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Overweight and Obesity

 

It seems that as a population we are obsessed with dieting. As many as one in three Americans are on a diet in one form or another yet overall energy consumption has increased, while physical activity has decreased.

The number of overweight or obese Americans has steadily escalated in recent years. It is estimated that 67% of adult males, 52% of adult females and 20-25% of children and adolescents are overweight or obese. This equates to about a 25% increase in overweight or obese adults in just 10 years. The increase in overweight and obesity is an epidemic problem that is currently being addressed at a national level. Along with dietary and exercise strategies, improving the design of towns and transport systems have also been suggested in an attempt to encourage more physical activity. Naturopathic healthcare professionals can play a role in the management of

 

Are you overweight or obese?

Overweight and obesity can be measured by a combination of methods:

  • Height in relation to weight via a height weight chart
  • Waist Hip Ratio (WHR) which compares the circumference measurements of hip and waist to determine excess abdominal fat
  • Body Mass Index (BMI) is a statistical measure of the weight of a person scaled according to height.
  • Waist circumference

A combination of BMI and waist circumference is generally used to define individuals who are overweight or obese.

  • Overweight correlates with a BMI of greater than 25 and a waist circumference of greater than 31 inches in women and 37 inches in men.
  • Obesity correlates with a BMI of greater than 30 and a waist circumference of greater than 35 inches in women and 40 inches in men.

 

Risk Factors Associated with Adult Overweight and Obesity

Excessive body weight, even a moderate 22 pound weight gain since early adulthood, is associated with increased mortality, coronary heart disease and stroke. Diseases associated with metabolic changes due to obesity include:

  • Type 2 diabetes
  • Insulin resistance
  • Hypertension
  • Gall bladder disease
  • Dyslipidaemia
  • Non alcoholic fatty liver disease

Health issues associated with excess weight in obesity include:

  • Sleep apnoea
  • Breathlessness
  • Asthma
  • Social isolation and related depression
  • Daytime sleepiness and fatigue

A moderate weight loss of 5-10% of starting weight can result in significant health benefits and reduce the risk of some of the above listed diseases.

 

Risk Factors for Overweight or Obese Children

Overweight children are more likely to become overweight adults and experience the health problems related to obesity. Genetic inheritance, low energy output, infant formula feeding, eating patterns, ethnicity, medications and socioeconomic status are some of the factors that can lead to obesity in children.

Some health issues faced by obese children and adolescents include:

  • Cardiovascular problems
  • Type 2 diabetes
  • Heat intolerance
  • Breathlessness
  • Sleep apnoea
  • Tiredness
  • Musculoskeletal discomfort

Again these health issues can be addressed through weight management strategies. Changes to family lifestyle choices to include more physical activity as well as parental modelling and support of the obese child are very important factors in successful weight management for the child.

 

Popular Weight Loss Diets

Some popular diets such as those involving modified fat, low carbohydrate, increased protein or low glycemic index (GI) foods show promise as treatment strategies for overweight or obese individuals but no long term evidence has been obtained at this stage.
Most popular diets can be categorized into three main groups:

  • High protein - e.g. The Zone, Atkins,
  • Low fat, high carbohydrate - e.g. Pritikin
  • Other - e.g. fad diets, low GI diet

The Zone Diet contains carbohydrate (40%), protein (30%) and fat (30%) as a fixed percentage of food intake at each meal. This contrasts with the typical American diet, which provides more carbohydrate, considerably less protein and about the same amount of fat. The Zone Diet is an energy-restricted diet and it is recommended that a meal or snack is eaten at least every five hours that fits the above percentage profile. Achieving the exact ratios every meal may be difficult in practice. As with any energy restricted diet, The Zone Diet can aid weight loss, but often when the diet is stopped previous food habits resume and weight may increase. There is no evidence at present to suggest that The Zone Diet has any benefit over other versions of calorie controlled eating.

The Atkins Diet is high in protein and fat, and low in carbohydrate foods. It is low in fiber due to the limitation on carbohydrates and may also be lacking in some vitamins, minerals and antioxidants, especially in the initial phases of the diet. The initial stage (minimum of two weeks) of the program recommends no more than 20g of carbohydrate per day. It seems that the maintenance amount of carbohydrate for a regular exerciser is upwards of 90g for daily functioning. Given the restrictions on carbohydrate intake, artificial sweeteners are promoted to replace natural sugars for sugarless sweet treats. Although reasonably effective for short term weight loss, long term effectiveness for weight loss is not well established.

The Pritikin Diet containing approximately 80% carbohydrate intake has been shown to prevent and possibly reverse atherosclerosis when combined with stress reduction and exercise. It is high in fiber, low in fat and aerobic exercise is promoted as an integral component. It is recommended that fat intake be less than 10% of total energy intake and this may also minimise the intake of essential fatty acids.

A recent study suggested that a low carbohydrate diet (The Atkins Diet) versus a low fat diet was more favorable in terms of weight loss but has more adverse effects such as headaches, halitosis and constipation. Weight loss in both diet forms resulted predominately from reduced energy intake. However another study found similar weight loss outcomes between a low carbohydrate diet versus a calorie controlled low fat diet.

A Low GI Diet is based on eating specific types of carbohydrate foods in a moderate to high percentage of the total dietary intake. It advocates lower fat, especially saturated fats, and average amounts of protein. The glycemic index (GI) is derived from physiological measurements and indicates carbohydrate quality. Carbohydrates that when digested, create a fast blood glucose response are referred to as high GI foods and those that create a slower blood glucose response are the low GI foods. Low GI foods are more favourable as part of a weight loss program. Eating mainly low GI foods can benefit diabetics and may also address obesity and heart disease through improving blood cholesterol and triglycerides.

Fad diets generally lack scientific evidence, have rigid menus and often overlook the need to exercise. They often consist of 'one food' type diets such as grapefruit or banana which encourage eating one food type while excluding other nutritional choices. These diets tend to be nutritionally unbalanced and can lead to poor eating habits.

Although some useful strategies can be taken from eating plans that focus on food choices to suit blood type or that suggest a 'cleansed' liver results in weight control, there is little scientific evidence to support their theories. It seems that overweight and obesity is more complex than being due to 'liver insufficiency' or consumption of foods that are not compatible with an individuals blood type.

Commercial Diets that involve strategies for education and support with prepackaged meals or rules for eating regular foods are generally nutritionally balanced and energy restricted. Although they may help with short term weight loss there is lack of data to support their effectiveness for long term weight management. Commercial diets that allow regular food and not prepackaged meals are preferred as a patient can make their own healthful food choices within the rules of that diet long after the program has finished.

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