Health District Compass Winter 2019 - Tackling Obesity

Tackling obesity for your health

By Julie Estlick

For many of us, the beginning of a new year brings enthusiasm for a fresh start. If you’ve struggled with weight issues and you’re ready to make a change in 2019, forget fad diets and extreme workouts, local experts say.

Doing an honest assessment of your eating patterns and establishing healthy eating and exercise habits that are sustainable for you will provide better results. When it comes to achieving a healthy weight, the stakes are often higher than just fitting into a new pair of jeans. A person who is overweight is at an increased risk for heart disease, stroke, type 2 diabetes, some cancers, and poorer mental health.

Obesity is clinically defined by measures that estimate your storage of fat based on body weight, body build, and height. The body mass index (BMI) is one measure used to define when a person is overweight or obese. (See chart below)

The World Health Organization and the international medical and scientific communities now recognize obesity as a chronic, progressive disease resulting from many diverse factors. It’s no longer considered a cosmetic issue, but a health hazard.

Currently, Colorado has the lowest prevalence of adult obesity in the nation at 22.6 percent, compared to a high of 38 percent in West Virginia. However, the proportion of obese residents in Larimer County and statewide has continued to increase since 2001, based on self-reported data from the Behavioral Risk Factor Surveillance System, an ongoing survey conducted by the Centers for Disease Control and Prevention and state health departments.

Complexities of obesity

In tackling obesity, seek help from a specialist who understands the complexities of the disease, such as a registered dietitian nutritionist (RDN) or a physician who specializes in obesity medicine.

“There is rarely one issue that is behind obesity—a lack of time, your work and home environment, and social influences are all factors that can make a healthy eating journey very stressful,” says Shelby Cox, interim director of Kendall Reagan Nutrition Center at Colorado State University. Cox is an RDN who is also a certified specialist in obesity and weight management and counsels many overweight and obese patients.

A successful weight-loss strategy is about a lot more than simply reducing calorie intake. It starts with understanding what motivates a person’s eating habits and food choices.

For instance, many people say they turn to food as therapy to cope when dealing with mental health issues like anxiety or depression. Stress can drive us to seek comfort foods that are salty, sugary, and high in fat, like potato chips, chocolate, and macaroni and cheese. Often referred to as “emotional eating,” consuming these calorie-dense foods can make a person temporarily feel emotionally uplifted and less depressed, but it is not effective for addressing the underlying issue and leads to additional challenges with weight management, Cox notes.

She suggests clients who are concerned about emotional eating talk to a mental health professional in addition to working with a nutritionist or obesity doctor. In fact, Cox emphasizes that taking the stress out of eating is key, because “adding increased stress hormones to an already complex condition makes weight loss increasingly difficult.”

One way to begin a weight-loss journey is to come up with realistic changes a person can make and gain momentum at the beginning, such as including more vegetables at dinner, or not skipping meals. Another is to plan and prepare more homemade meals to displace the less healthy restaurant meals.

No suffering required

A big problem with many weight-loss diets is that they are too restrictive. Then, when a person stops following the plan, the weight returns. Research has shown that cycling up and down with weight can be detrimental to one’s health.

So, forget the “suffering to get skinny” routine because regular physical exercise combined with a healthy diet is a much better way to maintain a healthy weight, and also prevents the development of chronic diseases and other health conditions.

“A combination of cardio and strength training is recommended, because each plays a different but important role in weight loss,” Cox says. “You want to find fitness that feels good, not like a punishment, but a celebration of what your body can do.”

Check with your doctor for medical clearance and then find a certified exercise professional, which is someone who has a combination of education and training, to provide exercise guidance as part of your weight-loss team.

Surgical options

For people with obesity complications who are unable to reduce their risk with lifestyle changes alone, guidelines recommend prescription weight-loss medications or even surgery be added to their overall health plan. Large weight gain leads to physical changes in the nerve pathways that make it hard to go back, experts say, meaning that eating less can’t change the body’s physiology. That’s where medication comes in.

Most FDA-approved weight loss drugs work to decrease the appetite and increase feelings of fullness after eating. Essentially, the medications mimic more food coming in and stimulate more nerves, which give more of a signal to your brain that you’re full. There is also a medication that inhibits the absorption of fats by blocking the enzymes that break down fat.   

The American Association of Clinical Endocrinologists and American College of Endocrinology’s guidelines state that for a person with a BMI of greater than 27 and even one mild-to-moderate obesity complication, weight-loss medications should be considered along with lifestyle changes. Examples of complications include type 2 diabetes, high blood pressure, nonalcoholic fatty liver disease, or obstructive sleep apnea. If you are living with a severe obesity complication and have a BMI over 27, weight-loss medication is recommended together with lifestyle therapy. And bariatric surgery should be considered in patients with a BMI of greater than 35 and at least one severe complication, according to the guidelines. 

It is important to seek out a physician who is board certified in obesity medicine who can help you choose the appropriate drug based on your medical history. Only a professional can help you manage the risks and benefits of different drugs.

However, if you have tried different weight loss medications and ruled out other possible reasons for lack of weight loss, including lifestyle habits, barriers to proper exercise and nutrition, and any prescriptions that cause weight gain, surgery might be an option for you.

Fort Collins surgeon Dr. Robert Quaid works with a lot of obese patients as medical director for the UCHealth Bariatric Center of the Rockies, a shared program between Northern Colorado Surgical Associates and UCHealth Poudre Valley Hospital. He has seen bariatric surgery help patients reach their goals for weight loss and improved health.

“Bariatric surgery, such as gastric bypass and gastric sleeve, reduces the size of the stomach, limiting the amount of food that the body can take in at one time,” Quaid explains. “The metabolic changes that cause the body to regulate itself to a lower weight level are an even more important effect of surgery. Fortunately, these two changes work together so that our patients do not feel hungry despite not being able to eat very much.”

Most insurance companies require patients to complete a medically supervised diet for a specific length of time prior to surgery, he notes. They must have a one-on-one dietary consult with a registered dietitian to learn what their diet will look like after surgery and attend classes where healthy lifestyle information is shared.

Shrinking the stomach is just one step on the weight-loss journey, which also demands a lifetime commitment to good diet, nutrition, and regular exercise to maintain the benefits. “Weight-loss surgery is a tool utilized to reach a healthy weight and reduce chronic illnesses or conditions,” Quaid says. “In order to sustain their weight loss, patients need to continue to incorporate healthy lifestyle changes and habits.”

Finally, while weight loss goals are important, they need to be realistic and attainable, says Cox. “Achieving 5 to 10 percent weight loss in six months may not seem like a lot, but it can lower your blood pressure, lower your risk for diabetes, and make you healthier.”

Ready, Set, Lose... the Weight

Colorado State University’s Kendall Reagan Nutrition Center:
nutritioncenter.chhs.colostate.edu/

UCHealth Bariatric Center of the Rockies:
uchealth.org/locations/uchealth-bariatric-center-of-the-rockies/

Programs that increase access to healthy eating and active living:
livewellcolorado.org

Comprehensive state obesity information:
colorado.gov/pacific/cdphe/obesity-resources

Obesity Support:
obesityaction.org

Find local, trained exercise professionals and exercise facilities throughout the country at usreps.org