Women’s Health

Obesity

Two–thirds of American adults are overweight with one out of three considered obese. We are now witnessing a health care epidemic. Between 1976–1980 and 2003–2004, the prevalence of obesity among adults aged 20–74 years increased from 15.0% to 32.9%. The problem cannot be overstated. In my opinion we will soon witness the first decrease in life expectancy in the United States since 1900. If current trends are not reversed we can expect to see an increase in early deaths due to diabetes, hypertension, heart disease and strokes. Presently 300,000 deaths per year are linked to obesity.

Obesity is generally defined as having a body mass index (HMI) of 30 or greater. One is considered overweight with a BMI or 25-30.

Weight is largely determined by the balance we strike between the calories we take in from food and the energy we expend during our daily activities. If we take in more calories than we use the unused calories get stored as fat.

What are the risk factors?

Diet
The regular consumption of foods that are calorie-rich, frequently found in fast foods, fatty foods, soft drinks, candies, deserts are the general culprits. The average American skips breakfast and often eats the bulk of their calories late in the afternoon and evening. This provides a cycle of fasting and binging which is another problem with the average American’s lifestyle.

Inactivity and lack of exercise
Sedentary people are more likely to gain weight because they don’t burn calories through physical activities.

Psychological factors
A lot of women don’t realize that they eat when they’re not actually hungry. Many women overeat to cope with daily stresses or to deal with difficult emotions. Some women eat out of boredom.

Genetics
If one or both of your parents are obese, your chance of being overweight is greater. Your genes may affect your chances of becoming obese and even where fat is distributed. But a family history of obesity does not mean that you have no ability to control your weight.

Age
The older we get the less active we become. Muscle mass also declines with age (especially without exercise). Since muscle mass is related to calorie consumption, the loss of muscle mass also slows down our metabolism and increases our chances of gaining weight. Again, this doesn’t mean that we’re helpless. It does mean that in order to prevent weight gain we have to take a disciplined approach to exercise.

Cigarette smoking
Many women smoke in order to control their food cravings and maintain their weight. When you quit smoking you’re at greater risk for gain weight. Why? Nicotine, apart from suppressing your appetite, increases your metabolic rate. With smoking cessation (unfortunately) your appetite may increase along with your slowing metabolic rate. The net result is that when smokers stop, they burn fewer calories and often gain weight. However, cigarette smoking is still considered a greater threat to your health than the extra weight.

Pregnancy
During pregnancy a woman’s weight should and does increase. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.

Medications
Corticosteroids and tricyclic antidepressants, in particular, can lead to weight gain. So can some high blood pressure and antipsychotic medications. Depo-Provera has been associated with some weight gain. Birth control pills, on the other hand, are not associated with significant weight gain. While this may have been true of oral contraceptives in the 1960s and 70s this argument doesn’t pertain to today’s very low dose pills, contraceptive patches and rings.

Medical problems
Uncommonly, obesity can be traced to a medical cause, such as low thyroid function, excess production of hormones by the adrenal glands (Cushing’s syndrome) or other hormonal imbalances, such as polycystic ovary syndrome. A low metabolic rate is rarely a cause of obesity. A medical problem, such as arthritis, can also lead to decreased activity, which can result in weight gain.

Alcohol
Many women are surprised to learn that just one regular beer contains about 150 calories. Many people are unaware that the calories in 2 glasses of wine taken every day can add up to some serious weight gain over the course of time. Additionally, excessive drinking can stimulate your appetite and make you less likely to control portion sizes.

When should I seek medical advice?

BMI (Body Mass Index)
Unfortunately, few women actually seek medical advice regarding their weight and most have no idea what their BMI is. If you wish to make a quick calculation visit this link:

http://www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/english_bmi_calculator/bmi_calculator.htm

The BMI is not a perfect tool. It doesn’t make allowances for women with a high muscle mass—unfortunately unless you’re a weight lifter this probably doesn’t apply to you.

If you’re BMI is between 19 and 24 you’re considered in a healthy weight range for your height. At a BMI between 25 and 29 you’re considered overweight and with a BMI of 30 or greater you’re considered obese. If you’re in the latter two categories it’s a least worthwhile getting some advice.

Waist Circumference
Weight distribution varies from one person to the next. Some women carry most of their weight around their hips, thighs and lower body and are “pear shaped”. Others carry most of their weight in their upper body and waist and are “apple shaped”. When it comes to your overall health it’s better to be “pear shaped”. Women with a waist over 35 inches have an increased incidence of various serious diseases including hypertension, diabetes, heart disease and the metabolic syndrome. So if you’re apple shaped with a BMI over 25 you now

Weight-related medical condition
A BMI over 25 increases your risk for hypertension, hypercholesterolemia, diabetes and arthritis. These conditions often improve (and even disappear) with weight loss.

Life-style issues
If you smoke, drink excessively and have a sedentary lifestyle coupled with a great deal of personal stress take action sooner rather than later. This is not a problem that gets better by itself.

Think about this
There are no magic pills or quick fixes to accomplish weight loss. Obesity, whether mild, moderate or severe is a national epidemic. Changing your weight is one of the most challenging things you can do and requires a tremendous commitment to an ongoing lifestyle change. Your weight is an important factor that will affect your risk of heart disease, strokes, diabetes, arthritis, sleep apnea, gall bladder disease, “fatty liver”, gout and even cancers (breast, colon and uterine).

The good news is that even modest weight loss can fix a world of ills—lower your blood pressure, lower your cholesterol, improve your diabetes, sleep apnea and arthritis. It can even lower your risk for developing some cancers. For many people the loss of 10 lbs is the difference between taking blood pressure medications or statins for their hypercholesterolemia. The best weight loss happens, not with crash diets that are not sustainable, but with slow and steady lifestyle and dietary changes. Exercising is an invaluable part of a weight loss regime. Don’t even start by saying you don’t have the time. Make an appointment with yourself at least 4 times a week for an hour and exercise.

Getting started on a weight loss program

There are many ways to successfully lose weight and there are many ways to fail. The best way to get started, in most cases, is to get some help. Start with your health care provider to put this issue in its proper perspective. Some women who think they have a weight problem don’t. Still others are quite naïve about the degree of the problem they do have and how it’s affecting their overall quality (and quantity) of life. If you’ve tried losing weight on your own and have not succeeded call and schedule an appointment. We can get you pointed in the right direction. You might be interested in some of these websites:
http://exercise.about.com/cs/weightloss/a/weightsuccess.htm