By Dr. Kevin Wang
Before I start my column, I’d like to remind everyone of a survey I’m conducting. I’m starting a research project in my program to increase awareness of the LGBT community in the medical community. These surveys ask you what you wish or would like your primary care physician to know about our community. Please e-mail me at the address below and I’ll send out the materials. I’d like to thank those of you who have responded. Your help is much appreciated. Now on to this month’s column!
Obesity: Part III
If you missed last month’s column, please go to https://www.pridesource.com/article.shtml?article=16906 and check out Part I.
In Parts I & II, we discussed the problems and health issues associated with obesity. In this final column regarding the issue, we’re going to discuss why it’s important to lose weight, the benefits (both physically and for self-image), some tips and the most appropriate treatment.
Recent studies have shown that a 5-10 pound weight loss significantly decreases the risk of developing adult-onset diabetes. Those who were obese and underwent a 10-pound weight loss had a 70 percent cure rate from diabetes. Those who didn’t lose weight had a much lower cure rate.
Another study showed that a weight loss of at least 20 pounds was associated with a 25 percent decrease in the risk of overall cardiovascular (strokes, heart attacks) and cancer deaths. Blood pressure is also significantly improved as studies show that for every 2 pounds lost the top number in blood pressure falls by 0.5-1. These are just some of the benefits associated with weight loss and the list goes on and on!
Instead of going into all the benefits of weight loss, let’s talk about what we can do to improve our health and become more fit. A quick note before we discuss these techniques. With any method of treatment (whether it’s for high blood pressure, plans for surgical treatment, etc.) there are risks associated with them. Please consult with your physician before starting any weight loss program.
The general principle of weight loss involves two simple facts: to decrease energy intake (take in less calories) or to increase energy expenditure (to exercise and move more) – something easier said than done! To achieve these goals, I usually start off with behavior modification, dietary therapy and exercise. The problem is, these are usually the hardest to change! As embarrassed as I am to say it, I have problems changing these habits myself and I’m always striving to eat better and exercise more.
If my patients’ insurances cover dietary education, I’ll try to squeeze that in. However, most don’t and a simple way to watch what one eats is to simply keep a food diary. Not to advertise a particular product, but a website that I frequently advise my patients to use is http://www.weightwatchers.com. It’s a great place to keep track of what one eats and after a couple of weeks, you’ll be a pro at figuring out how many servings are in what foods and how much of it you can eat. Another reason I like this particular website is it doesn’t make you starve yourself. You can still eat what you want but in moderation while maintaining a healthy diet.
Exercise is another important step. I certainly don’t advise my patients to go out and start running 5 miles a day while lifting weights with three sets of 20 reps! Starting off that way is a reason why many people stop, simply because it’s hard to keep up with something that vigorous. I like my patients to start off with walking around the mall (or anywhere of their liking) for about 20 minutes or so nonstop for about three times per week. If they have arthritis, water aerobics is a good way to prevent hard impact on the joints. As my patients get used to this regimen, I ask them to step it up to 30 minutes and then slowly begin to increase the frequency.
Now using these two methods alone won’t work as well as using them in combination. Some of my patients see dramatic weight losses in a few months and some not for a year. However, even if there’s only a 10 to 15 pound weight loss, don’t give up! Studies show that consistent exercise and diet with a 10 percent weight loss will still decrease percent body fat and improved cardiovascular health. Again, that is why I stress my program as improving health with weight loss as a side effect!
One last weapon I have in my arsenal includes medications to either curtail appetite, to decrease the absorption of fat or to increase one’s metabolism. There are even some off-label uses of other medications that have weight loss as a side effect. I usually don’t use these medications due to potential side effects, potential for abuse and contraindications (reasons not to use certain medications due to either a side effect profile or due to a patient’s other health problems). However, if I have a patient who has been sticking with diet and exercise, I may use it sparingly only with a consult with a dietician and strict monitoring. This is a step I rarely take and only if I know a patient will be compliant and careful!
There are other methods of weight loss that are out there. Unfortunately, I don’t have significant experience in these but I’ll just bring them up to be complete. There’s always plastic surgery. It’s something I don’t necessarily bring up as a first-line option since it’s a quick fix to a problem that should be carefully considered and worked upon. However, I have seen cases where it was a great jumpstart to changing a patient’s behavior and the boost in self-esteem and self-image were fantastic!
The other option is bariatric surgery or stomach stapling. This procedure is usually reserved for patients who are classified as “morbidly obese.” As I’m sure most of you have heard, it pretty much decreases the size of your stomach to a small pouch so that you get full on a small amount of food. By vastly decreasing the amount of calories you take in, you lose a lot of weight in a short amount of time. This procedure isn’t without complications as you’ll have to be on a huge amount of supplemental vitamins (if you don’t take these, you’ll become anemic, fatigued, etc.) and there certainly are risks associated with the procedure. Please consult your doctor before considering these options!
Now there is one significant problem associated with these therapies – there’s always the risk of gaining the weight back! When I have patients that come to see me for weight loss, I usually tell them that I have a program to improve health. A side effect of my program may include weight loss but my concern is improving the general health (cardiovascular, emotional, etc.) of my patient to decrease the risks associated with a sedentary and overweight lifestyle. With any change in lifestyle, there are going to be some slips. Just because I have a patient that attempts to quit smoking and ends up picking it back up again, I’m not going to let them give up. It’s going to take multiple attempts and I’m going to be right there with them to improve their health!
That’s it for this column. In my next column, I’m going to discuss a topic that is the opposite of obesity – people who strive to be as thin as possible and those who suffer from bulimia, anorexia and the health issues associated with these conditions. And as always, please see your primary care physician for any of your health concerns and to discuss ways to improve your health. I hope this column finds all of you in good health and spirits. See you next month!