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January 1, 2011

A Healthy Body Weight
Nora Norback, MPH, RD, Ernest H. Rosenbaum, MD and Lisa Tremont, MPH, RD

Body Mass Index
Health Consequences Of Obesity
I'm Overweight What Should I Do
The Keys To Permanent Weight Loss

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Millions of people check their weight when they get up n the morning, discover they've gained a few pounds and start the day in a tailspin. They may take drastic measures for several months, but when willpower wears out, they fall to the other direction. The body and the ego suffer.

Approximately one quarter to a third of Americans are overweight. Millions of Americans are trying to lose weight at a given moment and using all types of weight loss strategies. Our culture promotes beauty, slenderness and a trim body. We spend millions on trying to achieve an ideal and millions more trying to hide what isn't. But what is ideal?

What Is Ideal? What Is Realistic? What Matters?
It is important to be realistic when determining your desirable body weight, and to recognize that the various methods used do not fully account for individual differences such as genetics, age, gender, and muscle mass. If you have been obese since childhood or adolescence, for example, you may find it difficult to reach or maintain your weight within a desirable range. In general, your adult weight should not be much more than it was at approximately age 25.

Body Mass Index
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Weight can also be evaluated using something called the Body Mass Index or BMI. Too high a BMI is associated with conditions such as heart disease, stroke, diabetes, and high blood pressure.

Body Mass Index And Disease Risk
BMI Weight Class Disease Risk
20-25 normal very low
25-30 overweight low
30-35 obese moderate
35-40 obese high
40 and over morbidly obese very high
Calculate your BMI and ask yourself, "does my weight present a risk to my health?"

Calculating your Body Mass Index (BMI)
Step 1: Convert your weight to kilograms: Body weight in pounds (without clothes) = (A) ÷ 2.2
Step 2: Convert your height to meters: Height in inches (without shoes) = (B) × 39.4
Step 3: Square your height (height in meters)2 = (C)
Step 4: Divide (A) by (C) BMI= (A) ÷ (C)
Step 5: Compare your BMI to the standards

Percent Body Fat
The best way to evaluate your disease risk as it relates to body weight is to determine your body composition. Your body is composed of fat and lean tissue (including water). There is a normal range for how much fat (percent body fat) a person should carry. Percent body fat is influenced in part by gender, genetics, but also by food intake and exercise.

Body fat percentage can be determined through hydrostatic (underwater) weighing, using calipers (devices that pinch and determine how much fat is under the skin) or by using a bioelectrical impedance device (another machine). If you know your percent body fat, compare it to the table below:

Disease Risk Percent Body Fat
Male Female
minimum 5-10% 12-16%
recommended 15-22% 18-32%
health risk (young) 22% 32%
health risk (older) 25% 35%

Health Consequences Of Obesity
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They are as sick that surfeit with too much as they that starve with nothing.
-- William Shakespeare (1S64-1616), Merchant of Venice, I.ii.

Do an extra 10 or 15 pounds of weight affect your health as much as an extra 30 or 50 extra pounds? No. A person less than 10% over ideal weight is at minimal risk. The greater, the excess weight, the greater the health risk.

- Overweight people have a higher risk of gallbladder disease, high blood pressure, adult-onset diabetes, heart disease and stroke, and some cancers, including cancers of the colon, prostate, breast and gallbladder.

- Obese men have a higher death rate from cancers of the colon, rectum and prostate.

- Obese women have a higher death rate from gallbladder, colon, breast, uterus and ovarian cancers.

- Obese men and women present a greater surgical risk and they do not heal as readily after surgery.

- Obesity is associated with sexual impotence: in men, there may be a reduced sperm formation and in women, infertility and amenorrhea (loss of menstruation) may occur.

- Overweight children have a greater chance of developing respiratory diseases, diabetes, orthopedic disorders, and becoming overweight adults.

- Other problems associated with being overweight include psychological, social, sexual, financial, job discrimination, self-image, and mobility problems.

- A woman who is 40% above her idea body weight, however, is four times as likely to die of cancer of the uterus.

- Overweight persons (age 20-40) are likely to have hypertension.

- The diabetes rate is three times higher among overweight persons.

I'm Overweight What Should I Do?
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First and foremost, don't underestimate the challenge! If finding and maintaining an appropriate weight were easy, Americans would have done it by now. You may want to enlist some before embarking on your journey. Here are some people who may be able to help:

l. Your doctor: Your doctor can determine your weight condition, evaluate special medical problems you may have, and then direct you towards an appropriate weight reduction plan. Sometime a radical approach (e.g. : supervised fasting, surgery) is appropriate, sometimes it is not. Your doctor can help you decide and refer you to resources such as a registered dietitian or a program. Plan to discuss your progress with your doctor frequently.

2. A Registered Dietitian: A Registered Dietitian is a qualified nutrition expert who can design an eating plan to meet your food likes and dislikes, activity level, and lifestyle, as well as your weight loss goals. To contact an RD in your area, call your local Dietetic Association.

3. A weight loss program: Commercial weight loss programs such as Weight Watchers are highly recommended because they provide adequate nutrition while helping you to establish permanent changes in your eating and exercise habits.

4. A support group: Support groups allow members to share their experience and feelings about weight loss in a supportive, informal environment, usually at no cost. Members recognize that they are not alone, and receive encouragement from others. Support groups also provide the opportunity to receive and share helpful weight loss strategies. To locate a support group in California, call the California Self-Help Center at l-800-222-LINK.

What Not To Do:
Crash and Burn -- crash diets don't work

Crash diets don't work for three reasons:

l) Most significantly, the body adapts to a reduced calorie intake by lowering metabolic rate and thus resists burning off fat. It thinks Hey, I'm not getting much food these days, I'll hold on tight to every morsel I get and not waste my time burning off fat. After a 10 pound weight loss, one often returns to old eating habits. The body responds by saying OK, there's more food now, but I don't trust it. Fat burning continues at the reduced rate and excess calories are stored as fat.

A series of crash diets does more harm than good. Often more weight is regained than was lost. The regain occurs more quickly with each crash and burn cycle. This cycling can be hard on the heart and other body systems, as well as on self-esteem.

2) The second reason why crash diets don't work is the human, psychological response to initial weight loss.

Early weight loss is water, not fat. Water loss can result in a false sense of victory, and the persistence necessary for fat loss does not develop.

3) Third, consuming less than 1,200 calories a day can result in muscle tissue loss, not just fat loss. Since muscle weighs more than fat, the dieter may falsely believe that he/she is losing fat when the numbers on the scale go down. It is important to maintain muscle mass because muscle helps to burn fat.

The Keys To Permanent Weight Loss
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To lose one pound of fat, your body has to burn 3500 calories more than it takes in. A safe and recommended amount of weight loss is 1-2 pounds per week. The three cornerstones to permanent weight loss are:
(1) Reduce your calorie intake (especially from fat)
(2) Increase your calorie expenditure (exercise more) and
(3) Make these behavior changes a permanent part of your lifestyle!

Achieving weight loss is not easy! If it were, people would not attempt weight loss over and over and over, Weight loss occurs when your body uses more calories than it takes in. One can consume fewer calories, burn more calories or better yet, do both. Eating less and exercising more is most effective, and you must make the changes a permanent part of your lifestyle.

The Keys Explained

1. Cut Back On Fat
Fats make you fat faster than carbohydrates (fruits, vegetables and grains) and proteins (beans, fish, poultry and meats). Thats because fat provides 9 calories per gram, whereas carbohydrates and proteins provide only 4 calories per gram. A large potato (carbohydrate) has roughly the same number of calories as a tablespoon of butter (fat). That means you don't have to go hungry or eat less food to lose weight.

Word to the Wise: While it is entirely possible to eat more and still lose weight when cutting back on fat, be careful not to overdo the low-fat carbohydrates. Calories are still calories and too many lead to weight gain.

2. Cut Calories
By cutting out 500 calories a day, You can lose about 5 pounds a month. While you could theoretically do this by consuming a 1,000 calories diet of potato chips, ice cream and donuts -- your physical and emotional well-being would suffer. Quality counts! The best way is to eat a variety of fruits, vegetables, grains and cereals, lean meats, fish and poultry, skim milk and low-fat dairy products.

Word to the Wise: Consuming fewer than 1,200 calories per day can result in nutrient deficiencies, and lead to muscle loss which slows down your metabolism making it harder to keep the weight off. Remember, slow is easier and better.

3. Scale Down Serving Sizes
By cutting your servings by 25 percent, you'll drop 10 pounds in about 10 weeks. This way, you don't have to forgo your favorite foods. you simply eat smaller portions of them. For example, by eating a 4-ounce serving of meat (about the size of a deck of cards), instead of a typical 8-ounce serving, you'll save about 250 calories and 12 grams of fat.

Word to the Wise: Many people do not realize what a normal serving size is. To get a better idea, use measuring utensils to measure out portions for a week. You may be surprised to find that the 3/4 cup serving of cereal listed on your cereal box doesn't fill the breakfast bowl.

4. Add Aerobics
Aerobic exercise -- such as running, cycling, aerobic dance, brisk walking and cross country skiing -- is one of the best ways to burn body fat. It also builds muscle, promotes cardiovascular fitness, and reduces stress. Begin with at least 20 minutes of activity, three times a week working toward the goal of 50 to 60 minutes three to five times a week,

Word to the Wise: Getting started is the easy part. To maintain your exercise program, start slow and easy, seek convenience, add variety and consider finding an exercise buddy.

5. Walk Off The Weight
If changing your eating habits isn't your style, nor aerobic classes, you can walk off the weight. Walking builds muscle, reduces body fat and helps reduce stress -- which leads to overeating. It's free (with the possible exception of a good pair of walking shoes), can be done just about anywhere (try the park or shopping mall), and at anytime. Further, you don't need to learn how to do it!

Word to the Wise:. Your appetite may increase initially. To keep the hunger pangs away, enjoy a low-fat snack such as fresh fruit, vanilla wafers or pretzels before or after your walk. And remember to drink lots of water -- you may just find that you've been mistaking hunger for thirst.

6. Lift Weights
Weight training builds muscle which can both trim you down and increase the rate at which you burn calories. It does this because weight training changes your body composition. You may find clothes fitting more loosely before you see a weight change on the scale. Theoretically, you can lift three days a week for 45 minutes per session to drop 10 pounds of fat in 10 months.

7. Mix And Match
This is the fun part! To increase your chances of permanent weight loss, mix and match any or all of the above approaches. Each one has its merits, but is stronger when combined with any of the others. For example, you can lose over 10 pounds in less than 5 months by eating just 150 fewer calories a day and adding a 40 minute walk three times a week. Cutting back on fat while maintaining a weight lifting program is an extremely effective combination of stripping away fat, as is cutting back on calories while adding aerobics.

Other helpful techniques include keeping a diary of what you eat, eating slowly and with a friend, avoiding fast-food restaurants, stocking your cupboards with only ,what you intend to eat on your new diet, and joiiing a support program like Weight Watchers, or TOPS (Take Off Pounds Sensibly). You might also benefit from individual counseling from a Registered Dietitian (RD) American Dietetic Association at 1-800-877-l600.

Word to the Wise: Be patient with yourself and have fun.

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Why do some people suffer obesity while others don't? Surely you know a slender person who eats and eats and eats. Perhaps, friends don't understand your weight problem, or think you eat too much even though you eat less than they. In frustration you may shake a fist at the sky and ask Why? Why? Why?

Alas, the answer is not simple, nor even completely understood. With confidence, experts can say that weight gain occurs when calories in are greater than calories out. But it gets confusing after that. Numerous factors influence the hunger, appetite and eating.

Contributors To Overeating & Weight Gain
- social pressure
- advertising
- hormone levels
- blood sugar level
- fat cell enzymes
- diet composition
- low activity level
- body composition
- genetics
- past history of extreme dieting
- stress

The main factors that can have an effect on you are probably a unique combination of the above and more. It's, important to approach weight loss with some understanding for those factors, Some can be changed, some can be managed and some must simply be accepted. You can find and achieve a healthy body weight. Be kind to yourself in the process, it will take patience and persistence. You will win!

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