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obesity

 A nutrition professor at the University of Massachusetts, Amherst, coined the phrase, “American Affluenza” when he discussed obesity with his students.   Is obesity a problem of too much food, not enough activity, or a combination of both?  Think about yourself and the people you know…  American culture in the media is loaded with mixed messages – be buff and work out, but satisfy your desires.  Try this new fast weight loss diet but go to “all you can eat” buffets and pig out…  Be a gourmet chef and buy a lot of fantastic equipment for your kitchen but eat at fast food restaurants…  We have so many work-saving devices and a lot of sedentary diversions to occupy our time.  What do you do for entertainment and leisure activities?  How many times have you eaten in your car from the drive-thru at a fast food restaurant or doughnut emporium?

The current incidence of obesity in the US is 55% in adults and 33% in children. This constitutes a major public health problem.  Obesity is the second leading cause of preventable death in the US. The definition of obesity is a body mass index (BMI) of > 30.  You can calculate your BMI with this interactive calculator.


Obesity is correlated as a co-morbid condition of such chronic diseases as type 2 diabetes, hypertension, gout, osteoarthritis, cholecystitis, hyperlipidemia and cardiovascular disease, colon, breast, and prostate cancers and sleep apnea.  Overall morbidity is also increased in obese individuals.  Central or android-type obesity is more highly correlated with chronic disease than peripheral or gynecoid-type obesity.  This is often referred to as the apple vs. pear body fat distribution. Waist circumference is a good measure to determine chronic disease risk in this sense.  A waist circumference of > 35” for a female and > 40” for a male confers increased risk.   food

The table (access it by pressing here) summarizes the classification of overweight and obesity by BMI, waist circumference and associated disease risk.

Obesity is a very complex problem and requires multifactorial treatment regimens prescribed over a long period of time – it is considered a chronic disorder and should be treated as such.

Treatment Algorithm

Hyperlink to the treatment algorithm recommended by the National Heart Lung and Blood Institute to view how obesity should be managed by physicians. If you have the time, take a look at the National Heart Lung and Blood Institute’s website (http://www.nhlbi.nih.gov/index.htm) for information on obesity.

type 2 diabets mellitus

The major predisposing factor for the development of type 2 diabetes mellitus is obesity.  The reason for this is insulin resistance where receptor and post receptor defects exist, minimizing insulin utilization in the body.  Modest weight reduction of 10-15% can ameliorate this problem and improve outcomes. The Texas Department of Health provides an algorithm on Weight Loss for Overweight and Obese Adults on their website (http://www.tdh.state.tx.us/diabetes/pdf/algorithms/wtloss.pdf).

If you would like more information about diabetes, there are a few Internet resources that you may want to visit. Among these are the American Diabetes Association (http://www.diabetes.org/) and The National Institute of Diabetes and Digestive, Kidney Diseases (NIDDK) (http://www.niddk.nih.gov/) and the Diabetes Medical Nutrition Algorithm for Type 2 Diabetes Prevention and Therapy and Type 1 Diabetes Therapy (http://www.tdh.state.tx.us/diabetes/pdf/algorithms/nutritio.pdf).

hypertension

Is hypertension caused by excessive sodium intake?  For some “salt-sensitive” individuals, it may be.  Studies have shown that certain populations such as African-Americans and elderly people are more sensitive to high blood pressure induced by a high sodium diet. 

Obesity exacerbates hypertension, and again modest weight reduction can result in a lowering of blood pressure.  Excessive alcohol intake is another dietary factor linked with hypertension and reduction or abstinence from alcohol often results in blood pressure lowering. 

On the positive side, the Dietary Approaches to Stop Hypertension diet, the DASH diet, (a clinical trial using a diet low in fat and rich in fruits and vegetables) showed a reduction of blood pressure.  To learn more about the DASH diet, check out the National Heart Lung and Blood Institute’s website and look at their high blood pressure education program subsite.

 

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