Frequently Asked Questions About Obesity

What You Need  To Know

You’ll find many “solutions” to weight loss online and in the world today. Each year they have the latest and greatest weight loss program. While some may work, more often than not we find ourselves feeling great in the short term, only to see the weight gain return in a matter of months or years. A big problem we find with extreme weight loss programs is that people are not losing the weight safely, causing harm to their bodies.

At IHM you’ll be introduced to a medical weight loss program that has been proven for over 30 years. With a medical approach to weight loss we’ll teach you how to set a goal weight, safely lose the initial unwanted fat and help you maintain lifelong weight loss.


WHAT IS OBESITY?

Obesity is a metabolic derangement in which individuals have too much body fat. It is usually defined as a body mass index (BMI) of greater than 30. The BMI is a function of weight divided by the square of height, which allows us to estimate the magnitude of obesity in anyone, regardless of height. Currently, class I obesity is a BMI of 30-35. Class II is BMI 35-40. Class III obesity is a BMI of greater than 40. The use of BMI to classify obesity has some pitfalls; the major one is that people with a large muscular frame often have a high BMI but are not obese.

WHAT IS IDEAL BODY WEIGHT?

The ideal body weight of a person is a somewhat theoretical weight originally determined from insurance actuarial tables as the weight at which mortality is the lowest. Shocking! We know that weight and mortality have "J -shaped" relationship with increased mortality below a BMI of 20 and increased above a BMI of 25. A graph of mortality on the y-axis and body weight on the x-axis has a J-shape, which is common for a number of biological parameters including blood pressure, for example. A BMI of 20-25 is considered ideal. That being said, if a person has obesity -related illnesses such as high blood pressure, diabetes, arthritis, or hyperlipidemia, that person's ideal body weight may be a BMI of 20 and not 24. (Note that BMI cutoffs for Asians are 2 points lower than for Caucasians. An Asian BMI above 28 is considered to be obesity.)

WHO IS OBESE?

Roughly 1/3 of Americans today are obese (BMI above 30). Roughly 1/3 of Americans today are overweight (BMI 25-30) and 1/3 are normal weight (BMI 20-25). A recent assessment found that West Virginia had the highest obesity rate at 37.7% of adults and Colorado had the lowest at 22.3%. The obesity rates for children ages 10-17 have increased dramatically in the last 20 years. A recent estimate found the highest rate was 37.7% of children in this age group in Tennessee were obese and the lowest was 19.2% in Utah (https://stateofobesity.org/state-policy/). The effect of this trend on the overall lifespan of Americans is so large that for the 1st time in US history current estimates predict that our children will have a shorter lifespan than we do as adults. For the past 10 years or so obesity-related diabetes (type II diabetes) is more common in children than autoimmune diabetes (type I diabetes). This is a shocking reversal of the situation in the 1970s and 1980s when type II diabetes mellitus was very uncommon in children.

WHAT IS VISCERAL FAT?

Visceral fat is fat within the body cavity, primarily within the abdomen into a lesser extent within the chest cavity. Visceral fat has more detrimental metabolic and cardiovascular effects than does subcutaneous fat. Subcutaneous fat is fat between the skin and the body cavity. In general, women have a higher percentage of subcutaneous fat than men and a higher percentage of fat below the waist. Visceral fat is not easily measured by routine clinical tools. One can crudely estimate visceral fat by waist circumference and by waist/hip circumference ratios. A waist circumference above 40 inches (102 cm) for men and 35 inches (88 cm) for women is an indication of excess visceral fat. Measurement of girth is taken either at the navel are at the midway point between the lowest rib and the iliac crest. Somewhat lower cutoffs apply for Asians.

WHAT CAUSES OBESITY?

There are a large number of genetic factors associated with obesity. We know from studies in twins and in families that body weight is highly heritable. We know that one's resting metabolic rate (that is the amount of energy used at complete rest) is also highly inheritable. However, contrary to what you might think, one's resting metabolic rate does not does not predict with certainty who will become obese. Obesity is a polygenic disorder. A number of single gene defects cause obesity, but these are rare. Obesity has been strongly linked to a sedentary lifestyle and over-consumption of sugary liquids and high carbohydrate diets. Other factors associated with obesity include alcohol excess, depression, stress, and sleep deprivation.

HOW DO WE PREVENT OBESITY?

Most states in America today have passed regulations to help prevent obesity. These include providing access to drinking water at schools, limiting access to sugary drinks, increased food labeling and awareness of calorie and carbohydrate content of foods we eat, and increased efforts to get daily exercise. A general recommendation exists that we should all try to get at least 30 minutes of aerobic (hungry for air) exercise daily. We should all try to achieve a well-balanced lifestyle with healthy plant-based diets, stress management, and good sleep hygiene. A rule of thumb is that half of what we eat should be non-starchy vegetables. We should limit our alcohol intake to the equivalent of 1-2 glasses of wine or beer per day.

HOW DO WE TREAT OBESITY?

Cultivation of a healthy lifestyle is the hallmark of treating obesity. There is no substitute for eating healthy foods and having a healthy level of exercise. There are a growing number of online and personal fitness tools to help us track our activity level and calorie intake. There are a number of organizations such as Weight Watchers that provide a structured, individual/group approach to "low-calorie" dieting. There are also a number of clinics that offer "very-low-calorie diets". Four FDA-approved medications for long-term obesity exist today. These include phentermine/topamirate (Qsymia), Lorcaserin (Belviq), bupropion/naltrexone (Contrave), and liraglutide (Saxenda). The 1st three are daily pills; liraglutide is a daily subcutaneous injection. Unfortunately, many people using FDA-approved drug treatments fail to achieve even 10% loss in body weight. Moreover, insurance coverage for obesity treatments is hit or miss and often leaves people with large co-pays. Bariatric surgery has emerged in the past 10-20 years as a viable option for many individuals with severe obesity related illnesses.

WHAT IS A VERY LOW-CALORIE DIET?

At the Institute of Health Management we offer a "very low-calorie diet" for treatment of obesity. A "very low-calorie diet" is generally 500-800 cal per day. A "low-calorie diet" is usually 1100 to 1600 cal per day. In general if someone restricts food intake by 400 cal per day for a sustained period of time meaningful weight loss will be achieved. Low-calorie diets can safely allow individuals to lose 1 to 3 pounds a month, which is 12 to 36 pounds a year. This is an excellent rate of weight loss and is probably the rate of weight loss that we all should strive for. That being said, many people are not successful with low-calorie diets and are unable to achieve sustained weight loss. For these individuals a very low-calorie diet may be ideal.

WHAT IS A PHYSICIAN-SUPERVISED PROTEIN-SPARING MODIFIED FAST?

A protein-sparing modified fast is a very low-calorie diet that is designed to achieve loss of visceral and subcutaneous fat while "sparing" the loss of lean body mass. Our lean body mass is primarily muscle and bone. Most individuals on protein-sparing modified fast who consume 500-800 cal per day will lose 3-5 pounds per week. In general weight loss in excess of 2 pounds per week for an extended period of time should be monitored by a physician. At IHM every participant is asked to see a physician or highly trained nurse practitioner on a weekly basis. Laboratory assessments such as potassium levels, kidney function, liver function, cholesterol profile, and blood counts are done every 2 weeks. An EKG is done every 2 months due to early reports (in the 1970s) that very low-calorie diets could be associated with cardiac arrhythmias. This is not been an issue with modern meal replacement supplements.

INSTITUTE OF HEALTH MANAGEMENT PHASE 1

Prior to beginning the protein-sparing modified fast all participants will undergo a complete history and physical examination with routine laboratory work and an EKG. These can be done either are at IHM or by the primary care physician. In this way a complete medical assessment of safety and medical issues for each participant in the program can be made. We have safely supervised the weight loss of patients with a variety of medical conditions including cardiac arrhythmias, emphysema, asthma, kidney disease, diabetes, hypertension, and osteoarthritis.  IHM will assume responsibility for scaling back on diabetes and blood pressure medications as weight loss is achieved.