Weight Management

Overview

A startling 60-75% of the adult population in the United States is overweight or obese. Around the world, the prevalence of obesity nearly doubled from 1980 to 2008. Obesity shortens the life span by an average of 8-10 years compared with people of average weight. For every 33 extra pounds, risk of early death increases by nearly 30%.

Being overweight significantly increases the risk of cardiovascular disease, arthritis, high blood pressure, and malignancies such as breast, prostate, pancreatic and colon cancer. Excess body weight also impacts mobility, interferes with sleep, contributes to digestive disorders, and lessens overall quality of life.

Despite genuine efforts to increase energy expenditure and decrease food consumption, many aging obese individuals battle against biology as a number of metabolic and hormonal processes promote weight gain. It turns out the obesity epidemic is much more complex than the overly simplistic "eat less food to lose weight" message often promoted by diet gurus and governmental health agencies.

Symptoms & Diagnosis

While symptoms of obesity are myriad and quickly observable, risk factors of obesity include chronic inflammation, cancer, insulin resistance (diabetes), sleep disorders, GERD, high blood pressure, arthritis, and a host of autoimmune disorders.

Obesity is typically diagnosed and defined by analysis of body size, weight, and composition. Body mass index (BMI) is the most commonly accepted metric for defining obesity and is calculated as body mass (in kilograms) divided by height squared (in meters). In simple figures, an individual weighing 200 pounds and standing six feet tall would calculate a BMI of approximately 27.

BMI Statuskg/m2
Underweight<18.5
Normal Range18.5-24.9
Overweight25-29.9
Obese class I30-34.9
Obese class II35-39.9
Obese class III / Morbid obesity?40

Although BMI is strongly correlated with total body fat, it is by no means perfect. For example, BMI overestimates body fat content for athletic individuals with high muscle mass. Also, BMI cannot accurately measure the concurrent loss of lean muscle and increase in body fat in aging individuals. Alternative measurements (skin-fold thickness and waist-to-hip ratio) have been proposed as more accurate methods for body fat estimation, but BMI has shown similar accuracy and remains an acceptable measurement despite its shortcomings.

Medical Treatment

The cornerstone of any medical weight loss strategy is the use of low-calorie diets to create a deficit of 500-1000 calories per day and a resulting weight loss of 1-2 pounds per week. Lifestyle modification and weight loss are the recommended methods for lowering blood pressure and blood lipids as well as for lowering blood glucose in overweight type 2 diabetics. Also required is moderate physical activity for 30-45 minutes per day for 3-5 days per week.

Pharmaceutical drugs are often incorporated into a weight loss plan depending upon an individual's BMI score and concurrent risk factors or diseases. Weight loss surgery is reserved for individuals with whom non-invasive methods have failed.

Bariatric surgical procedures modify the size or course of the gastrointestinal tract to attenuate the appetite. Gastric bypass reduces the stomach to a small pouch and bypasses part of the small intestine. The laparoscopic gastric band fits around the upper part of the stomach, creating a smaller stomach volume that limits food intake. Sleeve gastrectomy removes only part of the stomach but leaves its connection to the small intestine intact.

Most of these procedures are permanent, require lifelong follow-up, and are not without surgical risk. Because they dramatically alter anatomy and physiology, they can lead to malabsorption issues and deficiencies of certain nutrients (especially vitamins B9, B12, and D and minerals such as iron, calcium, zinc, and copper).

How We Can Help

It is important to consider a multimodal approach to weight loss, in which low-calorie diet and exercise are augmented by nutritional steps to restore optimal levels of steroid and thyroid hormones, promote insulin sensitivity, and modulate macronutrient absorption. Through this approach, individuals not only increase their chance of successful weight loss but also reduce many of the risks associated with obesity such as cancer and cardiovascular disease.

If any weight loss strategy is to be successful, it must progress beyond the conventional cliche that weight loss requires only a reduction in calorie consumption. Instead, successful weight management requires a paradigm that acknowledges the multifactorial and complicated nature of obesity.

At Divine Design, this can be accomplished with targeted nutritional interventions to replace the things we commonly mislabel as meals - cakes, cookies, crackers, candies, and nutritionally deficient processed foods. Genetically modified organisms (GMOs), artificial ingredients, preservatives, and foreign chemicals in our meals usually evade the radar of many diet approaches, substituting an obsessive counting of calories with no regard given to detoxification or proper nutritional supplementation. If the body is constantly starving for proper nutrients, the brain has no choice but to promote eating in order to ingest the desired substance. And this, in a nutshell, is the root cause of the world's obesity epidemic.