat so few of the foods they like. Eventually most dieters will
long for some foods higher in fat or for more protein than the grains, fruits, vegetables and small amounts of protein allowed
on this diet. This desire is usually followed by a lapse which is generally followed by abandoning the diet.
Low Carb
Low or restricted carbohydrate diets, such as the “New” Atkins
Diet, are very popular because they result in rapid weight loss. It has the appeal of a quick fix. Unfortunately once the
dieter resumes a more normal diet the weight is regained, in part because much of the weight lost is water, which is excreted
when lean body mass is broken down to produce glucose As soon as a more normal
diet is resumed the muscle tissue is rebuilt and weight may be regained. There is also some concern among some experts about
the high saturated fat content of this diet and the fact that carbohydrates are cut significantly below the recommended level
set by the National Academy of Sciences’ Institute of Medicine.
The low-carbohydrate diet works because it severely reduces calorie intake.
Unfortunately this diet also limits fruits, vegetables, legumes, and whole grains which are many of the very items recommended
to promote good health.
The South Beach Diet’s phase one is highly restrictive of many of the
beneficial carbohydrates. Phase One results in rapid weight loss because it severely cuts calories. However, the second phase
which reintroduces “good” carbohydrates and the third phase which allows for moderate consumption of a wide variety
of foods are actually healthy options because they stress eating lean protein, low-fat dairy, whole grains, unsaturated fats
as well as fruits and vegetables and plenty of water.
Weight Watchers
Weight Watchers uses group meetings as a foundation for their program. The
meetings are lead by individuals who have been successful following the Weight Watchers system. There is a small joining fee
for new group members and a weekly fee to attend meetings—miss four weeks and you are dropped and must sign up (and
pay another joining fee) before you can pay to attend more meetings. On the other hand, if you maintain your goal weight for
six weeks you can attend meetings free. There is also a fee-based online program.
The current diet plan involves having a set number of food points per day based
on body weight and learning to eat within the points allowed. There is also a bonus of 35 flexible points that can be used
throughout the week. A person can eat almost anything on this system (including ice cream for dinner), although portions must
be observed to stay within the point system. The overall plan steers dieters toward low-fat high fiber food choices as these
are the ones that cost the fewest points. In addition many of Weight Watchers’ ideas, such as encouraging physical activity
and healthy eating habits and group support are excellent. Membership also entitles members to online diet tools. Unfortunately
the weekly membership fees can add up over time. And finally, not everyone wants to face a weekly weigh-in with other people.
While the online service gets around the weigh-in there are still significant fees for the service.
Weight Watchers has published some wonderful cookbooks over the years that
can facilitate a dieter in selecting appealing menu items, buying and preparing the items along with information about nutrition
facts and portion size. Also some of their ideas such as the value of eating frequently are very smart.
Jenny Craig
Jenny Craig is a commercial weightloss diet center. There are two main membership
plans: Platinum and Gold. New programs and specials are introduced regularly.
Jenny Craig is a balanced nutrition plan based on the current food guide pyramid
recommendations. The company sells pre-packaged meals which are convenient and solve portion size issues for you. While exercise
is encouraged, it is not a primary element of this part of the program. This program is capable of helping a dieter eat nutritional
meals and lose weight. However, if a dieter does not learn how to prepare and control portion sizes on their own it will be
difficult to maintain weight losses once the dieter returns to eating their own food.
The program provides one of their counselors to assist during the transition period from active dieting using their
meals to maintaining weight losses. The transition period focus is on lifestyle changes such as being more active and developing
a healthy relationship with food.
NutriSystem
NutriSystem is also a commercial diet plan that has moved from being center-based
to being an online weight-loss program. It too is a reduced calorie diet that focuses on balanced nutrition based on the current
food pyramid. It sells expensive pre-packaged meals—although their meals are not required purchases, it is much easier
to follow their program using their meals. Their meal plan stresses low-glycemic carbohydrates with the proper amounts of
protein to keep blood sugar stable and metabolism strong to burn more fat. Their program features three meals and two snacks—in
perfect portions. They also stress their MindNourish and BodyNourish programs to get mind and body in gear to maximize weight
loss.
If a dieter buys the complete meal plan they will spend nearly about $275 for
a 28-day package. A discount is offered for the automatic ship program. Since a dieter does not have to go to a diet center
counseling takes place online—not face to face.
If a dieter is able to stay on this well-balanced, low calorie diet they will
lose weight. But like so many plans that push their pre-packaged food the transition from active dieting with prepackaged,
convenience foods to maintenance with food your purchase and prepare yourself can be a challenge.
Diet Pills
Diet pills have been around for decades. At the current time there are no pharmaceutical
silver bullets for overweight and obesity.
Amphetamines were long the diet drug of choice. They were supposed to facilitate
weight loss by stimulating the metabolism and reducing the appetite. But there were costs to the 10 to 20 lb weight loss that
was possible before the drugs lost their effectiveness. Amphetamines interfere with sleep and in general are exhausting for
the body since it is kept in a constant state of arousal. Amphetamines can also cause hallucinations and psychiatric disorders,
can dangerously raise heart rate and blood pressure, are addictive and frequently cause withdrawal problems when stopped.
They can also cause congestive heart failure, seizures, and sudden death.
Fenfluramine and phentermine came onto the market in the 1970s as individual
weight loss drugs. In 1994 it became common for a combination of these drugs to be prescribed together following positive
results in a research study. This combination was known as Fen/Phen. Another drug called dexfenfluramine, Redux, was offered
in 1996. While weight loss was slightly enhanced in many dieters while using these drug combinations it was soon discovered
that many users of fenfluaramine and dexfenfluamine developed valvular heart disease. These drugs were also associated with
primary pulmonary hypertension and neurotoxicity. Dexfenfluramine and fenfluramine were removed from the US
market in 1997. All these risks for a drug that helped produce an average six pound weight loss.
Ephedra is another drug that has recently been removed from the marketplace
due to health concerns including instances of sudden death. Ephedra proponents have said that the drug is harmful only if
taken in excessive amounts. But such is the temptation to desperate people trying to loss weight.
While carb blockers may help to lose a few pounds, this small bit of additional
help comes at the price of gastrointestinal symptoms such as gas, bloating and diarrhea. Fat blockers also cause these same
symptoms, gas, bloating and diarrhea. To make matters worse fat blockers have not been shown to help lose weight but they
do reduce the absorption of fat-soluble vitamins.
Herbal, “natural” diet drugs also can be dangerous. A dieter should
talk with their doctor and pharmacist before taking these medications, especially if they are taking prescription medications
because some herbal supplements have been found to have serious health implications when combined with certain prescription
medications
Caffeine is sometimes used to aid weight loss because it slightly increases
metabolism and slightly decreases appetite. Unfortunately it also can raise heart rate to dangerous levels, cause sleep disturbances,
and raise blood pressure.
While there are a few weight loss prescription drugs currently available, all
have side effects. They may not work for everyone, and the lost weight is usually regained when the drugs are stopped.
In short, there is no silver bullet to solve a weight problem.
Surgical Intervention for Weight Loss
Weight loss surgery is known as bariatric surgery and changes the anatomy of
the digestive tract to limit the amount of food that can be eaten and digested. It entails significant risks, including death,
and results in indefinite lifestyle changes. It is usually reserved as a treatment of last resort for those who are severely
obese and have serious health problems as a result of their obesity.
The most common type of procedure restricts the stomach size to achieve weight
loss. Gastric bypass is the most common restrictive procedure performed in the North America. Gastric
bypass results in the surgeon creating a small pouch on top of the stomach together with a bypass around a segment of the
small intestine. The pouch is stapled off from the rest of the stomach leaving only the small pouch that can hold about one-half
ounce of food. The small intestine is then cut and sewn directly to the pouch. This arrangement redirects food bypassing most
of the stomach and first part of the small intestine which reduces the body’s ability to absorb calories. Some surgeons
are able to perform this surgery laparoscopically (small incision surgery) for some patients.
A multidisciplinary team usually evaluates candidates for these procedures.
It is very important to determine if undiagnosed psychological issues such as depression or substance abuse might hinder the
patient’s commitment to lifestyle changes or if a person is ready to accept and cope with the changes in body image.
We all think that a new slimmer body will improve our work and social situations; unfortunately it might be a source of tension,
anxiety and depression.
The results of gastric bypass surgery can be dramatic but there are risks and
major life changes in the path to achievement of a more normal weight. If an individual survives the surgery there is the
possibility of the opening between the stomach and small intestine closing which has to be either dilated by a tube through
the mouth or through surgery. The first six months if a bypass patient eats too much or too fast they either vomit or suffer
severe stomach pain. The stomach is reduced to about the size of a small egg. Meals are reduced to 2 ounce portions, eaten
four to six times a day. Most people learn quickly how much can be consumed at one time—courtesy of nausea and pain.
Over time the amount you can eat increases.
With such a significant reduction in the amount a person can eat comes the
risk of iron deficiency, B-12 deficiency, gallstones or a bleeding ulcer. As a result the gallbladder is sometimes removed
during the surgery. If the gallbladder is not removed bile supplements may need to be taken in an effort to prevent the development
of gallstones A daily multivitamin with iron may be needed as well as B-12 supplements taken for the rest of the life. A bleeding
ulcer may be treated with medication or may require surgery.
Genes
Your body weight is influenced by genetics. If one of your parents is obese
you are several times more likely to be obese than someone who has parents of a healthy weight. If both parents are obese
you are at a very high risk of becoming obese yourself.
Genes influence how efficiently calories are used. Efficient energy users have
more calories left over to store as fat than less efficient calorie burners.
However, genetics only determines a tendency to become overweight or obese.
Lifestyle choices such as eating healthy portions of nutritious food, exercising and finding other ways to relieve stress
and disappointment rather than eating also influence a person’s weight.
Eating patterns
If you come from a family in which rich food is the center of family gatherings,
both nuclear and extended, you will likely have different attitudes about food than someone whose family prefers broiled meats
and steamed vegetables and brown rice. If the types of food enjoyed by your family are high calorie and/or high fat and the
table is set with bowls of food from which individuals may choose and eat their fill then you may be at more of a risk than
in a family where plates are served in the kitchen and portions more controlled. If high fat snack foods are always available
in your pantry and refrigerator you are more at risk for weight problems than if such treats are saved for special occasions.
If most of your family’s meals are from fast food retailers, eaten in
the car as necessary, you are likely to develop different eating habits than if most of your meals are prepared at home from
fresh ingredients and eaten in a relaxed atmosphere around the family table. If you learn to eat quickly you will also be
at greater risk for gaining weight than if you eat more slowly. Slower eating increases the probability of your recognizing
when you have had enough to eat before overeating occurs.
Metabolic rates
We are told that for every ten years beyond our early to mid-twenties our metabolism
slows about 10%. While a reduction in metabolism is usually observed it may actually be more of a product of reduced activity
rather than merely the passage of time. Inactivity causes loss of muscle tissue. Muscle tissue is very metabolically active—both
during exercise and after. So, if muscle mass is loss our metabolism slows. However, if we continue to exercise, especially
if we do strength training with weights, we can reduce the loss of muscle mass or even increase it.
As we age we have two choices to prevent weight gain. We can reduce caloric
intact in order to prevent a calorie surplus or we can add more physical activity to keep the energy equation in balance.
Moving more seems to be the better of the two choices, especially because of all the advantages to an active as compared to
a sedentary lifestyle.
Balanced diet
Most dieters who are successful do so because they are able to learn to eat
a diet that is relatively balanced as to the amount of carbohydrates, fats, and protein. A well balanced diet provided the
essential nutrients needed by the body with an adequate number of calories to support the energy demands of the individual’s
lifestyle. Such a scheme works on a long term basis, it is a lifestyle not an on again off again reducing diet.
As far as the weight loss phase of a diet, choose what suits you best. It does
not matter whether one starts from a fairly carbohydrate restrictive diet to adding healthy carbohydrates, or from a higher
carbohydrate diet to which care is applied to insure a healthy proportion of good fats and proteins to complement the carbohydrates.
In the end diets that result in long term weight loss work because they reduce calories sufficiently to slowly reduce body
weight in conjunction with an increase in activity. Such a diet uses real food that the dieter understands how to prepare
in a healthy fashion as well as how the foods work together and what portions should be consumed. Everyone occasionally splurges
on special treats; and it does not matter if the overall diet is good. If the overall diet is balanced a piece of birthday
cake, or a steak, or a holiday meal are just that—special treats to be enjoyed. The next meal, or the next day one goes
back to a more balanced food plan and no harm is done.
Achieving a negative energy balance
A negative energy balance, fewer calories in than are needed to meet the activities
of daily life and physical activity, can be achieved by either reducing calories, significantly increasing activity or a combination
of cutting calories and adding activity. Adding activity is essential because exercise may reduce the amount of muscle tissue
that is lost due to dieting and it will establish a habit of exercising which is the key for weight management.
The amount of reduction and the consistency of that reduction will determine
the speed of weight loss. A pound or two a week is considered to be the fastest, safe rate to lose weight. Generally this
is caused by dropping about 500 to 1000 calories daily from the diet and exercising strenuously enough to add a several hundred
calorie deficit. However, it is generally inadvisable to go below the 1200 calorie range unless one is being medically supervised.
It is also possible to make less drastic cuts in calories, add exercise and reduce at a slower rate. It does take patience
but weight lost slowly while feeding the body well, tends to stay off because the weight loss is due to lifestyle changes
that you can live with indefinitely.
For
personal coaching on weight management contact us.
