its ok to be fat and theres nothing wrong to have a fat friend...but you have to consider the risk factors of being fat or obese. if you want to help your friend through his/her health read this info so you could manage the health of your friend.
What is obesity?
The definition of obesity varies depending on what one reads, but in general, it is a chronic condition defined by an excess amount body fat. A certain amount of body fat is necessary for storing energy, heat insulation, shock absorption, and other functions. The normal amount of body fat (expressed as percentage of body fat) is between 25-30% in women and 18-23% in men. Women with over 30% body fat and men with over 25% body fat are considered obese.
How common is obesity?
Obesity has reached epidemic proportions in the United States. One in three Americans is obese. Obesity is also increasing rapidly throughout the world, and the incidence of obesity has nearly doubled form 1991 to 1998.
What are the health risks associated with obesity?
Obesity is not just a cosmetic consideration; it is a dire health dilemma directly harmful to one's health. In the United States, roughly 300,000 deaths per year are directly related to obesity, and more than 80% of these deaths are in patients with a BMI (body mass index, which will be discussed later in this article) over 30. Obesity also increases the risk of developing a number of chronic diseases including:
* Insulin Resistance. Insulin is necessary for the transport of blood glucose (sugar) into the cells of muscle and fat (which is then used for energy). By transporting glucose into cells, insulin keeps the blood glucose levels in the normal range. Insulin resistance (IR) is the condition whereby the effectiveness of insulin in transporting glucose (sugar) into cells is diminished. Fat cells are more insulin resistant than muscle cells; therefore, one important cause of IR is obesity. The pancreas initially responds to IR by producing more insulin. As long as the pancreas can produce enough insulin to overcome this resistance, blood glucose levels remain normal. This IR state (characterized by normal blood glucose levels and high insulin levels) can last years. Once the pancreas can no longer keep up with producing high levels of insulin, blood glucose levels begin to rise, resulting in type 2 diabetes, thus IR is a pre-diabetes condition. In fact scientists now believe that the atherosclerosis (hardening of the arteries) associated with diabetes likely develops during this IR period.
* Type 2 (adult-onset) diabetes. The risk of type 2 diabetes increases with the degree and duration of obesity. Type 2 diabetes is associated with central obesity; a person with central obesity has excess fat around his/her waist, so that the body is shaped like an apple.
* High blood pressure (hypertension). Hypertension is common among obese adults. A Norwegian study showed that weight gain tended to increase blood pressure in women more significantly than in men. The risk of developing high blood pressure is also higher in obese people who are apple shaped (central obesity) than in people who are pear shaped (fat distribution mainly in hips and thighs).
* High cholesterol (hypercholesterolemia)
* Stroke (cerebrovascular accident or CVA)
* Heart attack. The Nurses Health Study found that the risk of developing coronary artery disease increased 3 to 4 times in women who had a BMI greater than 29. A Finnish study showed that for every one kilogram (2.2 pounds) increase in body weight, the risk of death from coronary artery disease increased by one percent. In patients who have already had a heart attack, obesity is associated with an increased likelihood of a second heart attack.
* Congestive heart failure
* Cancer. While not conclusively proven, some observational studies have linked obesity to cancer of the colon in men and women, cancer of the rectum and prostate in men, and cancer of the gallbladder and uterus in women. Obesity may also be associated with breast cancer, particularly in postmenopausal women. Fat tissue is important in the production of estrogen, and prolonged exposure to high levels of estrogen increases the risk of breast cancer.
* Gallstones
* Gout and gouty arthritis
* Osteoarthritis (degenerative arthritis) of the knees, hips, and the lower back
* Sleep apnea
* Pickwickian syndrome (obesity, red face, underventilation, and drowsiness)
What Causes Obesity?
The balance between calorie intake and energy expenditure determines a person's weight. If a person eats more calories than he or she burns, the person gains weight (the body will store the excess energy as fat). If a person eats fewer calories than he or she burns, he or she will lose weight. Therefore the most common causes of obesity are overeating and physical inactivity. At present, we know that there are many factors that contribute to obesity, some of which have a genetic component:
* Genetics. A person is more likely to develop obesity if one or both parents are obese. Genetics also affect hormones involved in fat regulation. For example, one genetic cause of obesity is leptin deficiency. Leptin is a hormone produced in fat cells, and also in the placenta. Leptin controls weight by signaling the brain to eat less when body fat stores are too high. If, for some reason the body cannot produce enough leptin, or leptin cannot signal the brain to eat less, this control is lost, and obesity occurs. The role of leptin replacement as a treatment for obesity is currently being explored.
* Overeating. Overeating leads to weight gain, especially if the diet is high in fat. Foods high in fat or sugar (e.g., fast food, fried food and sweets,) have high energy density (foods that have a lot of calories in small amount of food). Epidemiology studies have shown that diets high in fat contribute to weight gain.
* A diet high in simple carbohydrates. The role of carbohydrates in weight gain is not clear. Carbohydrates increase blood glucose levels, which in turn stimulate insulin release by the pancreas, and insulin promotes the growth of fat tissue and can cause weight gain. Some scientists believe that simple carbohydrates (sugars, fructose, desserts, soft drinks, beer, wine, etc.) contribute to weight gain because they are more rapidly absorbed into the blood stream than complex carbohydrates (pasta, brown rice, grains, vegetables, raw fruits, etc.) and thus cause a more pronounced insulin release after meals than complex carbohydrates. This higher insulin release, some scientists believe, contribute to weight gain.
* Frequency of eating. The relationship between frequency of eating (how often you eat) and weight is somewhat controversial. There are many reports of overweight people eating less often than people with normal weight. Scientists have observed that people who eat small meals four or five times daily, have lower cholesterol levels and lower and/or more stable blood sugar levels than people who eat less frequently (two or three) large meals daily. One possible explanation is that small frequent meals produce stable insulin levels, whereas large meals cause large spikes of insulin after meals.
* Slow metabolism. Women have less muscle than men. Muscle burns more calories than other tissue (which includes fat). As a result, women have a slower metabolism than men, and hence, have a tendency to put on more weight than men, and weight loss is more difficult for women. As we age, we tend to lose muscle and our metabolism slows, therefore, we tend to gain weight as we get older particularly if we do not reduce our daily caloric intake.
* Physical inactivity. Sedentary people burn fewer calories than people who are active. The National Health and Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes.
* Medications. Medications associated with weight gain include certain antidepressants (medications used in treating depression), anti-convulsants (medications used in controlling seizures such as carbamazepine and valproate), diabetes medications (medications used in lowering blood sugar such as insulin, sulfonylureas and thiazolidinediones), certain hormones such as oral contraceptives and most corticosteroids such as Prednisone. Weight gain may also be seen with some high blood pressure medications and antihistamines.
* Psychological factors. For some people, emotions influence eating habits. Many people eat excessively in response to emotions such as boredom, sadness, stress or anger. While most overweight people have no more psychological disturbances than normal weight people, about 30 percent of the people who seek treatment for serious weight problems have difficulties with binge eating.
* Diseases such as hypothyroidism, insulin resistance, polycystic ovary syndrome and Cushing's syndrome are also contributors to obesity.
What are other factors associated with obesity?
* Race. Racial factors may influence the age of onset and the rapidity of weight gain. African American women and Hispanic women tend to experience weight gain earlier in life than Caucasians and Asians. Hispanic men tend to develop obesity earlier than African American and Caucasian men.
* Childhood weight. A person's weight during childhood, teenage years, and early adulthood may also influence the development of adult obesity. For example:
o Being mildly overweight in the early 20's was linked to a substantial incidence of obesity by age 35.
o Being overweight during older childhood is highly predictive of adult obesity, especially if a parent is also obese.
o Being overweight during teenage years is even a greater predictor of adult obesity.
* Hormones. Women tend to gain weight especially during certain events such as pregnancy, menopause and in some cases with the use of oral contraceptives, however, with the availability of the newer low dose estrogen pills, weight gain has not been as great a risk.
How is body fat measured?
Measuring a person's body fat percentage is not easy, and often inaccurate if the methods are not monitored carefully. The following methods require special equipment, trained personnel, can be costly and some are only available in certain research facilities:
* Underwater weighing (hydrostatic weighing): This method weighs a person underwater and then calculates lean body mass (muscle) and body fat. This method is one of the more accurate ones, however, it is generally done in special research facilities, and the equipment is costly.
* BOD POD: The BOD POD is a computerized, egg-shaped chamber. Using the same whole-body measurement principle as hydrostatic weighing, the BOD POD measures a subject's mass and volume, from which their whole-body density is determined. Using this data, body fat and lean muscle mass can then be calculated.(1)
* DEXA: Dual-energy X-ray absorptiometry (DEXA) is used to measure bone density. It uses X-rays to determine not only the percentage of body fat, but also where, and how much fat is located in the body.
The following two methods are simple and straightforward:
* Skin calipers: This method measures the skinfold thickness of the layer of fat just under the skin in several parts of the body with calipers (a metal tool similar to forceps), the results are then calculated and the percentage of body fat is determined.
* Bioelectric impedance analysis (BIA): Another seemingly simple method. There are two methods of the BIA. One involves standing on a special scale with footpads. A harmless amount of electrical current is sent through the body, and then percentage of body fat is calculated. The other type of BIA, involves electrodes that are typically placed on a wrist and an ankle, and on the back of the right hand and on the top of the foot. Change in voltage between electrodes is measured. The person's body fat percentage is then calculated from the results of the BIA.
Health clubs and weight loss centers often use the skin caliper or bioelectric impedance analysis method, however, they can yield inaccurate results if an inexperienced person performs them or they are used on someone with significant obesity.
What about weight-for-height tables?
Measuring a person's body fat percentage can be difficult, therefore, other methods are relied on to diagnose obesity. Two widely used methods are weight-for-height tables and body mass index (BMI). While both measurements have their limitations, they are reasonable indicators that someone may have a weight problem. The calculations are easy, and no special equipment is required.
Most people are familiar with weight-for-height tables. Doctors and nurses (and many others) have used these tables for decades to determine if someone is overweight. The tables usually have a range of acceptable weights for a person of a given height.
One small problem with using weight-for-height tables is that doctors disagree over which is the best table to use. Several versions are available. Many have different weight ranges, and some tables account for a person's frame size, age and sex, while other tables do not.
A grave limitation of all weight-for-height tables is that they do not distinguish between excess fat and muscle. A very muscular person may appear obese, according to the tables, when he or she in fact is not.
What is the body mass index (BMI)?
The body mass index (BMI) is a new term to most people. However, it is now the measurement of choice for many physicians and researchers studying obesity.
The BMI uses a mathematical formula that accounts for both a person's weight and height. The BMI equals a person's weight in kilograms divided by height in meters squared (BMI=kg/m2).
The BMI measurement however, poses some of the same problems as the weight-for-height tables. Not everyone agrees on the cutoff points for "healthy" versus "unhealthy" BMI ranges. BMI also does not provide information on a person's percentage of body fat. However, like the weight-for-height table, BMI is a useful general guideline and is a good estimator of body fat for most adults between the ages of 19 and 70 years of age. However, it may not be an accurate measurement of body fat for body builders, certain athletes, and pregnant women.
It is important to understand what "healthy weight" means. Healthy weight is defined as a body mass index (BMI) equal to or greater than 19 and less than 25 among all people aged 20 or over. Generally, obesity is defined as a body mass index (BMI) equal to or greater than 30, which approximates 30 pounds of excess weight. Excess weight also places people at risk of developing serious health problems.
The table below has already done the math and metric conversions. To use the table, find the appropriate height in the left-hand column. Move across the row to the given weight. The number at the top of the column is the BMI for that height and weight.
BMI
(kg/m2) 19 20 21 22 23 24 25 26 27 28 29 30 35 40
Height
(in.) Weight (lb.)
58 91 96 100 105 110 115 119 124 129 134 138 143 167 191
59 94 99 104 109 114 119 124 128 133 138 143 148 173 198
60 97 102 107 112 118 123 128 133 138 143 148 153 179 204
61 100 106 111 116 122 127 132 137 143 148 153 158 185 211
62 104 109 115 120 126 131 136 142 147 153 158 164 191 218
63 107 113 118 124 130 135 141 146 152 158 163 169 197 225
64 110 116 122 128 134 140 145 151 157 163 169 174 204 232
65 114 120 126 132 138 144 150 156 162 168 174 180 210 240
66 118 124 130 136 142 148 155 161 167 173 179 186 216 247
67 121 127 134 140 146 153 159 166 172 178 185 191 223 255
68 125 131 138 144 151 158 164 171 177 184 190 197 230 262
69 128 135 142 149 155 162 169 176 182 189 196 203 236 270
70 132 139 146 153 160 167 174 181 188 195 202 207 243 278
71 136 143 150 157 165 172 179 186 193 200 208 215 250 286
72 140 147 154 162 169 177 184 191 199 206 213 221 258 294
73 144 151 159 166 174 182 189 197 204 212 219 227 265 302
74 148 155 163 171 179 186 194 202 210 218 225 233 272 311
75 152 160 168 176 184 192 200 208 216 224 232 240 279 319
76 156 164 172 180 189 197 205 213 221 230 238 246 287 328
Table Courtesy of the National Institutes of Health
Body weight in pounds according to height and body mass index.
Below is a table identifying the risk of associated disease according to BMI and waist size.
BMI Category Waist less than or equal to 40 in. (men) or 35 in. (women) Waist greater than 40 in. (men) or 35 in. (women)
18.5 or less Underweight N/A N/A
18.5 - 24.9 Normal N/A N/A
25.0 - 29.9 Overweight Increased Risk High Risk
30.0 - 34.9 Obese High Risk Very High Risk
35.0 - 39.9 Obese Very High Risk Very High Risk
40 or greater Extremely Obese Extremely High Risk Extremely High Risk
Table Courtesy of the National Institutes of Health
oes it matter where body fat is located? (Is it worse to be an 'apple' or a 'pear'?)
Concern is directed not only at how much fat a person has but also where that fat is located on the body. The pattern of body fat distribution tends to differ in men and women.
Women typically collect fat in their hips and buttocks, giving their figures a "pear" shape. Men, on the other hand, usually collect fat around the belly, giving them more of an "apple" shape. (This is not a hard and fast rule, some men are pear-shaped and some women become apple-shaped, particularly after menopause).
Apple-shaped people whose fat is concentrated mostly in the abdomen are more likely to develop many of the health problems associated with obesity. They are at increased health risk because of their fat distribution. While obesity of any kind is a health risk- yes, it is better to be a pear than an apple.
In order to sort the types of fruit, doctors have developed a simple way to determine whether someone is an apple or a pear. The measurement is called waist-to-hip ratio. To find out a person's waist-to-hip ratio, measure the waist at its narrowest point, and then measure the hips at the widest point. Divide the waist measurement by the hip measurement. For example, a woman with a 35-inch waist and 46-inch hips would have a waist-to-hip ratio of 0.76 (35 divided by 46 = 0.76). Women with waist-to-hip ratios of more than 0.8 and men with waist-to-hip ratios of more than 1.0 are "apples."
Another rough way of estimating the amount of a person's abdominal fat is by measuring the waist circumference. Men with waist circumference of 40 inches or greater and women with waist circumference of 35 inches or greater are considered to have increased health risks related to obesity.
What can be done about obesity?
All too often, obesity prompts a strenuous diet in the hopes of reaching the "ideal body weight." Some amount of weight loss may be accomplished, but the lost weight usually quickly returns. More than 95% of the people who lose weight regain the weight within five years. It is clear that a more effective, long-lasting treatment for obesity must be found, lest obesity lead to oblivion.
We need to learn more about the causes of obesity, and then we need to change the ways we treat it. When obesity is accepted as a chronic disease, it will be treated like other chronic diseases such as diabetes and high blood pressure. The treatment of obesity cannot be a short-term "fix," but has to be an ongoing life-long process.
Instead of staring nearsightedly at the goal of attaining an "ideal weight," obesity treatment must acknowledge that even modest weight loss can be beneficial. For example, a modest weight loss of 5 to 10% of the initial weight, and long-term maintenance of that weight loss can bring significant health gains, including:
* Lowered blood pressure
* Reduced blood levels of cholesterol
* Reduced risk of type 2 (adult-onset) diabetes. In the Nurses Health Study, women who lost 5 kilograms (11 pounds) of weight reduced their risk of diabetes by 50% or more.
* Decreased chance of stroke
* Decreased complications of heart disease
* Decreased overall mortality
It is not necessary to achieve an "ideal weight" to derive health benefits from obesity treatment. Instead, the goal of treatment should be to reach and hold to a "healthier weight" (for more, please read the "Aim for a Healthy Weight" article). The emphasis of treatment should be to commit to the process of life-long healthy living including eating more wisely and increasing physical activity.
In sum, the goal in dealing with obesity is to achieve and maintain a "healthier weight."
What is the role of physical activity and exercise in obesity?
The National Health and Examination Survey (NHANES I) showed that people who engage in limited recreational activity were more likely to gain weight than more active people. Other studies have shown that people who engage in regular strenuous activity gain less weight than sedentary people. Studies on twins (twins have identical genes) showed that physical activity might actually protect the more active twin from developing obesity.
Physical activity and exercise help burn calories. The amount of calories burned depends on the type, duration, and intensity of the activity. It also depends on the weight of the person. A 200-pound person will burn more calories running 1 mile than a 120-pound person, because the work of carrying those extra 80 pounds must be factored in. But exercise as a treatment for obesity is most effective when combined with a diet weight-loss program. Exercise alone without diet will have a limited effect on weight because one has to exercise a lot to simply lose one pound. However regular exercise is an important part of a healthy lifestyle to maintain a healthy weight for the long term. Another advantage of regular exercise as part of a weight-loss program is a greater loss of body fat versus lean muscle compared to those who diet alone.
Other benefits of exercise include:
* Improved blood sugar control and increased insulin sensitivity (decreased insulin resistance)
* Reduced triglyceride levels and increased good HDL cholesterol levels
* Lowered blood pressure
* A reduction in abdominal fat
* Reduced risk of heart disease. A study performed in men found those with moderate activity had a 23 percent lower risk of death than those who were less active.
Remember, these health benefits can occur independently (with or without) achieving weight loss. Before starting an exercise program, you should talk to your doctor about the type and intensity of the exercise program.
General exercise recommendations:
* 20-30 minutes of moderate exercise 5 to 7 days a week, preferably daily. Types of exercise include walking, stationary bicycling, walking or jogging on a treadmill, stair climbing machines, jogging, and swimming.
* Exercise can be broken up into smaller 10-minute sessions.
* Start slowly and progress gradually to avoid injury, excessive soreness, or fatigue. Over time, build up to 30 to 60 minutes of moderate to vigorous exercise every day.
* People are never too old to start exercising. Even frail, elderly individuals (ages 70-90 years) can improve their strength and balance.
Exercise precautions:
The following people should consult a doctor before vigorous exercise:
* Men over age 40 or women over age 50.
* Individuals with heart or lung disease, asthma, arthritis, or osteoporosis.
* Individuals who experience chest pressure or pain with exertion, or who develop fatigue or shortness of breath easily.
* Individuals with conditions that increase their risk of developing coronary heart disease, such as high blood pressure, diabetes, cigarette smoking, high blood cholesterol, or having family members with early onset heart attacks and coronary heart disease.
What is the role of diet in the treatment of obesity?
The first goal of dieting is to stop further weight gain. The next goal is to establish realistic weight loss goals. While the ideal weight is a BMI of 20-25, this is difficult to achieve for many people. Thus success is higher when a goal is set to lose 10% to15% of baseline weight as opposed to 20% to 30% or higher. It is also important to remember that any weight reduction in an obese person would result in health benefits.
One effective way to lose weight is to eat fewer calories. One pound is equal to 3500 calories. In other words, you have to burn 3500 more calories than you take-in to lose one pound. Most adults need between 1200- 2800 calories/day-depending on body size & activity level to meet the body's energy needs.
If you skip that bowl of ice cream, then you will be one-seventh of the way to losing that pound! Losing one pound per week is a safe & reasonable way to get off those extra pounds. The higher the initial weight of a person, the more quickly he/she will achieve weight loss. This is because for every one-kilogram (2.2 pounds) of body weight, approximately 22 calories are required to maintain that weight. So for a woman weighing 100 kilograms (220 pounds), he or she would require about 2200 calories a day to maintain his or her weight while a person weighing 60 kilograms (132 pounds) would require only about 1320 calories. If both ate a calorie-restricted diet of 1200 calories per day, the heavier person would loose weight faster. Age also is a factor in calorie expenditure. Metabolic rate tends to slow as we age, so the older a person is, the harder it is to lose weight.
There is controversy in regard to carbohydrates and weight loss. When carbohydrates are restricted, people often experience rapid initial weight loss within the first two weeks. This weight loss is due mainly to fluid loss. When carbohydrates are added back to the diet, weight gain often occurs, simply due to a regain of the fluid.
General diet guidelines for achieving and (as importantly) maintaining a healthy weight:
* A safe and effective long-term weight reduction and maintenance diet has to contain balanced, nutritious foods to avoid vitamin deficiencies and other diseases of malnutrition.
* Eat more nutritious foods that have "low energy density." Low energy dense foods contain relatively few calories per unit weight (fewer calories in a large amount of food). Examples of low energy dense foods include vegetables, fruits, lean meat, fish, grains, and beans. For example, you can eat a large volume of celery or carrots without taking in many calories.
* Eat less "energy dense foods." Energy dense foods are high in fats and simple sugars. They generally have a high calorie value in a small amount of food. The United States government currently recommends that a healthy diet should have less than 30% fat. Fat contains twice as many calories per unit weight than protein or carbohydrates. Examples of high-energy dense foods include red meat, egg yolks, fried foods, high fat/sugar fast foods, sweets, pastries, butter, and high fat salad dressings. Also cut down on foods that provide calories but very little nutrition, such as alcohol, non-diet soft drinks and many packaged high calorie snack foods.
* About 55% of calories in the diet should be from complex carbohydrates. Eat more complex carbohydrates such as brown rice, whole-grain bread, fruits and vegetables. Avoid simple carbohydrates such as table sugars, sweets, doughnuts, cakes, and muffins. Cut down on non-diet soft drinks-these sugary soft drinks are loaded with simple carbohydrates and calories. Simple carbohydrates cause excessive insulin release by the pancreas, and insulin promotes growth of fat tissue.
* Educate yourself in reading food labels, estimating calories and serving sizes.
* Consult your doctor before starting any dietary changes. You doctor should prescribe the amount of daily calories in your diet.
What is the role of medication in the treatment of obesity?
Medication treatment of obesity should be used only in patients who have health risks related to obesity. Medications should be used in patients with a BMI greater than 30 or in those with a BMI of greater than 27 who have other medical conditions (such as high blood pressure, diabetes, high blood cholesterol) that put them at risk for developing heart disease. Medications should not be used for cosmetic reasons.
Like diet and exercise, the goal of medication treatment has to be realistic. With successful medication treatment, one can expect an initial weight loss of at least 5 pounds during the first month of treatment, and a total weight loss of 10-15% of the initial body weight. It is also important to remember that these medications only work when they are taken. When they are discontinued, weight gain can occur.
The first class (category) of medication used for weight control cause symptoms that mimic the sympathetic nervous system. They cause the body to feel "under stress" or " nervous". As a result, the major side effect of this class of medication is high blood pressure. This class of medication includes sibutramine (Meridia) and phentermine (Fastin, Adipex P). These medications also decrease appetite and create a sensation of fullness. Hunger and fullness (satiety) are regulated by brain chemicals called neurotransmitters. Examples of neurotransmitters include serotonin, norepinephrine, and dopamine. Anti-obesity medications that suppress appetite do so by increasing the level of these neurotransmitters at the junction (called synapse) between nerve endings in the brain.
Phentermine
Phentermine (the other half of fen/phen) suppresses appetite by causing a release of norepinephrine by the cells. Phentermine alone is still available for treatment of obesity, but only on a short-term basis (a few weeks). The common side effects of phentermine include headache, insomnia, irritability and nervousness. Fenfluramine (the fen of fen/phen) and dexfenfluramine (Redux) suppress appetite mainly by increasing release of serotonin by the cells. Unfortunately, both fenfluramine and dexfenfluramine were withdrawn from the market in September 1997 because of association of these two medications with pulmonary hypertension (a rare but serious disease of the arteries in the lungs), and association of fen/phen with damage to the heart valves. Since the withdrawal of fenfluramine, some have suggested combining phentermine with fluoxetine (Prozac) - a combination that has been referred to as phen/pro. However, no clinical trials have been conducted to confirm the safety and effectiveness of this combination. Therefore, this combination is NOT an accepted treatment for obesity.
Sibutramine (Meridia)
Sibutramine (Meridia) suppresses appetite by increasing the amount of neurotransmitters serotonin and norepinephrine in the brain synapses. Unlike fenfluramine and dexfenfluramine, sibutramine does not increase release of these neurotransmitters from the cells. Instead, sibutramine inhibits the re-uptake of these neurotransmitters by the nerve cells. Therefore, the action of sibutramine is similar to that of anti-depressants that inhibit re-uptake of serotonin such as fluoxetine (Prozac) - a medication that has been used for years without known association with pulmonary hypertension or heart valve damage.
In December 1997, the United States Food and Drug Administration (FDA) approved sibutramine (Meridia) to treat obesity (both in attaining and in maintaining weight loss). According to FDA guidelines, Meridia should be considered only for patients with BMI of 30 or higher, or for those with a BMI of 27 or higher who also have other conditions (such as high blood pressure, diabetes mellitus, sleep apnea) that can improve with weight loss. Meridia should be accompanied by regular exercise and reduced-calorie diet.
Meridia is available in 5, 10, and 15mg capsules. The recommended starting dose is one 10 mg capsule per day. The dose of Meridia can be increased if weight loss is inadequate. Meridia should always be prescribed by doctors familiar with the patients' medical condition, and familiar with the use and side effects of the medicine.
In clinical trials involving 6,000 individuals, Meridia produced statistically significantly more weight loss when compared to placebo (sugar pill). Generally, weight loss achieved with Meridia is modest. On average, patients treated with Meridia lost 5% to 10% of initial weight at various dosage levels. In two 12-month studies, maximal weight loss was achieved by six months, and statistically significant weight loss was maintained over 12 months.
Thus far, there are no reported increases in pulmonary hypertension or heart valve damage associated with the use of Meridia. Like any newly released medication, however, close monitoring will be necessary to determine the drug's long-term safety and effectiveness. Certain side effects may not become apparent until months to years after release.
The known side effects of Meridia are mild and transient. They include dry mouth, headache, constipation and insomnia. Meridia also causes a small increase in average blood pressure and heart rate. But in some individuals, the increase in blood pressure can be more pronounced. Therefore, patients on Meridia should have regular monitoring of their blood pressure. Meridia should not be used in patients with uncontrolled high blood pressure, history of stroke, coronary heart disease, and congestive heart failure. For more, please read the Meridia article.
Orlistat (Xenical)
The next class (category) of drugs changes the metabolism of fat. Orlistat (Xenical) is the only drug of this category that is FDA approved. This s a new class of anti-obesity drugs called lipase inhibitors, or fat blockers. Fat from food can only be absorbed into the body after being broken up (a process called digestion) by digestive enzymes called lipase in the intestines. By inhibiting the action of lipase enzymes, Xenical prevents the intestinal absorption of fat by 30%. Drugs in this class do not affect brain chemistry. Theoretically, Xenical also should have minimal or no systemic side effects (side effects in other parts of the body) because the major locale of action is inside the gut lumen and very little of the drug is absorbed.
In clinical trials, Xenical with a moderately reduced calorie diet was found to be superior to placebo in achieving weight loss. The average patient in the one-year trial using Xenical lost about 10% of body weight. Many patients who continued treatment were able to maintain the weight loss. In addition, Xenical treated patients had statistically significant reductions in total and LDL cholesterol, blood pressure, and improvements in blood glucose levels after one year when compared to patients on only placebo and diet.
The clinical trials showed that Xenical was well tolerated. The most common side effects were gas, cramps and diarrhea. These side effects were believed to be due to the action of the drug (the unabsorbed fat in the gut can cause cramps and diarrhea). According to Hoffmann La- Roche, the maker of Xenical, these side effects generally occurred early in treatment and were of short duration.
Long-term decrease in fat absorption can cause deficiency of fat-soluble vitamins (such as vitamins A, D, E, K). Therefore, patients on Xenical should receive adequate vitamin supplementation. For more, please read the Vitamins and Calcium Supplements and Xenical articles.
In May 1997, the United States FDA Endocrinology and Metabolic Drugs Advisory Committee recommended the approval of Xenical as an adjunct to diet and exercise in treating obesity. After a temporary delay, the FDA has approved Xenical.
What about herbal fen/phen?
Since the withdrawal of fen/phen from the market, "herbal fen/phen" has been proposed as an alternative in treating obesity. But the Food and Drug Administration has issued a warning that "herbal fen/phen" has not been shown to be a safe and effective treatment for obesity and may contain ingredients that have been associated with injuries.
The main ingredients in most herbal fen/phen products are ephedrine and St. John's wort. Ephedrine acts like amphetamines in stimulating the central nervous system and the heart. Ephedrine promotes weight loss in part by an increase the body's temperature, and when this happens, the body burns more calories. Ephedrine use has been associated with high blood pressure, heart rhythm irregularities, strokes, insomnia, seizures tremors, and nervousness. There have been reports of deaths in young individuals taking ephedrine. St. John's wort has been used in Europe to treat mild depression, but not obesity. The action, effectiveness, and side effects of St. John's wort either alone or in combination with other agents have not been adequately studied. For additional information, please read the Dotor's View, Beware of Herbal Phen-Fen!
What about meal substitutes, artificial sweeteners, and OTC products?
Meal substitutes
When used as substitutes for regular meals, meal substitutes are a convenient way to reduce calories as part of a low calorie diet plan. A typical meal substitute available in powder and liquid form is Slim-Fast. Ensure is another meal substitute available in both liquid and bars. Meal substitutes should provide protein and be low in fat and calories. The label should include the amount of calories per serving and the percentages of protein, carbohydrates, and fat. The total number of calories per serving is predetermined so it is easier to keep track of the daily consumption of calories.
Artificial sweeteners
Saccharin (Sweet 'N Low) and aspartame (Equal) are sugar substitutes that provide little or no calories. They may be used as a substitute for table sugar. Using saccharin instead of a teaspoonful of sugar eliminates 33 calories from the diet. People with phenylketonuria (a serious genetic disease in which an individual is unable to break-down and eliminate an amino acid, phenylalanine) should not use aspartame because it contains phenylalanine.
Fructose, sorbitol and xylitol may be used as alternatives to sugar, but they provide more calories than saccharin and aspartame. Excessive use of sorbitol also may cause diarrhea.
Over-the-Counter (OTC) weight-loss products
Despite claims by manufacturers, the use of OTC products alone does not cause weight loss. Herbal weight loss products or preparations called "fat burners" are even more misleading. These products may contain a combination of ma huang (a botanical source of ephedrine), white willow (a source of salicin), and/or guarana or kola nut (a source of caffeine). These agents are stimulants, which theoretically increase the metabolism and help the body break down fat. Nevertheless, there is no evidence that they are effective for weight loss. In addition, ma huang has been linked to serious side effects such as heart attacks, seizures, and death. Chromium also is a popular ingredient in weight loss products, but there is no evidence that chromium has any effect on weight loss.
Weight loss teas contain strong botanical laxatives (Senna, cascara sagrada) and diuretics (Rhamnus purshiana) cause diarrhea and loss of water from the body. Diarrhea and water loss lead to the depletion of sodium, potassium and can lead to dehydration. Although an individuals weight may decrease, the loss is fluid and is only temporary. Moreover, low sodium and potassium levels may cause abnormal heartbeats and can even lead to death.
Guar gum preparations have also been promoted as a weight loss agent. Guar gum thought to work by leading to a feeling of fullness early in the meal. It has not been scientifically proven, and has been associated with abdominal pain, gas and diarrhea.
All of the OTC products discussed above are not considered drugs and are therefore not regulated by the Food and Drug Administration (FDA). As a result, there is little information on their effectiveness or safety.
Phenylpropanolamine
The United States FDA in November 6, 2000 took steps to remove phenylpropanolamine (PPA) from all drug products and requested that all drug companies discontinue marketing products containing phenylpropanolamine. The FDA issued a public health advisory concerning the risk of hemorrhagic stroke, or bleeding into the brain, associated with phenylpropanolamine hydrochloride. For more information about the FDA Advisory, please read the Doctor's View, FDA Issues Public Health Warning on Phenylpropanolamine.
What is the role of Surgery in the treatment of obesity?
The National Institute of Health consensus has suggested the following guidelines for surgery in obese patients:
* Patients with a BMI of greater than 40.
* Patients with a BMI of greater than 35 who have serious medical problems such as sleep apnea, that would improve with weight loss.
A study done in Sweden compared the rates of diabetes and hypertension in two groups of obese patients - those who underwent surgery and those who didn't. Each group had similar body weight at baseline (the start of the study). At 2 years, diabetes and high blood pressure were lower in the surgery treated patients.
Surgical procedures of the upper gastrointestinal tract are collectively called bariatric surgery. The initial surgeries performed were the jejunocolic bypass and the jejunoileal bypass (where the small bowel is diverted to the large bowel, bypassing a lot of the surface area where food would have been absorbed). These procedures were fraught with problems and are no longer performed. Currently, procedures used include making the stomach area smaller or bypassing the stomach completely.
In the cases of making the stomach smaller, vertically banded gastroplasty is the most common procedure, where the esophagus is banded early in the stomach. The other procedure is gastric banding, where an inflatable pouch causes gastric constriction. Changing the volume in the ring that encircles the stomach can change the amount of constriction. Gastric bypass essentially causes weight loss by bypassing the stomach.
The risks of surgery include the usual complications of infection, blood clots in the lower extremities and in the lungs, and anesthesia risk. Specific long-term risks related to obesity surgery include lack of iron absorption and iron deficiency anemia. Vitamin B 12 deficiency can also develop and could lead to nerve damage (neuropathies). Rapid weight loss may also be associated with gallstones.
What is new in obesity research?
Researchers at UC Davis are studying how genes influence the amount of arachidonic acid (a fatty acid important in the synthesis of prostaglandins in the body) in the liver and muscle cells of a special strain of rats called Zucker rats. They found that rats that have inherited obese genes from both parents have decreased levels of arachidonic acid in their muscles and liver. These rats will become fat even when fed a very low calorie diet. More importantly, researchers were able to reduce body weight and body fat in these obese rats by feeding them a special fatty acid supplement that increased arachidonic acid in their muscle cells. Researchers also found decreased arachidonic acid in the blood of obese humans. They are studying the effectiveness of this special fatty acid supplement in maintaining lost weight in previously obese individuals.
Trials using leptin injection in humans are underway, and appear to be successful in patients who have " leptin resistance".
Other hormones such as neuropeptide Y, cholecystokinin, and glucagon like peptide 1 are also being actively explored as appetite suppressants in the treatment of obesity.
Scientists have made tremendous strides in understanding obesity and in improving the medication treatment of this important disease. In time, better, safer, and more effective obesity medications will be available. But currently there is still no "magic cure" for obesity. The best and safest way to lose fat and keep it off is through a commitment to a life long process of proper diet and regular exercise. Medications should be considered helpful adjuncts to diet and exercise for patients whose health risk from obesity clearly outweigh the potential side effects of the medications. Medications should be prescribed by doctors familiar with the patients' conditions and with the use of the medications. Medication(s) and other "herbal" preparations with unproven effectiveness and safety should be avoided.
Choosing a safe and successful Weight-Loss Program
Almost any of the commercial weight-loss programs can work, but only if they motivate you sufficiently to decrease the amount of calories you eat or increase the amount of calories you burn each day (or both). What elements of a weight-loss program should a consumer look for in judging its potential for safe and successful weight loss? A responsible and safe weight-loss program should be able to document for you the five following features:
1. The diet should be safe. It should include all of the Recommended Daily Allowances (RDAs) for vitamins, minerals, and protein. The weight-loss diet should be low in calories (energy) only, not in essential foodstuffs.
2. The weight-loss program should be directed toward a slow, steady weight loss unless your doctor feels your health condition would benefit from more rapid weight loss. Expect to lose only about a pound a week after the first week or two. With many calorie-restricted diets there is an initial rapid weight loss during the first 1 to 2 weeks, but this loss is largely fluid. The initial rapid loss of fluid also is regained rapidly when you return to a normal calorie diet. Thus, a reasonable weight loss goal must be expected.
3. If you plan to lose more than 15 to 20 pounds, have any health problems, or take medication on a regular basis, you should be evaluated by your doctor before beginning your weight-loss program. A doctor can assess your general health and any medical conditions that might be affected by dieting and weight loss. Also, a physician should be able to advise you on the need for weight loss, the appropriateness of the weight-loss program, and a sensible goal of weight loss for you. If you plan to use a very low-calorie diet (a special liquid formula diet that replaces all food intake for 1 to 4 months), you should be examined and monitored by a doctor on a frequent basis.
4. Your program should include plans for weight maintenance after the weight loss phase is over. It is of little benefit to lose a large amount of weight only to regain it. Weight maintenance is the most difficult part of controlling weight and is not consistently implemented in weight-loss programs. The program you select should include help in permanently changing your dietary habits and level of physical activity, and to alter a lifestyle that may have contributed to weight gain in the past. Your program should provide behavior modification help, including education in healthy eating habits and long-term plans to deal with weight problems. One of the most important factors in maintaining weight loss appears to be increasing daily physical activity Try to be more active throughout the day and incorporate some simple calorie-burners into your everyday routine. Even the most basic activities (such as taking an after-dinner walk, using the stairs at the mall or office instead of taking an escalator or elevator, park your car farther away so you have a longer walk) can get you prepared for more regular exercise like walking or jogging. You may choose to incorporate an individually tailored exercise program into your schedule.
5. A commercial weight-loss program should provide a detailed statement of fees and costs of additional items such as dietary supplements.
Obesity is a chronic condition. Too often it is viewed as a temporary problem that can be treated for a few months with a strenuous diet. However, as most overweight people know, weight control must be considered a life-long effort. To be safe and effective, any weight-loss program must address the long-term approach or else the program is largely a waste of time, money and energy.
Review of Popular Weight Loss Diets
The following review examines the advantages and disadvantages of several popular diet plans. Most of the diets are based on low-carbohydrate approaches. These hotly debated low-carbohydrate diets were subject of a recent study in the "Journal of the American Medical Association" that found more research is needed on the safety and efficacy of such plans. The article analyzed hundreds of published studies about low-carbohydrate plans and found a lack of scientific evidence for or against the diets. "It is also important to note that in most of the studies contained in the analysis, weight loss occurred when study participants were on diets for longer periods, and when they ate fewer calories," according to a statement by Robert H. Eckel, a physician and chair of the American Heart Association's Nutrition, Physical Activity and Metabolism Council.
Keeping that in mind, let's look at a few popular diets, and go through some of the pros and cons, and the theory behind their potential effects.
The Atkins Diet (Robert C. Atkins, M.D.)
The Diet Plan Theory:
The Atkins diet is a high-protein, high-fat, low-carbohydrate plan. The diet allows for unrestricted amounts of meat, cheese and eggs while severely restricting carbohydrates, including sugar, bread, pasta, milk, fruits and vegetables. Atkins' diet is based on the theory that eating carbohydrates creates a production of insulin, a hormone secreted from the pancreas, leading to increased weight gain and hunger, which is a true physiologic response. When converting to this approach, the plan holds that dieters will experience reduced appetite and their bodies will use stored fat for energy versus burning glucose from carbohydrate digestion. Burning fat for energy will supposedly lead to weight loss.
Disadvantages:
The medical community continues to debate the potential damaging effects of long-term, high-protein diets on kidney function, cholesterol levels, and possible increased risk of heart disease, osteoporosis and cancer. The Atkins diet restricts carbohydrates and limits the amounts of fruits, vegetables, milk and other high-fiber foods. These foods naturally provide essential vitamin and minerals to maintain health. Atkins diet followers may have difficulty maintaining this diet long term. The problem is taste. The only way to really satisfy taste without carbohydrate is by increasing fat. And this is another concern with the Atkins plan. Weight loss occurs predominately through a process called ketosis, and a majority of it (at least initially) is fluid loss. There have been no long-term randomized studies to support the safety of this diet.
Advantages:
People like eating high amounts of protein foods that are often restricted on other diets. Those who have been unsuccessful on other low-fat, high-carbohydrate diets will often lose weight with this plan. The diet is easy to follow; no point system, calorie counting or complicated meal plans are involved.
The Carbohydrate's Addict's Diet (Richard Heller, M.D. and Rachael Heller, M.D.)
The Diet Plan Theory:
The Carbohydrates Addict's diet is a low-carbohydrate eating plan. The diet recommends eating low-carbohydrate meals and one "reward meal" daily. The reward meal combines carbohydrates, protein and vegetables. It must be eaten within an hour from start to finish. The Hellers' diet is based on the theory that many overweight people are carbohydrate addicts; they suffer from a biological condition caused by a hormonal imbalance. Excess insulin is produced after eating carbohydrates, resulting in all-day food cravings and a willingness in the body to store fat. The plan holds that converting to this low-carbohydrate plan reverses such biological conditions, reducing appetite and body fat storage. The body will convert to burning fat for energy versus burning glucose from carbohydrate digestion. In general, although the finer points may differ, this can be viewed as a modified Atkins plan.
Disadvantages:
There are no long-term randomized studies to support the theory of carbohydrate addiction. Enjoying carbohydrate foods is not enough for an addiction diagnosis. Also, there are no long-term randomized studies to support the safety of this diet. Eating a low-carbohydrate diet leads to consuming larger amounts of fat and protein. Although debated by the medical community, long-term low-carbohydrate diets are believed to increase risk for colon cancer and osteoporosis. High-fat and high-protein diets could cause kidney function loss, elevate cholesterol levels and increase risk of heart disease. Following this diet long term will be a challenge for many.
Advantages:
Weight loss may occur with this diet. It provides a comprehensive list of foods to consume. It encourages drinking plenty of water daily. It is less restrictive than the Atkins' diet.
The Pritikin Principle (Created by Nathan Pritikin, Revised by Robert Pritikin)
The Diet Plan Theory:
The Pritikin diet is a low-fat, high-carbohydrate eating plan. The focus is to eat vegetables, fruits and high-fiber grains. Fats should not exceed 10% of total daily calories. Nathan Pritikin's diet is based on the theory of eating low-fat, low-calorie, plant-based foods to promote weight loss and improve or prevent heart disease. The revised Pritikin diet includes a "Calorie Density Solution" - consume low-calorie dense foods (e.g. apples, brown rice) until full six to seven times daily. Eating low-calorie foods throughout the day will reduce hunger and cause weight loss.
Disadvantages:
Many medical and nutrition professionals agree with this plant-based, high-fiber approach. However, they believe 10% total daily fat intake is too low. Dietary fat provides essential fatty acids and the fat soluble vitamins A, D, E, K needed for normal cell function and tissue growth. At this fat-consumption level, it is difficult to consume all essential fatty acids naturally found in foods. This diet may not be practical for all. Those eating outside the home on a regular basis will find it difficult to maintain this low-fat diet. Low-fat diets often fail to satisfy appetite and may not be palatable for some people.
Advantages:
Weight loss may occur with this plan. It encourages eating balanced meals that include high-fiber fruits, vegetables, beans and grains. Meals are customized to meet personal needs and tastes from a wide range of foods and menus. Although debated in the medical community, there is evidence low-fat diets play a positive role in preventing heart disease and some cancers. The Pritikin diet also encourages daily exercise and stress-reduction techniques.
Protein Power Lifeplan (Michael R. Eades, MD, and Mary Dan Eades, MD)
The Diet Plan Theory:
The Protein Power Lifeplan diet is a high-protein, high-fat, low-carbohydrate eating plan. The diet allows for liberal amounts of fish, poultry, red meat, low-fat cheese, eggs and tofu. It offers a three-tiered nutrition plan designed for your level of health commitment: Hedonist, Dilettante or Purist. Daily caloric needs are determined based on protein requirements that are linked with activity levels. The Eades' Protein Power Lifeplan is based on the theory that the body is designed to metabolize and thrive on fats and proteins; there are no physical needs for carbohydrates and processed foods. The diet focuses on controlling insulin levels by decreasing carbohydrate consumption. By ingesting a low-carbohydrate diet, the body uses fat for energy versus burning glucose from carbohydrate digestion. Using fats for the body's energy source will decrease appetite and promote weight loss.
Disadvantages:
The Power Protein Lifeplan restricts carbohydrates and calories, limiting the amount of essential vitamins and minerals consumed naturally in foods to maintain health. High-fat diets are debated in the medical community. However, there is strong evidence to support increased cholesterol levels, and increased risk of heart disease, osteoporosis, cancer and the potential for accelerating loss of kidney function. There are no long-term randomized studies to support the safety of this diet or to support the theory of the body's preference to metabolize proteins and fats with greater efficiency than carbohydrates.
Advantages:
Weight loss may occur with this diet. The plan encourages consuming healthier fats, low-fat cheese and avoiding fried foods.
Sugar Busters (H. Leighton and associates)
The Diet Plan Theory:
The Sugar Busters diet is a high-protein, high-fat, low-carbohydrate plan. This diet recommends reducing all refined sugars along with some high-sugar fruits and vegetables. Restricted foods include refined sugars, potatoes, corn, white rice, some breads, beets, carrots, corn syrup, molasses, honey and soda. The authors believe sugar is toxic. The plan holds that when refined sugars are eaten, blood sugar rises quickly and this causes an overabundance of insulin. The excess amount of insulin is not readily used to convert blood sugar - glucose - into energy. Instead, the body stores the glucose as fat, leading to weight gain. Eliminating refined sugars forces the body to convert fat into energy versus burning glucose from carbohydrate digestion. Appetite subsides, the body stores less fat and weight loss occurs.
Disadvantages:
The authors' scientific theories are misleading. Sugar is really not TOXIC. Pesticides are toxic. They claim lower insulin levels in the blood stream can reduce insulin resistance. Insulin resistance is a medical condition diagnosed by a physician and is typically seen in obese people and Type 2 diabetics. The authors also believe you can avert diabetes with this diet. Eating sugar itself does not cause diabetes or insulin resistance in a healthy person. But, highly refined white sugar on its own does make blood sugar levels rise quicker than eating a complex sugar (such as a carbohydrate) combined with fat and protein. Being overweight is a factor in developing both insulin resistance and diabetes. Losing weight, with any diet plan, aids in preventing these conditions. The medical community continues to debate the effect long-term, high-protein diets have on accelerating the loss of kidney function, elevating cholesterol levels, increasing risk for heart disease, osteoporosis and cancer. There have been no long-term randomized studies to support the safety of the Sugar Busters diet. Following this diet over the long term will be difficult.
Advantages:
Weight loss may occur with this diet. It provides clear guidelines on foods to avoid and it encourages eating high-fiber vegetables, stone-ground whole grains, lean and trimmed meats, fish, fruit and drinking alcohol in moderation. The authors recommend looking at your food portions versus traditional calorie counting.
Suzanne Somers' Get Skinny on Fabulous Food (Suzanne Somers and associates)
The Diet Plan Theory:
Somers' diet is a high-protein, high-fat, low-carbohydrate eating plan. The diet foods include unlimited amounts of meat, cheese, eggs, cream, oils and butter; and controlled portions of low-carbohydrate vegetables, whole-grain pastas, cereals, breads, beans, fruits and non-fat dairy products. There is a list of "funky foods" to eliminate, guidelines of when to eat fruits, and how to combine protein, fat, vegetables and carbohydrates. The diet is based on the theory that when eating protein and carbohydrates together, their enzymes cancel each other, halting digestion and leading to weight gain. The key to "Somersizing" is to eliminate foods high in sugars, a.k.a. carbohydrates.
Disadvantages:
There is no scientific data to support combining certain foods to lose weight or that protein and carbohydrate enzymes react when eaten together to stop digestion. Some foods naturally combine protein and carbohydrates, including nuts, milk, beans and whole-grain breads. The body digests these foods. The medical debate over potential harmful effect of long-term, high-protein diets on kidney function, cholesterol levels, and increased risk for heart disease, osteoporosis and cancer also applies to this plan. Ms. Somers herself had a bout with breast cancer. Whether this is related or not is, of course, up for speculation and discussion. There are no long-term randomized studies to support the safety of the diet.
Advantages:
Weight loss may occur with this diet. Meals are customized from a wide range of foods to meet personal tastes.
The Zone Diet (Barry Sears, Ph.D.)
The Diet Plan Theory:
The Zone diet is a high-protein, higher-fat, lower-carbohydrate eating plan. It is not as restrictive as other high-protein diets. It allows for a broad range of foods to be consumed. A small amount of protein is combined with twice the amount of "favorable" carbohydrates, including fruits and vegetables. If choosing "less desirable" carbohydrates, the portion size is smaller. Sears' Zone Diet is based on the theory that the human body is genetically programmed to reach peak efficiency when all meals, including snacks, consist of a set caloric ratio of carbohydrates, proteins and fats. The diet recommends 40% of calories from carbohydrates, 30% from protein, and 30% from fats (40-30-30). When this ratio is achieved, the body is working within the "zone." The body will have maximum energy and weight loss.
Disadvantages:
The medical and nutrition community have mixed feelings about the Zone Diet. There are no long-term randomized scientific studies to support the theory the human body is genetically designed to reach maximum efficiency with a 40-30-30 caloric ratio. The zone diet ultimately is a low-calorie diet. It is difficult to consume essential daily vitamins and minerals naturally from foods on low-calorie diets. Following the Zone Diet over the long term may be difficult.
Advantages:
Weight loss may occur with this diet. It encourages eating balanced meals that include high-fiber fruits, vegetables and beans and grains. The eating plan is easy to follow.
Summary:
While there are many more diets available, these are the ones that seem to generate the most interest and the most questions. We will not even begin to address fad diets such as the " cabbage soup diet" or the " Hollywood diet" etc. There is simply no role for the use of get-skinny-quick fads. They are nutritionally devoid, and frankly dangerous.
Conclusion
Maintaining your ideal body weight is a balancing act between food consumption and calories needed by the body for energy. You are what you eat. The kinds and amounts of food you eat affect your ability to maintain your ideal weight and to lose weight.
Medical science has established that eating proper foods can influence health for all age groups. The U.S. Department of Agriculture's current dietary guidelines state:
"Eat a variety of foods. Balance the food you eat with physical activity--maintain or improve your weight. Choose a diet low in fat, saturated fat, and cholesterol. Choose a diet moderate in sugars. Choose a diet moderate in salt and sodium. If you drink alcoholic beverages, do so in moderation."
Obesity At A Glance
* Obesity means having excess body fat. For adults 35 and older, BMI greater than 27 is considered obese.
* Obesity is not just a cosmetic consideration. It is a chronic medical disease that can lead to diabetes, high blood pressure, heart disease, gallstones, and other chronic illnesses.
* Obesity is difficult to treat and has a high relapse rate. Greater than 95% of those who lose weight regain the weight within 5 years.
* Even though medications and diets can help, the treatment of obesity cannot be a short-term "fix" but has to be a life-long commitment to proper diet habits, increased physical activity, and regular exercise.
* The goal of treatment should be to achieve and maintain a "healthier weight", not necessarily an ideal weight.
* Even a modest weight loss of 5%- 10% of initial weight and the long-term maintenance of that weight loss can bring significant health benefits by lowering blood pressure and lowering the risks of diab