Weight Loss

Due to our increasingly chair-bound lifestyles and poor eating habits, the rates of obesity in both children and adults alike are rising to epidemic proportions year on year since the 1980s. Studies prove that obesity is a serious risk to health, causing many life threatening diseases including diabetes and heart attacks. Consider these sobering statistics:

• Every fourth adult has become obese (BMI >30, 2002 data)
• Over half of men and women were either overweight or obese (2003 data)
• Our children are suffering as well and the UK has one of the highest proportions of overweight children in Europe.
• Almost one third of children are either overweight or obese
• Obesity is a leading cause of heart attacks, hypertension, diabetes, and some cancers, which is a huge cost to the economy and many lives are lost. The prevalence of these diseases could be avoided if obesity is reduced

The energy equation

Obesity can be seen as a disorder of energy balance. ENERGY INTAKE is all the energy that a person derives from food. ENERGY EXPENDITURE is all the energy required to run the essential functions of the human body (resting metabolic rate), as well as energy required for physical activity. Think of a scale, with coins on one side representing energy intake (food) and coins on the other side representing energy expenditure (activity).

To maintain weight, ENERGY INTAKE from food must balance ENERGY EXPENDITURE. If you eat a high number of calories (adding to energy intake), you will need to do more physical activity to maintain weight (ie by adding to energy expenditure).
 
Adding to energy intake (by eating more) without doing enough physical activity to compensate will tip the scales towards energy intake, causing a state of energy imbalance. Excess energy is entering the system, and this results in weight gain. (DIAGRAM)

To loose weight, the person must aim to put more coins on the other side of the scale by increasing activity or remove some coins from the intake side by eating less. This will tip the scales in favour of weight loss. (DIAGRAM)

How to tell if you are obese

Obesity should be seen as having a body type that represents serious risk to future health. Weight and height together are required to know whether a person is overweight or obese. Weight alone is not helpful as a tall person may be heavy relative to a shorter person, but not be overweight. The medical profession uses a calculation that takes both weight and height into account. This is called the Body Mass Index (BMI).

BMI = Weight (kg)/height (m) squared 
Underweight    BMI: Less than 18.5
Ideal              BMI 18.5-25
Overweight     BMI 25-30
Obese            BMI 30-40
Very obese     BMI greater than 40

If your BMI is greater than 25, or less than 18.5, then this is an unhealthy weight and you are more at risk of developing disease. The higher the BMI, the higher the risk.

The BMI is not an accurate measure of health if the person is very muscular, very frail, pregnant or breast feeding. It may also not apply well to certain ethnicities, such as those who are Asian, as they are at higher risk of developing heart disease, and may be considered clinically obese at a lower BMI. If you feel that your BMI is higher than ideal, or you have any health concerns, you should consult a health professional.

Another measure of whether you are overweight is a waist measurement. The more fat carried around the waist, the higher the risk of developing disease. If two people have the same BMI, the one with the higher waist measurement will be at greater risk of developing diseases such as diabetes, hypertension and heart disease.

Increased health risk
Men: Waist 94-102 cm (37-40 inches)          
Women: Waist 80-88cm (31-35 inches)       

High health risk
Men: Waist over 102cm (>40 inches)
Women:Waist over 88cm (>35 inches)

To measure your waist, find the bottom of your ribs and the top of your hips. Place a non stretchy tape measure around the midpoint between these two landmarks. Take the measurement after you have exhaled, but do not suck in! For most people this measurement will be around the belly button.

Why is obesity is harmful

Obesity leads to serious life threatening diseases that can occur at younger ages than would otherwise have been the case. These diseases often require decades of medication to control them:

• heart disease,
• hypertension,
• type II diabetes
• some cancers (eg breast and endometrial cancer).

It is thought that many of these diseases can be prevented and many lives saved, if people achieved healthy weights.
 
Other health problems associated with obesity include infertility, polycystic ovarian syndrome, facial hair, varicose veins, back pain, arthritis, depression, obstructive sleep apnoea, gall stones and fatty liver.

The good news

Taking control of your weight and achieving a healthy weight, will not only make you feel good, but could add years to your life, which will hopefully be disease free. Any amount of weight loss will be beneficial, but of course, the more the better. Even 5-10% weight loss can lead to many health benefits such as:

• Lower cholesterol
• Lower Blood pressure
• Better glucose control and lower diabetes risk
• Less risk of a heart attack
• Better fertility
• Better sleep
• Less aches and pains
• Better self esteem
• Longer life

Why is there so much obesity?

Obesity is related to changes in our society. These days, people drive more, walk less, and are more likely to have a desk job. Television and computer games have resulted in more time being spent sitting still whilst at home. Other labour saving devices such as washing machines means that less energy is used when cleaning our homes.

In addition to this, there are many pressures to eat more. Portion sizes have increased over the years, and unhealthy ‘junk' food is popular and is heavily marketed to adults and children.

As a result, for most of us, the energy balance equation is tipped in the direction of ENERGY INTAKE, and results in weight gain. Put simply, we all eat a bit too much and do not get enough physical activity.

How to manage your weight (adults)

1. Increase physical activity. The minimum recommended in the UK is 30 minutes of moderate intensity activity on five days of the week. However, if you are clinically obese, you may require between 60-90 minutes per day. See the physical activity section for information on how to achieve these targets. The aim for weight loss is to create an energy imbalance by eating a bit less and exercising a bit more. Aim for a deficit of approximately 600 kCal per day, and tip your energy equation towards weight loss.

2. Healthy eating: balancing food groups and eating healthily is an important step in managing weight and preventing obesity. Healthy eating advice applies to everybody. See healthy eating section.

3. Decrease your energy intake. This applies to people that are overweight or obese. This is achieved by cutting down on calorie intake. Fad diets are best avoided, and gradual reductions in energy intake should be aimed for. Healthy eating and safe dieting are important. Talk to a health professional for advice if you are considering very low calorie diets (less than 1000kcal/day) as these are not routinely recommended and can be dangerous. Low calorie diets (1000-1600 kcal/day) can be considered, but are more likely to be nutritionally incomplete.

4. Set realistic targets. Aim for a maximum of 0.5kg - 1kg weight loss per week with an initial target of 5-10% weight loss. Do not become obsessed with the ideal weight, but gradually make small changes to achieve your target. Even 5-10% of weight loss provide great health benefits and will help safeguard your future health.

5. Think long term. Lifestyle changes are the key to permanent weight improvement. In order to achieve and maintain weight loss, people need to change their lifestyles and address some of the causes of obesity. Think about picking one of the following lifestyle changes to start with, then add to it:

• Increased brisk walking,
• Take a regular evening walk, with your family if possible
• Take up cycling
• Watch less television and play less computer games
• Walk or cycle to work.
• Leave the car behind whenever possible.
• Park further away and walk in
• Always take the stairs instead of the lift.
• Cook fresh healthy food and avoid processed foods and ready meals
• Substitute your daily bag of crisps for an extra piece of fruit
• Take up more outdoor activities as a family.
• If you eat fried chips every day, change these to a healthier option (eg boiled potatoes)

Any one of these changes will make a huge difference over time.

6. Make one change a time. Doing too much at once can be daunting. Make one change, however small. Give yourself time to get used to it, and then introduce another change.

7. Buy a pedometer. One large public health initiative from USA, was to encourage people to eat 100 calories less per day and walk an extra 2000 steps. It has been hugely successful. The message is that small, simple changes are the first step towards weight loss and a healthy life.
www.americaonthemove.org

8. Stop smoking: People worry about putting on weight when they stop smoking. Therefore take that opportunity to combine healthy living with smoking cessation whenever possible. See stop smoking section for more information.

9. Reward yourself: If you or any of your family members achieve their targets, do not forget to praise them and reward them. Buy yourself something nice, or take a holiday if possible.

How can your doctor can help

If you are overweight or obese, then it is worthwhile discussing this with a health professional. They may want to make a more detailed assessment of your risk of developing heart disease or diabetes. They may ask if any of your close relatives have suffered from heart attacks at a younger age, or whether you or your relatives have had high cholesterol or lipid levels. You should have your blood pressure checked, your height and weight measured, and possibly blood tests checking cholesterol and blood glucose. On the basis of all this information, your health professional should be able to give you an idea as to your risk of developing hypertension, cardiac disease, diabetes and other health problems.

If you lead a sedentary life, are obese, or have any medical health problems, then you should consult a health professional before embarking upon exercise and weight loss programs.

Medication and Surgery

Several medications are available that can help with weight loss. They work in different ways. They can either act to limit absorption of food from the bowel, thereby decreasing total calories absorbed from each meal, or they can help prevent cravings for food, by acting on the brain, in a similar way to an antidepressant. Dietary, exercise and behavioural approaches should be tried first. Medication may be suitable for people with a BMI between 27-30, but you should discuss this with a health professional, who will consider prescribing in accordance with national guidelines.

Certain types of operation can help manage severe obesity. One of which is placing a band around the stomach (gastric banding). This limits the amount of food that can be eaten at any one time. This operation can be performed via key hole (laparoscopic) surgery. If your BMI is greater than 40, or greater than 35 with certain conditions such as diabetes, your health is at serious risk, and you may be entitled to surgery on the NHS.

National Institute of Clinical Evidence (NICE). Obesity. Guidance on the prevention, identification, assessmentand management of overweight and obesity in adults and children. December 2006

Links

www.nationalobesityforum.org.uk
www.dh.gov.uk
www.iotf.org
www.healthcalculators.org/calculators/waist_hip.asp
www.nice.org.uk

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