Experts Recommend Weight Loss For Health
After losing and regaining tons of fat, overweight Americans and their doctors are still battling obesity, which affects roughly 25% of the U.S. population.
While some weary dieters are abandoning their calorie counting and scales, medical experts caution that some patients need weight-loss regimens to remain healthy
Groups like the 3,500-member National Association to Advance Fat Acceptance of Sacramento. Calif., worry Theodore Van Itallie, M.D. professor emeritus,., at St Luke S Roosevelt Hospital Center in New York City. Its members, who range from 170 to 500 pounds, have been dieting unsuccessfully for decades and have “stopped putting their lives on hold,” said Sally Smith, the group’s executive director.
“People who say that they should eat what they want to eat are ignoring the fact that it puts their’ health, at risk,” said Dr. Van Itallie.
But physicians must learn to assess whether a patient needs to lose weight for health reasons. ‘The questions to ask are:
Does the patient have medical problems for which weight loss is indicated, is the fat in the abdomen or on the hips and thighs, and is the patient’s weight acceptable for his or her height and age?” said C. Wayne Callaway, M.D., of Washington, D.C., and a member of the Dietary Guidelines Advisory Committee of the U.S. Department of Agriculture and the U.S. Department of Health and Human Services.
Physicians should look for a family history of obesity related diseases-diabetes, gallbladder disease, hypertension, hypercholesterolemia and heart disease, he added.
People with pot bellies face a greater risk of illness than do people with fat on their hips and thighs because abdominal fat releases fatty acids into the portal vein and, ultimately, into the liver, where it interferes with insulin metabolism, according to Dr. Callaway.
To assess whether a patient is carrying too much abdominal fat, physicians can estimate the waist-to-hip ratio (WHR) by dividing the circumference of the waist (defined as a point midway between the lower rib margin and the iliac crest) by the circumference of the hip (the widest point over the buttocks). The WHR should be less than .95 for men and .80 for women.
Ironically, “men with beer bellies” have the highest WHR ratios but go on diets less frequently than pear-shaped women, who face fewer health risks, said Dr. Callaway.
The greatest predictors of successful weight loss are the patient’s willingness to keep records and a commitment to exercise, according to Dr. Callaway. A patient’s determination to change his or her life-style, and not just drop a few pounds, is another good way to predict diet outcome, said Dr. Van Itallie, who has been treating obese patients since 1952.
“The physician has to assess whether the patient has an understanding of the problem and the intellectual ability to change life-style and manner of eating,” he said. A number of previous weight-loss attempts is a strong indicator that a new diet will fail. Another important consideration is the stress level of the patient’s job.
Physicians should suggest, not coordinate, weight-loss programs for their patients, according to the Washington, D.C., physician.
There is no substitute for a registered dietitian and a professional knowledgeable in behavioral modification, said Dr. Callaway.
“The doctor should not get involved in dietetics,” he said.
“All people in private practice should have one or two or more dietitians with whom they can work.”
Responsible and ultimately successful weight loss involves long-term changes in eating habits, according to Dr. Callaway.
“The program must be tailored to the individual,” he said.
“The patient’s irregular eating habits and any psychiatric disorders must be taken into consideration. All patients should not be given the same 1, 200-calorie diet,” he added.
Referring a patient to a commercial program is “the easy way out,” according to Dr. Callaway. “Physicians working at – cal-center-based weight-loss programs are not trained in the field.” he said.
It is estimated that most people who lose weight gain back pounds and more.
Nevertheless, 48 minion Americans were on a diet in 1991, and 101 million were “eating light,” using fat-free foods and gar-free sodas, according to the Calorie Control Council, a low calorie-foods trade association in Atlanta, Ga.
Adherence to an exercise program is crucial to the success of a eight loss program.
The minimum exercise regimen for maintaining fitness-20 minutes of aerobic activity three times a week-is not enough to help people lose weight, according to Dr. Van Itallie.
He recommends that patients walk more, for as much as two hours a day.
“Walking for an hour burns 240 calories,” he said. “Do that two times a day.”
Alvin J. Ciccone, M.D., a family physician in Norfolk, Va., just tells his patients to get moving, and estimates that “a mile of anything burns about 100 calories.”