Obesity is common in the United States, and many struggle to lose weight for a variety of reasons, including physical limitations.
More than 93 million Americans are affected by the disease of obesity. Obesity carries with it various other diseases, such as type 2 diabetes, hypertension, sleep apnea and more. Combined with obesity, these conditions may greatly impact an individual’s quality of health and life.
Treating obesity can often be difficult. If you’re affected by obesity, you know first-hand that addressing your weight and improving your health is not always an easy task to accomplish. The scope of weight-loss options are wide and can often be confusing and intimidating.
It is important to note that all methods for addressing obesity should be utilized as “tools” as part of a comprehensive approach to addressing your weight and improving your health. There is no single treatment. A combination of the appropriately selected tools and lifestyle modification are essential in a successful obesity treatment and weight management plan.
We all know that the ideal way to maintain a healthy body is through exercise and a sensible diet. But what if you can’t lose weight? Sometimes it is more than a matter of willpower.
What are some weight loss options:
Gastric bypass and other weight-loss surgeries are major, life-changing procedures. While weight-loss surgery can help reduce your risk of weight-related health problems — such as type 2 diabetes, high blood pressure and sleep apnea — it can also pose major risks and complications. You may need to meet certain medical guidelines to qualify for weight-loss surgery. You likely will have an extensive screening process to see if you qualify.
When is surgery an option:
In general, gastric bypass and other weight-loss surgery could be an option for you if:
· Efforts to lose weight with diet and exercise have been unsuccessful
· Your body mass index (BMI) is 40 or higher (extreme obesity)
· Your BMI is 35 to 39.9 (obesity) and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea.
In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems.
When you go to the doctor:
-make an appointment with a bariatric doctor for an evaluation
-find out if your insurance covers the procedure
-be ready to make a life-time commitment to bettering your health
Two-thirds of residents in South Texas are Hispanic and health problems are typically linked to lifestyle choices. More than 50% of South Texans do not get the recommended amounts of exercise, defined as 150 minutes of moderate physical activity per week, and 76% do not eat enough fruits and vegetables. These rates are similar to the rest of the state and nation.
Weight-loss is an important goal for overweight or obese persons, particularly those with type 2 diabetes. Moderate and sustained weight-loss (five percent to 10 percent of body weight) can improve insulin action, decrease fasting glucose concentrations and reduce the need for some diabetes medications. A program of diet, exercise and behavior modification can successfully treat obesity, but pharmacotherapy and/or surgery may be warranted.
Diet Weight-loss occurs when energy expenditure exceeds energy intake. Creating an energy deficit of 500-1,000 calories per day will result in a one to two pound weight-loss per week. Writing down the food, portion size and calorie amount has been found to increase awareness and will provide objective evidence of calorie intake.
For effective weight-loss, it is the calories that count, not the proportion of fat, carbohydrates or protein. However, when individuals are losing weight they should follow a diet similar to that recommended in the U.S. Dietary Guidelines for 2005: fat 20-35 percent of calories; carbohydrates 45-65 percent; protein 10-35 percent.
For the obese patient with diabetes or insulin resistance, limiting servings of complex carbohydrates may be beneficial. These foods include bread, rice, pasta, potatoes, cereal, peas and sweet potatoes. Complex carbohydrates tend to raise blood sugar more than other foods and will cause the body to produce more insulin. With insulin resistance, these increased amounts of insulin can promote weight gain.
Increasing the amount of fiber in ones diet may be beneficial for both diabetes and obesity. A high intake of dietary fiber, particularly of the soluble type, may improve glycemic control, decreases hyperinsulinemia and lower plasma lipid concentrations in patients with type 2 diabetes. Additionally, high fiber foods assist in weight-loss and long-term weight maintenance by: requiring more chewing and taking longer to eat, providing fewer calories per serving, creating a sense of abdominal fullness and enhancing fullness between meals.
Physical Activity Regular physical activity helps maintain weight-loss and prevent regain. It also improves insulin sensitivity and glycemic control, may decrease the risk of developing diabetes and reduces mortality in patients with diabetes.
A goal should be set for 30 to 45 minutes of moderate exercise five times per week. The exercise does not need to occur in a single session to be beneficial. Dividing the activity into multiple and short episodes produces similar benefits and can enhance compliance. Using a pedometer can help set objective exercise goals. Gradually increasing the number of steps per day, with a goal of 8,000 steps, is ideal. Any increase in activity over baseline will help in balancing the equation of less calories in and more calories out to promote weight-loss.
Medication There are several medications intended to treat diabetes, insulin resistance and obesity. A full review of these medications is beyond the scope of this article. However, metformin is one medication that has been found helpful in reducing the risk of type 2 diabetes in patients with insulin resistance. Metformin reduced the rate of progression to diabetes in obese persons with impaired glucose tolerance.
Men treated with metformin who had central obesity and other features of metabolic syndrome (insulin resistance, hypertension, hyperlipidemia) had slightly more weight-loss and slightly lower fasting blood glucoses that those given a placebo.
Bariatric Surgery According to the National Institute of Health (NIH), bariatric surgery should be considered by those who have a BMI greater than 40, or have a BMI of 35-39.9 and medical problems such as diabetes, heart disease or sleep apnea.
Bariatric surgery changes the normal digestive process. There are three types of surgery: restrictive, malabsorptive and combined restrictive/malabsorptiv.
Studies continue to show that diabetes can be cured in many patients using bariatric surgery. These clinical improvements occur not only because of the significant weight-loss, but because of hormonal changes that occur when foods bypass the stomach.
Patients and their doctors need to consider the risk of bariatric surgery compared to the risk of obesity and the associated medical problems. When other methods of weight-loss have failed, bariatric surgery may be the best chance for significant and sustained weight-loss.
Prevention Preventing and treating obesity will help in the prevention and treatment of diabetes. Promoting a healthy lifestyle in children and adolescents will put them on a path that will decrease their risk of diabetes and its complications. Helping adults at high risk for diabetes to change their diet and lifestyle may prevent them from developing diabetes and its consequences.
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