Thursday, July 12, 2012

Is Obesity A Problem?

You probably think you know the answer to this question. From a medical perspective, your answer probably evolves around the fact that obesity leads to the development of chronic diseases such as diabetes, heart disease, cancer, dementia, arthritis, etc. These diseases lead to costly medical care which still leads to premature death. That sounds like a problem.

Well, based on a new study from the University of California Davis published in the Journal of the American Board of Family Medicine, you may be wrong. The study, which tracked 50,994 Americans between the ages of 19 and 90 for a total of six years, suggests that obesity itself may not be a harbinger of impending death; rather, hypertension and type 2 diabetes, which are often associated with obesity, are what leads to an early meeting with the grim reaper.

You may ask isn't that a question of semantics? Aren't obesity, diabetes, and hypertension so closely related that they may be considered one and the same? Isn't diabesity, as some call it, the right name for it? The answer may surprise you.

The study showed that obese people without these conditions were no more likely to die than non-obese people, and non-obese people with these conditions were more likely to die than obese people without them. So it's not weight per se that kills you, but the diseases that often, but not always, accompany excess weight.

In fact, in my practice I have seen many people who did not suffer from a weight problem, but were still struggling with diabetes. Well, that seems to make sense because weight itself is not the main factor in the development of diabetes and some people who are naturally heavier than others, still seem to enjoy good health.  (I remember many years ago when I worked in a summer sleep-away camp that there was a rather heavy young man that was an incredible athlete. He moved faster and stronger than most of his leaner peers. One would be hard pressed to say that he was unhealthy.) 

Nonetheless, this California study is consistent with a new movement that advocates HAES, which stands for Healthy At Every Size. The HAES camp believes that your health is more important than your size or body mass index (BMI) and I agree.

From the inception of MDPrevent, I have been telling patients not to focus on their weight loss; rather, I have been teaching, begging, exhorting, cajoling, and a number of other words ending in 'ing' to improve their health by eating certain foods and avoiding others, by staying more physically active all day long, by taking steps to ensure a good night's rest, and by developing strategies to manage stress effectively. My lectures often also focus on the need for a strong social network, the benefits of engagement and purpose, and the value of surrounding yourself with like-minded individuals. So, yes, one study doesn't prove anything, but it's not the first study to show the wisdom of focusing on your health and not your weight.

So now you may be thinking that obesity is not a problem, but you would be wrong. Obesity is still often associated with the predominance of chronic disease development. Even in the Albert Einstein College of Medicine study that identified Eastern European Jews who seem to have a longevity gene and who claimed to eat whatever they want, the results showed that those who survived into their 90s were almost always lean. Perhaps they had a genetic predisposition to being lean, but again, lean won almost every time.

I think the most serious reason obesity is a problem is because we don't as a society really seem to understand it. Quite frankly, my head is spinning from reading all the studies and books that purport to have defined, if not offered the perfect solution, to the problem. The list is almost endless.

Here's my abridged version of solutions offered (not saying they work or don't work; just listing to make a point):

Don't eat processed foods that contain white sugar and flour, avoid almost all carbs even the complex ones in fruits, eat more proteins, be a Vegan, eat more meat, drink more dairy, avoid saturated fats, avoid gluten, drink more water, balance your energy intake and output, don't live near fast food restaurants, eat more smaller meals, snack, don't snack, use small plates, eat breakfast within 30 minutes of waking up, don't eat breakfast until after you exercise, don't eat past seven at night, take dietary supplements that speed up metabolism, avoid anything other natural foods, stay physically active all day, go to Weight Watchers, follow the Adkin's diet, the South Beach Diet, the Zone Diet, the Cookie Diet, the grapefruit diet and countless other diets, take HCG and other appetite suppressants, take medications like Orlistat or Tenuate, have lap-band or stomach bypass surgery, etc.

Yes, there are quite a number of pundits that feel they have the solution, and that's a huge problem. Given so many choices, analysis paralysis sets in and we end up doing nothing or a little of this and a little of that, and that my friend is what I think is the biggest problem with obesity.

At this point, after reading countless books, articles, and studies, watching documentaries, attending conferences,  speaking to thought leaders, and working with patients, my solution is simple. Pick something that you think you can live with that has at least some decent science supporting it and STICK WITH IT. Getting healthy and losing weight takes time to do it right. It takes effort and concentration and it doesn't happen overnight. For many it will be a life-long struggle. Sacrifices will have to be made. Favorite foods may need to be given up perhaps forever. Trade-offs will be made and battle-lines drawn. That's the reality of the situation for most and I challenge anyone to prove otherwise.

If you need support, get it. If you are a do-it-on-your-own type of person, that's fine, but have a plan and follow it religiously.

If you are looking for some direction and/or insight, here's my suggestions: avoid processed foods, stay active during as much of the day as possible, drink fluids to keep your urine a pale yellow, don't take any pills you don't absolutely need to take, make fruits, vegetables, beans, nuts, and whole grains the bulk of your diet, eat some wild salmon at least 2-3 times a week, get at least 7 hours sleep a night, learn how to manage stress better, nurture relationships, and find something that gives you pleasure to engage in consistently both physically and mentally.

If you follow this advice, I can't promise what weight, if any, you will lose, but I'm pretty sure you will be healthier than you are now. In the final analysis, I hope you agree that being healthy is the most important goal.

1 comment:

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