Medical Weight Loss
“Obesity is a chronic, relapsing, multifactorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”
Obesity, or adiposity, is a disease of excess fat, which causes mechanical problems, and also of “sick fat,” or adiposopathy, which causes disease from release of inflammatory chemicals. This is why obesity affects almost every system in the human body, and has been linked to over 200 medical conditions. Some are obvious, such as diabetes, heart disease or high cholesterol, but others such as sleep apnea, liver disease, blood clots, gout, arthritis, depression, gallstones, polycystic ovaries and even cancers are also linked to obesity. It is a disease that is growing in alarming rates, with overweight or obesity affecting 70% of US adults.
Why should we treat obesity?
Though many believe that obesity is purely a cosmetic issue, we know that there are many health problems that can stem from having excess fat. It is important to strive to be healthy at every size, and maintain realistic expectations of the changes our bodies can make. Chronic illnesses can take a toll on our body and quality of life, and we put ourselves at risk for disease if we accumulate excess fat.
We have a better understanding now how many illnesses are all interrelated. In the past, separate medications were used to treat what we thought were separate conditions. Now, we see a close, direct link between these conditions and diseased fat. Obesity impairs our body’s ability to operate at its highest level.
How do we categorize obesity?
We use BMI, or Body Mass Index, in an attempt to standardize weight and height. This is calculated using a standard math formula.
BMI<18.5: Underweight
BMI 18.5-24.9: Normal weight
BMI 25-29.9: Overweight
BMI 30-34.9: Class 1 obesity
BMI 35-39.9: Class 2 obesity
BMI above 40: Class 3 obesity
What is visceral fat?
Visceral fat is excess fat around the abdominal area. This has been shown to be a strong marker for insulin resistance, which affects so many functions in the body and can increase your risk for diabetes and cardiovascular diseases. Many people believe this is a better predictor of disease than BMI. The waist circumference is an indicator of this risk.
A waist circumference above 40 inches for men and above 35 inches for women is associated with health problems. In fact, many experts feel that it is better to “lose waist”, than to “lose weight”.
Key Elements of Achieving a Healthy Weight:
Mindfulness
Mental and emotional mindfulness is central to achieving any goal because it affects your behavior. It’s important to understand the motivation for making any change. What is driving you towards your goal? Are there any hidden thoughts or feelings that keep you from achieving them? This is an important process for self discovery and it can be very empowering. There have been great advances in understanding the body’s biology in how weight is regulated, but all of this biology can be overridden by your behavior. Therefore, this is a critical component of any weight loss plan.
Nutrition
Choose a nutrition plan that is sustainable for the long term, and understand how food makes your body feel. Food sends information to your body and affects its function. What kinds of fuel do you want your body to receive so that it operates at its highest level? It’s important to understand your body’s signals so you can give it what it needs. Are you eating because of hunger, thirst, boredom, habit, or stress? Identity those feelings so that your reaction is appropriate.
When you recognize the positive effects of a healthy diet on your body, you are more likely to be motivated to continue that kind of eating. Good nutrition involves actively participating in meal planning. It cannot be left to chance or the last minute. It involves understanding some basic cooking techniques and food prep, how to maneuver buying food at the grocery store, and reading labels to see the exact ingredients in a package. Without planning, you are caught off guard. Hunger is powerful and it can cloud your decision making process and lead to bad choices.
Physical Activity
Physical activity is the foundation of weight loss maintenance. It can be hard and seem overwhelming at the beginning. However, it is also the tangible, physical reward that you can see during this process as your body changes. You may regain function and abilities that you thought were lost previously. You may be able to experience things and places that were not possible to you prior to this journey, whether it is a trip, a race, an adventure with family or friends, or the day-to-day pleasures of energy and health. This can reinvigorate you and challenge you to continue this path and grow. It motivates you to take care of your body and perhaps discover things that your body can do that will surprise you.
Sleep
We underestimate the restorative power of sleep. We push ourselves, believing that we function effectively day-to-day with less and less sleep. We ask our body to do things well when we do not give our organs and our cells the rest that it needs.
Our body is built with an internal circadian rhythm, the master clock in the brain regulated by light. It is programmed to be its most effective within this circadian cycle. When we deprive it of adequate rest and recovery, abnormal signals are sent.
With lack of sleep, our body will secrete more hunger hormones, less of the satiety hormones that make us feel satisfied, and more stress hormones, all of which work to sabotage our metabolism. Therefore, part of a healthy routine is ensuring adequate sleep: between 7-8 hours a night.
Medications
There are a variety of reasons people may need medications to help with weight loss. In some cases, due to illnesses, they may be taking medications that affect their metabolism and cause weight gain. For others, despite maximal lifestyle changes, the weight loss results are not as expected. In addition, there may be a pressing medical need to lose weight which may necessitate use of medications.
The biology of weight regulation is a complex process. Many people are able to lose weight but find themselves not able to keep the weight off. This is because they are fighting against their body’s biological processes that continually work to try to regain the weight. Research has shown that when a person loses weight, the body makes a shift to lower the metabolism in an effort to protect itself from a perceived threat of starvation. This makes it very difficult to maintain the lower weight. Medications have been developed to try to affect the biology of this weight regulation and circumvent these metabolic changes. Medications are one tool to counteract these effects.
Surgery
For some people with serious medical complications such as diabetes, surgery is a viable option. Many people have success with this method. In fact, for people with diabetes and excess weight, improved sugar results are seen within days of the surgery. Surgery is not just a smaller stomach to hold less food, but in fact, there are biologic and chemical changes that also happen. Most of the hunger hormones are produced in the stomach, so these hormones levels go down with surgery. There are other hormones that are changed with surgery as well, which helps to increase your metabolism.
Several types of surgeries are available, but the most common procedure is the vertical gastric sleeve, in which a large portion of the stomach is removed with no rerouting of the intestines. Most of the procedures are done by several small incisions using a camera and a catheter, and recovery is fairly quick. Surgery is not an option for everyone, but it is another tool available to help treat obesity.