Sunday, February 25, 2007

Obesity: A Chronic Disease

One out of three men and women in the United States weighs more than 20% above his or her ideal weight. This suggests we need to take on a new approach in the treatment of obesity.

We already spend more than $70 billion per year in health care costs of obesity related diseases. Unhealthy diet and lack of activity are listed as the second leading cause of death in the United States.

While common misperceptions, quick fix remedies and the overall lack of nutritionally educated population exist, obesity is now recognized as a multifactorial disease. This insidious disease brings treatment considerations to multiple levels of intervention. With this in mind, it is necessary to take into account for optimal treatment, the co morbidities and behavioral patterns of the individual. When offering an individual treatment, education, support and ongoing intervention, which would include periodic assessment is necessary and more effective than a single intervention.

Weight cycling (the lose and gain and lose and gain syndrome) is at an all time high.

Long ago, Bariatric Physicians (docs who specialize in weight loss) and clinics across the country were billing our then private insurances for the treatment of obesity in a round about way. They were using the diseases their patients had as a result of being overweight as the diagnosis for treatment and collecting lots of money. Along the way with changes in our healthcare system, and the rise in HMOs caused the red flag to go up and medical insurance companies to put a halt to this mode of secondary treatment.

In fact, instead our insurance companies have made it possible for our grossly obese population (grossly is a medical term used for patients who are 100 pounds or more overweight) to have gastric reduction surgery for weight loss. Leading many people who are teetering on the verge of 60-80+ pounds overweight to start thinking in gaining more weight so they can have the surgery and have their insurance pay for it!

Studies have shown that even a 10% reduction in weight can significantly improve obesity related diseases, such as, diabetes, hypertension, heart disease to name a few and decrease the percentage of risk for heart attack, stroke, kidney disease and cancer. Yes, cancer! Many studies have been performed; the likelihood of cancer increases as weight increases. Point taken.

So what does multifactorial mean in relation to obesity? It means that long gone are the days where your GP (general practitioner, family doctor) says, "Gee Mr./Mrs. Smith your blood pressure is up and your blood sugar is teetering on the verge of diabetes, here is a 1,200-1,400 calorie ADA (American Diabetes Association) diet, you need to drop a few pounds. See you in six months" I know you have the willpower to do it, end of story.

Now, you don't even get to see a doctor, nine out of 10 times. You get to see the NP (nurse practitioner) or PA (the physician's assistant). Although they do recommend a reduction of weight, now they are realizing that a piece of paper that has 1,400 calories of food on it, won't cut it on it's own. We all know it isn't willpower that will make us or keep us healthy and lean.

We are a food-oriented culture; think about it. A friend calls and wants to visit with you, you make plans for dinner or lunch, someone gets married you eat, someone gets a promotion, you eat, someone gets fired you eat, someone is going to be born (baby shower) you eat, someone dies, you eat, happy or sad, you eat, get the picture? That is only one of our many mountains to climb.

Another trigger for us, would be a Pavlovian stimuli, people, places, things, get our salivary glands and our taste buds working overtime. When I go to Disneyland I always want to eat that wonderful Dole pineapple at the Tikki room.

Some people are affected by emotional eating. They eat when they aren't feeling "good" about themselves or a situation. This can also fall into the habit category. When we were younger and got hurt there was usually an adult around to wipe away the tears and offer consolation with a cookie or a piece of candy.

This can even be a problem when we are experiencing cold of flu symptoms, we want to give our bodies, "feel good food" and lots of it. I can't begin to count the number of clients I counseled who would deviate from their intended path toward their healthy goal weight, that would allow themselves "sinful" foods, and then say, "well, I wasn't feeling well, and I needed to eat that devil's food cake to make me feel better. I didn't think my body would tolerate any other food."

Fear plays a prominent role in weight loss and maintenance. We need to really sit and think about what we believe is our benefit to failure. Why it is that our attempts at weight loss and a healthier lifestyle have failed in the past. If I get to my lean or goal weight, now I have no place to put the blame.

For example, "I didn't get that job or promotion because I am overweight," "my relationship with my boyfriend/girlfriend isn't working out because I am overweight," we take away the excuse for not having or being what we "dream" of; we have a scapegoat, our weight.

Another consideration would be our loved ones. They tend to sabotage our progress, due to fear as well, "will she still love me if she is thin," how will he behave," "will they treat me differently" "he is only losing weight so that he can find someone else and leave me," etc …

Last but by far not least are those %*#! cravings we all have from time to time. Cravings are triggers, we already talked about some of these, people, places, emotions and of course events. There also is a physiological craving, this is when the body is lacking in some nutrient and your brain sends messages to you to eat some particular food that has the nutrients the body is lacking. In other words, yes, it is important to take your nutritional supplements and your vitamins and minerals (chelated is best) to keep those particular controllable cravings at bay.

Overall, the need for weight loss has its aesthetic benefits, but our health should be the No. 1 concern.

Thursday, February 8, 2007

Exercising After Illness

Along with the change of seasons comes changes in your health sometimes triggered by seasonal allergies. These bouts with illness can interrupt your daily exercise routine raising the question of when you should return to exercise after being ill.

The main concern with upper-respiratory illnesses such as the common cold, strep throat, sinusitis and inner ear infection, is fever. When you have a fever, the red blood cells in your body are unable to carry the usual amount of oxygen, therefore, placing an extra burden on your heart to pump oxygen to your body's muscles and major organs where it's needed. Your heart rate can increase approximately 10 beats per minute for every degree of fever you have.

Lower-respiratory illnesses, which include bronchitis and pneumonia, make it difficult for oxygen to be transported from the lungs to the red blood cells. This, once again, places more demand on the heart to pump faster in order to get oxygen carrying blood through your body.

So, if you have any of these illnesses you should be fever free and completely recovered of the illness before you return to exercising. Follow these simple guidlelines and it won't be long until you're back into your regular routine.