The Doctor’s Prescription: The Health Importance And Clinical Significance Of An Ideal Weight Control

The presence of overweight or obesity in a patient is of medical concern because it increases the risk of several diseases such as cardiovascular diseases, hypertension, diabetes mellitus and high cholesterol. Too much body fat is toxic to the heart’s muscle cells. Obese people’s heart undergoes physical changes that could promote heart failure.

Effective treatment:

Dietary theory: There is no magic formula for weight loss. You must eat fewer calories than you burn. A safe diet should include all the recommended daily allowances for vitamins, minerals and proteins. The weight loss diet should be low in calories (energy) only, not in essential vitamins or minerals.

Facts about Calories: You need enough calories to maintain energy level, but do not take in more than you can burn off. This is called an energy balance.

1. If you take more calories than you burn, you gain weight.
2. If you take in fewer calories than you can burn, you lose weight
3. If you balance the two, you maintain your weight.

The number of calories you need depends primarily on age, gender and activity level. Slow and steady weight loss programs are ideal and so you will need a doctor counselor, dietitian and exercise physiologist. They will determine and set your weight goals. Adopting DASH Diet will be helpful.

1. Moderately contribute to weight loss
2. May decrease abnormal fat
3. Increases cardio respiratory fitness
4. May help with maintenance of weight loss

Aerobic exercise results in modest weight loss, reduces abdominal mass and increase cardio respiratory fitness.

Combines therapy (Diet and Exercise): This combination produces greater weight loss, greater reduction in abdominal mass and improves cardio respiratory fitness than diet alone or physical activity alone.

Behaviour Therapy: This provides additional benefit in assisting patient to lose weight. This is to reinforce changes in diet and physical activity. Specific behavioural strategies include the following:

1. Self monitoring of both eating habits and physical activity
2. Stress management
3. Stimulus control of learning to shop carefully for healthy foods
4. Problem solving- This refers to the self correction of problem areas related to eating and physical activity.
5. Contingency management- use of rewards for specific actions
6. Cognitive restructuring- modification to help change self-defeating thoughts and feelings that undermine weight loss efforts
7. Social support.

Family members, friends or colleague can assist an individual in maintaining motivation and providing positive reinforcement.

Pharmacotherapy: This involves use of drugs, but drugs should never be used without concomitant lifestyle modification. Most of the available weight- loss medication are “appetite suppressants” and can be obtained only by doctor’s prescriptions.

Two key measures are used to determine if someone is overweight or obese. These are: the body mass index (BMI) and waist circumference.

Body Mass Index: The BMI, which describes relative weight for height, is significantly correlated with total body fat content. It is not applicable to pregnant women. Calculation of BMI:

• Measure your weight in Kilogram (Kg) e.g 85 Kg. This is your “weight number”
• Measures your height in meters square. For example, your height is 180cm, to meters it will be 1.8m and its square would now be 1.8m X 1.8m = 3.24m². This is your “height number”.

BMI = Weight number/height number = 85/3.24 = 26.23 Kg/m²

So, from our previous example, the person is pre-obese with increased risk of morbidity. BMI gives an assessment of how much of your body is composed of fat. It is also used to assess overweight and obesity and to monitor changes in body weight. BMI is easy to calculate and you can easily monitor your weight control, provided you have a weight and height scales.

Waist Circumference: The presence of excess fat in the abdomen out of proportion to total body fat is an independent predictor of risk factors and morbidity. Waist circumference is positively correlated with abdominal fat content. The specific cut off points that indicate health risks are as tabulated below.

In conclusion, weight loss therapy is not appropriate for pregnant or lactating women, those with serious psychiatric illness and in patients who have a variety of serious illness in whom calories restriction will exacerbate the illness.