Obesity is one of the most problematic diseases in modern society. More than one-third (36.5 percent) of adults are considered obese (Swainson et al.) Obesity-related diseases are among the leading causes of death in the United States. Obesity has more than doubled in children, and quadrupled in adolescents, in the past 30 years (Ogden et al.).  Most people recognize that obesity can shorten life expectancy, but few recognize its profound impact on almost every system of the body.  It increases the risk of Type 2 diabetes, heart disease, high blood pressure, cancer, and infertility.

Diagnosing Obesity

Obesity is most commonly assessed using the body mass index (BMI) scale to classify an individual, based on internationally recognized standards.  However, recent research has shown that a more accurate indicator would be coupling the BMI scale with a waist to height ratio (Rolls et al.).  BMI alone is not a good indicator of fitness because it does not account for lean muscle mass. Early diagnosis of obesity is of the utmost importance because obese children often become obese adults. The percentage of children with obesity in the United States has more than tripled since the 1970s (Fryar et al.) Today, about one in five school-aged children (ages 6–19) has obesity (Ogden et al.)

Prognosis

The outlook regarding the future of obesity is bleak. Obesity-related deaths are progressing at an alarming rate due to increasingly sedentary lifestyles and poor work-life balance. Additionally, people tend to believe that eating healthy is expensive, however, the difference is negligible.  Per new research from Harvard School of Public Health, the healthiest diets only cost about $1.50 more per day than the least healthy diets (Mayuree et al). To effectively ameliorate this epidemic, a systematic, multi-faceted approach is necessary.

Proper intervention must consist of 3 components: mental rewiring, physical preparation, and emotional control.

Mental rewiring means thinking about health and fitness in a positive way.  Often, people think of fitness as a difficult, time-consuming, expensive endeavor.  However, physical activity can be as simple as finding time each day to walk the dog.  Physical preparation means that it is important to take initiative each day to prepare for your fit lifestyle. This preparation can be accomplished by preparing meals in advance, gathering gym shoes and clothes each morning, and plotting out your day to include at least 30 minutes of activity. Lastly, emotional control is the most important aspect of this three-pronged approach.  People tend to consume “comfort food” at a time of distress.  This type of behavior can completely sabotage an otherwise fit day. It is very important to recognize a stressful situation and take the proper measures to ensure you are not eating for comfort.

The Mental Dilemma

The “mental dilemma” occurs when a formerly obese person, returns to old habits.  A slow, steady weight reduction of 1-2 pounds per week is a healthy way to lose weight and sustain body weight reduction. Crash diets and surgeries may work in the short term. However, research on several participants from the TV show, “The Biggest Loser”, demonstrated that of the 14 contestants who participated in the 30-week competition, 13 regained their weight back (Fothergill et al.).

The problem with “The Biggest Loser” is that it is not reality. Reality is not being isolated with trainers and chefs at your disposal.  Reality is having to go to work, care for children, preparing dinner, and trying to find time to sleep in between.  For someone to create and maintain healthy habits for a lifetime, they need something more, they need “behavioral modification”. 

Making Changes

It takes time to create a new routine.  However, to ensure long-term success, lifestyle changes must be both realistic and sustainable.  Making small changes at first (see below), then gradually introducing more and more “good habits” is the key to success.  One of the primary keys to success is not going home after work.  I have found that once someone goes home after work, they are typically done for the evening.  I tell my patients to bring their exercise clothes to work and leave them in their car.  This “cue” is one of the best ways to create a new habit.  The “cue” leads to the “response” (going straight to the gym from work).  The “response” then leads to the “reward”, which is the wonderful feeling you get after a great workout!

First Steps

Few people can lose weight without cutting the calories they consume. A 500 kcal/day deficit is associated with a weight loss of about 1lb a week. Choosing unrefined carbohydrates with a low glycemic index may help to curb appetite. These changes to the quality of the diet will usually lead to modest weight loss. However, sustained weight loss will usually require a reduction in the quantity of food consumed.

Work conducted by Rolls and colleagues indicated that subjects fail to compensate for the greater caloric intake of a large snack, by eating less on subsequent meals.^.  For patients trying to lose weight, strict portion control of energy-dense foods is essential. Learning to avoid so-called supersize options, and choosing mini- or snack-size varieties can be a useful strategy.

Maintaining Weight Loss

To be successful in the long term, patients need to sustain the changes they have made, to be able to identify high-risk situations (when they may be likely to overeat) and to develop practical coping strategies. This may include learning how to shop for groceries or new finding new cooking methods. This knowledge is fundamental when eating out or cooking on a budget and are vital for long-term weight-loss maintenance.

Here are some quick tips:

• Eat vegetables to help you feel full.
• Drink plenty of water.
• Get tempting foods out of your home.
• Stay busy — you don’t want to eat just because you’re bored.
• Eat only from a plate, while seated at a table. No grazing in front of the ‘fridge.
• Don’t skip meals.
• Keep a food journal

Remember, motivation is what gets you started, habit keeps you going!

References

1. Fryar CD, Carroll M, Ogden C. (2014). Prevalence of overweight and obesity among children and adolescents:

   United

    States, 1963-1965 through 2011-2012. Atlanta, GA: National Center for Health Statistics.

2. Fothergill E, Guo J, Howard L, Kerns J, Knuth N, Brychta R, Chen K, Skarulis M, Walter M, Walter P, Hall K. (2016). Persistent metabolic adaptation 6 years after "The Biggest Loser" competition. Obesity (Silver Spring).24(8):1612-9

3. Swainson M., Batterham A., Tsakirides C., Rutherford, Z., Hind, K. (2017) Prediction of whole-body fat percentage and visceral adipose tissue mass from five anthropometric variables. PLOS ONE (12) 5.

4. Ogden C., Carroll M., Kit B., Flegal K. (2014) Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA (8):806–14.

5. Mayuree R, Ashkan A, Gitanjali S, Dariush M. (2013). Do Healthier Foods and Diet Patterns Cost More Than Less Healthy Options? A Systematic Review and Meta-Analysis.BMJ Open

6. Rolls B., Roe L., Kral T. (2004) Increasing the portion size of a packaged snack increases energy intake in men and women. Appetite (42): 1, 63-69.

7. Office of the Surgeon General (US). (2010) The Surgeon General's Vision for a Healthy and Fit Nation. Rockville (MD): Office of the Surgeon General (US).