Weight problems - why it's important to lose weight and how it should be done
Weight problems - why it's important to lose weight and how it should be done
What
is being 'overweight' and what is being 'obese'?
There is now an agreed method of measuring weight in order to detect whether individuals are outside the normal weight range. The method uses the individual's height and weight measurements to calculate (weight divided by height squared) the Body Mass Index (BMI). A person with a BMI of less than 25 is not overweight. A BMI between 25 and 30 is classified as being 'overweight' whereas a BMI of 30 or more indicates 'obesity'.
A person of height 5'9" weighing 12 stones 7 pounds has a BMI of 26 and is therefore overweight. If he/she was 14 stones 7 pounds then the BMI would be 30 and he/she would now be classified as obese.
A large waist measurement confers
greater risk in a person who is overweight or obese.
Why is there so much interest in obesity at present?
Obesity is now reaching epidemic
proportions in the western world. There are estimated to be 90 million
obese people in the USA and 9 million in the UK and the numbers are growing.
The rate of increase in the UK over several years now means that 18% of
women and 16% of men are obese and that a further 34% of women and 45%
of men are overweight1. The prevalence of obesity amongst adults
in England more than doubled between 1980 and 19961.
Why are
we becoming overweight?
Recent changes in lifestyle are mainly to blame. The increased availability and greater consumption of high-fat, high-energy foods combined with a dramatic fall-off in physical exercise is the main problem. Obesity is becoming particularly worrying amongst children where profound reductions in physical activity have led to a quarter of all children being overweight. Genetic factors account for about 40% of obesity. This can be seen when most or all members of a family are overweight; however over-consumption and underactivity are still important factors. Patients with a genetic predisposition may require medical assistance to help them lose weight and maintain their new body weight.
Medical causes such as an underactive
thyroid or other hormonal imbalances are not common. However, they must
be excluded because if present such conditions must be treated.
Why
is being overweight a problem?
Being overweight increases the chances of developing many diseases including:
The greatly increased levels of obesity
today are therefore an important public health issue in the western world.
As such there has been much media interest recently and the medical profession
has issued clinical guidelines on the management of overweight and obese
people5.
Does losing
weight help one's health?
Obese people with coexistent weight related problems (such as heart disease, high blood cholesterol, diabetes, high blood pressure and shortness of breath) who lose some weight have a significantly increased life-span.
Any weight reduction is beneficial and a loss of between 0.5 and 9 kg has been shown to reduce the chance of early death by 20%6.
Weight loss alone improves the outcome of the following coexistent diseases:
Weight loss of 5-1 0% in those
people who already have non-insulin dependent diabetes improves the blood
sugar levels and reduces the requirement for medication7.
In those with high blood pressure a weight loss of just 1 kg reduces a fall in pressure of 1-2mm Hg. Further weight reduction produces additional incremental falls8.
Weight loss in the obese also results in reductions in blood levels of cholesterols9.
Clearly there are also benefits in
the improvement of self-esteem, well-being and mood as well as breathing
and pain in weight-bearing joints.
How much weight needs to be
lost?
The aim of weight management is to prevent or reduce the health consequences of obesity. Even a weight loss of 5-1 0% reduces significantly the health risks associated with obesity. For a person weighing 15 stone this would amount to between three quarters and one and a half stone. Some people may lose greater amounts of weight but maintaining the new weight may be more difficult.
Continued weight loss beyond six months is unlikely and the objective thereafter is weight maintenance.
Weight needs to be lost slowly (1 to 21bs per week) in order that the loss be maintained.
How
can weight be lost, and the loss maintained?
Very frequently weight that is lost is soon put back on. This is extremely common as people fall back into old habits. It must be realised that once the weight is lost, maintenance of the new body weight will require a change in lifestyle.
Diet changes need to be supervised by an experienced and fully qualified dietician who will also advise on behavioural changes and an exercise programme; all of which must tailored to the individual.
Exercise does not have to be too strenuous. Brisk walking for 20 minute each day for five days of the week will help reduce weight and also to maintain the new weight.
Obese people and some overweight patients with risk factors may need help with medicines that help reduce weight and maintain its loss. Such people may require medical therapy if after a period of dieting and behavioural modification they have not lost sufficient weight. Those with a genetic predisposition to obesity may especially need such assistance.
Two new drugs that work through novel pharmacological mechanisms are now available.
Orlistat is a medicine that reduces the absorption of fat eaten in food from the gut. It is used along with an individually tailored low-fat diet and behavioural modification. Orlistat is itself not absorbed from the gut into the body and therefore is free from systemic side effects. As it reduces fat absorption it increases the amount of fat in the faeces.
Sibutramine is a medicine that is absorbed into the body and acts by increasing the body's metabolism resulting in weight reduction. It also makes one feel 'full-up' earlier thus helping to reduce the volume of food intake.
These medicines are unlike older
drugs for obesity which were noted for unpleasant and dangerous side effects.
The medicines are however prescription only medicines and need to be prescribed
by a physician with regular review of the patient.
How
can The Weight Management Clinic help me?
An initial assessment and medical examination along with certain blood tests and body measurements are undertaken. This is necessary in order to exclude any underlying medical causes for obesity.
A specific diet and behaviour modification plan is designed for each individual. Medical therapy may be advisable for those with resistant weight problems.
All patients are carefully followed up by the dietician and doctors with regular reviews and diet and behavioural control. Review of medical treatment, if initiated, is also carefully reviewed.
If you are concerned about being overweight call our nurse on 020 7636 4540. She will ask you a number of short questions including your weight, height and waist measurement. She will then be able to quickly calculate your body mass index (BMI) and tell you the result over the telephone.
She will also ask you whether you suffer from any of the following:
If your BMI is above 25 you will be eligible for an appointment.
The telephone call takes approximately
3 minutes.
The Weight Management Clinic follows the recommendations contained in the report of the Royal College of Physicians, "Clinical Management of Overweight and Obese Patients with Particular Reference to the Use of Drugs", December 1998.
The Weight Management Clinic,
32 Weymouth Street,
London,
W1N 3FA.
Tel: 020 7636 4540
Fax: 020 7637 2019
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References
1. Prescott-Clark P, Primatesta P (eds). Health survey for England.
1996. London: HMSO. 1998.
2. Jung RT. Obesity as a disease. Br Med Bull. 1997: 53: 307-21.
3. Lew EA. Mortability and weight: insured lives and the American
Cancer Study. Ann Intem Med. 1985; 103: 1024-9.
4. Huber HB. The importance of obesity in the development of coronary
risk factors and disease: the epidemiological evidence. Ann Rev Public
Health. 1986; 7: 493-502.
5. Clinical management of overweight and obese patients. A report
of the Royal College of Physicians. The Royal College of Physicians of
London. 1998.
6. Williamson DF, Pamuk E, Thun M et al. Prospective study of intentional
weight loss and mortality in never-smoking overweight US white women aged
40-64 years. Am J Epidemiol. 1995; 141: 1128-41.
7. Colditz GA, Willet WC, Rotnitzky A, Manson JE. Weight gain as
a risk factor for clinical diabetes mellitus in women. Ann Intem Med. 1995;
122: 481-6.
8. Wing R-R, Koeske R. Epstein LH, et at. Long-term effects of modest
weight loss in type 11 diabetic patients. Arch Intem Med. 1987; 147: 1749-53.
9. Goldstein DJ. Beneficial health affects of modest weight loss.
Int J Obese. 1992; 16: 397-415.
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