Waist Management: A Medical Perspective
As a bariatrician, (a physician who specializes in the medical treatment of the overweight and obese person), I am constantly amazed at the amount of mis-information disseminated to the public by nutritionists, personal trainers, the media and yes, health care professionals, too, in reference to effective treatment for weight loss and more importantly long term weight control.
Obesity... The Epidemic
We all agree that being overweight or obese is of epidemic proportions with 60% of adult Americans now considered to be overweight. We all agree that because of this “epidemic” the incidence of obesity related “co-morbid” diseases such as diabetes and hypertension are also increasing. Surely the fast food industry, processed food, refi ned sugar and less exercise now than twenty years ago has added insult to injury to this epidemic.
What most people don’t know and what the media never mentions is that six years ago the National Institutes of Health created new guidelines for what they considered to be a “healthy” weight. As a result of these guidelines which were based on a review of 29,000 scientific papers, thirty-five million Americans became overweight, overnight!! So, although the obesity epidemic is real, almost 1/3 of it occurred in one day.
Obesity... The Disease
Hopefully most now accept the fact that obesity is a disease. It is considered such by the American Medical Association, the American Society of Bariatric Physicians, the North American Association for the Study of Obesity, and since 2002 even the Internal Revenue Service! Obesity is indeed a metabolic, chronic, and progressive disease with a signifi cant genetic predisposition. In fact, it’s very much like its co-morbid cousins diabetes and hypertension with two notable differences. Unlike diabetes and hypertension, obesity cannot be hidden from those around you or the mirror in front of you; and it is 100% diagnosable, whereas only half the people with diabetes or hypertension even know they have those diseases. Surely, there are many overweight people who eat too much, but there are many skinny people who eat more than you and I combined and never gain an ounce.
Obesity... The Medical Treatment
The traditional paradigm for weight loss in this country ie: diet, exercise and behavioral modifi cation has proven time and again to be ineffective for the vast majority of people. Commercial weight loss programs have a 95% failure rate at 3-4 years. Although Weight Watchers may be a good source of nutritional information and support, the average weight loss for members is but six pounds at the end of two years! Has anyone noticed that the non-medical “gurus”, the Jenny Craigs, the Dr. Phils, the Oprahs, who claim to know the secrets for long term weight loss,would do well to lose a few pounds themselves and in some cases more?
To treat an overweight person by telling them to eat less and exercise more is like telling the person with hypertension to simply “relax”, or treating the diabetic by saying “eat less sugar”. A Medline search for clinical studies showing long term weight loss (>10%) based on diet and exercise alone are non-existent; whereas, with the addition of pharmacotherapy (prescription medication) numerous studies abound. Why?
Well, obesity, diabetes and hypertension as previously noted are chronic and progressive diseases. Chronic diseases (in almost all cases) require prescription medication as an integral part of their treatment protocols for control not cure. Medication that we use work to suppress appetite, control cravings, improve insulin sensitivity and lower one’s metabolic set point.
Most importantly the disease obesity needs to be taken seriously, treated seriously and treated with respect. In future articles I will discuss the “myths” of diet and exercise as they relate to long term weight loss and why dietary supplements work best to “slim your wallet” not your waist.
Dr. Skversky is the Medical Director of Weight No More and can be reached at 9951-699-0848 or 49-645-2930.