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Monday, Aug. 10, 2020

OBESITY: THE WAY FORWARD

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Using the body mass index as a guideline for weight

Obesity has become one of the most important public health problems in the United States and many other resource-rich countries. As the prevalence of obesity has increased, so has the frequency of the comorbidities associated with obesity.

The body mass index (BMI) is the accepted standard measure of overweight and obesity. BMI provides a guideline for weight in relation to height. When calculating BMI using pounds and inches, the formula needs to be altered slightly. Multiply your weight in pounds by 703. Divide that by your height in inches, squared: BMI = (your weight in pounds x 703) ÷ (your height in inches x your height in inches). The recommended BMI adopted by the National Institutes of Health (NIH) and World Health Organization (WHO) for Caucasian, Hispanic and black individuals are:

BMI Categories:

Underweight = <18.5

Normal weight = 18.5–24.9

Overweight = 25–29.9

Obesity = BMI of 30 or greater

• Class I – 30.0 to 34.9

• Class II – 35.0 to 39.9

• Class III – 40 (also referred to as severe, extreme or massive obesity)

Shreveport has become the second-fattest city in United States, and that has huge public health implications for us locally as a community. Recent research points to several significant facts: Shreveport residents have the lowest likelihood in the country to consume fresh fruits and vegetables while second highest in the country to have high blood pressure and high cholesterol.

Obesity is associated with a significant increase in morbidity (including diabetes, high blood pressure, high cholesterol, heart disease, stroke, sleep apnea and cancer) and mortality. Weight loss is associated with a reduction in obesity-associated morbidity.

Because of known health risks associated with excess body weight, people with BMI >25 kg/m2 are candidates for weight-loss interventions. The goal of weight-loss therapy is to prevent, treat or reverse the complications of obesity and improve the quality of life. Health benefits have been reported with weight loss of as little as 5% of body weight.

The initial management of individuals who would benefit from weight loss is a comprehensive lifestyle intervention: a combination of diet, exercise and behavioral modification. All patients who would benefit from weight loss should receive counseling on diet, exercise and goals for weight loss. The behavioral modification component facilitates adherence to diet and exercise regimens, and includes regular selfmonitoring of food intake, physical activity and weight.

Many types of diets produce modest weight loss. Options include balanced low-calorie, low-fat/lowcalorie, moderate-fat/low-calorie, or low-carbohydrate diets, as well as the Mediterranean diet. Dietary adherence is an important predictor of weight loss, regardless of the type of diet chosen. Thus, we advise tailoring a diet that reduces energy intake below energy expenditure to individual patient preferences, rather than focusing on the macronutrient composition of the diet.

Although less potent than dietary restriction in promoting weight loss, increasing energy expenditure through physical activity is a strong predictor of weight loss maintenance. Physical activity should be performed for approximately 30 minutes or more, five to seven days a week, to prevent weight gain and improve cardiovascular health.

Behavior modification or behavior therapy is one cornerstone in the treatment for obesity. The goal of behavioral therapy is to help patients make long-term changes in their eating behavior by modifying and monitoring their food intake, modifying their physical activity, and controlling cues and stimuli in the environment that trigger eating.

For patients who are unable to achieve weight loss goals with a comprehensive lifestyle intervention alone, options include pharmacologic therapy, the use of medical devices or bariatric surgery.

Drug therapy is often a helpful component in the treatment regimen for people with obesity; it can be considered for those with a BMI >30 kg/m2, or a BMI of 27 to 29.9 kg/m2 with weight-related comorbidities, who have not met weight loss goals (loss of at least 5 percent of total body weight at three to six months) with a comprehensive lifestyle intervention. The decision to initiate drug therapy should be individualized and made after a careful evaluation of the risks and benefits of all treatment options.

Given the public health importance of obesity as a disease locally in our community along with its multi-pronged ill effects on the health, it is crucial to consult a qualified physician to help guide weight loss while keeping an eye on obesity-related complications.

Dr. Kapil Kohli is the assistant professor of medicine at LSU Health Shreveport.

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