The current epidemic of obesity is not only worrying from a social and psychological point of view but exceedingly so from a health point of view. The question is what can be done? As someone "unknown" once said: "Luck is not random; it is attracted to those who work hard. Sweat, blood and tears are the ingredients of a champion". Like a rose that is part briar, part immaculate precious bud there are certain non-negotiables when it comes to weight loss and lifestyle related disease prevention – absolutely worth it but does not come without some (e=mc2) energy expenditure.
Yes there are definitely solutions to the great problem and they are indeed "do-able".
The gold standard being: EXERCISE!
Some facts for your perusal:
- DPP/Finish DPP/ Malmo and various other large worldwide studies have proven that exercise can prevent diabetes (Also: the nurses' health study, the Malta study, the Honolulu heart programme the middle aged Finnish men study)
- These same trials have proven that exercise IMPROVES control in already diagnosed diabetics
- The Harvard Study was a 36 year follow-up more than 50 000 alumni that showed a very clear relationship between activity patterns and longevity, death by heart attack, and all of these cause mortality – i.e. in the group that exercised more the poorer outcomes were markedly less
The key though is that you have to DO exercise, physical movement that results in a raised heart rate (increased pulse rate) and sweating. This can be done even if you are disabled in some way, i.e. in a wheelchair for some reason. Trials have been done using a bicycle wheel to do resistance training of the upper body and arms proving the same benefits. So no excuses in other words.
Another common reason not to exercise is the "time" excuse. If one believes the research – you die sooner if you do not exercise – thus you are only fooling yourself if you say you have no time to exercise – your time indeed will run out sooner than your friends who exercise. Once your health deteriorates the time you have on your hands (whilst in hospital or even in ICU) might precipitate a thought or two about time management.
Some people argue that they exercise but still do not lose weight. In studies done using multiple endpoints – like cardiovascular outcomes (heart attacks), Blood pressure, glucose control, waist circumference – even if no weight was lost – all these other outcomes were indeed beneficially influenced in the exercise group. Thus even if you are not necessarily losing weight (as long as you are losing your waist) it is benefitting your health.
Exercise – if you want to lose weight and live longer and healthier it is a non-negotiable.
Medications to lose weight are indeed available. There are formulations that used to be available over the counter that have largely been withdrawn due to safety concerns. Very recently a good weight loss medication has been withdrawn after a study in the USA has had negative outcomes associated with the drug. However, as with any medication, one always has to individualise treatment and make sure there are no medications that you are on that will interact with one another and importantly that you do not have known contra-indications (conditions that cause you to not be able to take a certain medication).
We have a weight loss medication available that can be prescribed if you are seriously overweight – BMI (body mass index) >30 (which is the number used to signify the start of obesity). (However much more importantly (at this point in the article just to clarify) is one's waist circumference). You can check this right now – men should be < 94 cm and women < 80 cm. These measurements are also linked to your race group – so if you are Asian vs. American the target is different. Importantly if your waist circumference is high you are at much greater risk for diabetes and heart disease.
Back to medications that aid weight loss: Duromine (Phentermine) is an appetite suppressant that helps you reduce calorie intake. Other medications that do this are molecules like d-Norpseudoephedrine. It is vitally important to know what you are taking and also to know that there are certain medical conditions that you absolutely should not take any of these medications in conjunction with having.
Mediation should be used short-term for a period of about 3 months in order to "kick-start" the weight loss in obese individuals with the understanding that during this period certain lifestyle changes are instituted that can be maintained: exercise, healthy eating (not dieting), control of other risk factors like blood pressure, cholesterol (medications) and cessation of bad habits like smoking and excessive alcohol intake.
On that note, alcohol has a lot of calories and just cutting down on alcohol consumption can drastically reduce weight. On the positive side, one glass of red wine for women/day and 2 glasses for men/day is proven beneficial in terms of diabetes and heart disease. (This does not mean that if you abstain you have to start using alcohol to be healthy).
Surgery is a new option, especially for morbid obesity (BMI>40), however once again this is relative and waist circumference is a much more sensitive indicator. Bariatric surgery can be done and entails surgery to your stomach (the first part of your intestinal tract into which the food is transported by the oesophagus – it is like a bag where the food undergoes initial digestion and stays a while before being emptied from here into the next part of the bowels) – the stomach in essence is made smaller and thus you are consequently unable to eat large meals and thus you lose weight. There is no doubt that this works. Drawbacks are: costs involved and undergoing surgery with possible complications due to surgery. Benefits are: positive effects on both health and psychologically (due to impressive weight loss and well as waist loss), both measurably in terms of risks as well as the immeasurable entities of psychological well-being.
What is new on the horizon? One of the new diabetes medications: the Incretins, are currently being used to treat diabetes and one of the side-effects is weight loss. There are a few trials currently being conducted using the incretins in Obese patients who are not diabetic in terms of inducing weight loss with positive results. The incretins are actually hormones produced in your own body that aid in glucose-induced insulin secretion, stop one of the hormones that acts against insulin, slows stomach emptying and reduces food intake. The laboratories have found a way to synthesize the incretins and use them as medications with the above effects – very exciting new form of therapy. This could possibly be used in the future to aid weight loss in obese individuals.
Obesity carries a 90 fold relative increased risk of developing diabetes. The knock-on effects of being obese are numerous and linked to much sadness and much morbidity. About a century ago the incidence of morbid obesity was negligible, what has changed? We eat junk (and loads of junk – calorie intake has at least doubled over the last century – we eat too much), we have stopped routine physical activity (transport by car, convenience factors etc.) and replaced it with a lot of slovenly television watching whilst we again eat too much. Simply put we have complicated our lives by being too busy, too stressed and try and stop the gaps with great piles of junk that we can't seem to get enough of.
The cure? Let us return to the life of more than a century ago – simplify your life with lots of deep breathing, smelling the roses, contemplation, normal physical activity and healthy eating. We can continue on the spinning hamster wheel that is ironically a slovenly couch life or we can choose to live balanced lives. It is a choice and no matter where you are on the scale of life (in kilograms or contemplatively) you have the power to choose and there are solutions to the conundrum. The first step is deciding to implement them. I challenge you today to contemplate.
Call to book your appointment with Dr Claudine Lee soon, on +27 (0)33 343 2243.