This week, we’re going to talk about the importance of maintaining a healthy weight for your age and body frame.
As physicians, I think we are really motivated to get this information across. Why? One, because for too long, the societal messaging around weight loss has been cosmetic. It has been all about how we look and how we appear. And let’s face it, that message is no good for anybody. But secondly, it’s important to relay this message of health and well-being when it comes to a healthy weight because it is empowering. Because when we are armed with the knowledge of what we can do for our own bodies when we put ourselves in the driver’s seat, then we can make the change that results in greater health, well-being, and really what’s important, which is quality of life. And that’s exactly what the studies show. The studies show that when we can achieve a healthier weight, not even an optimal way, but a healthier weight, in fact, we do improve our quality of life.
In prior posts, we’ve talked about the BMI (body mass index), which is a screening tool to screen for excess weight. And we’ve talked about the limitations of BMI, and why it is an imperfect screening tool. So, that’s just to catch you up to speed. BMI is an equation that takes into account an individual’s weight and height and gives us a number, and that number will tell us the degree of excess weight in terms of the risk for developing comorbidities or disease.
Now, the BMI does have its limitations. It does not account for gender, it does not account for age, it does not account for ethnicity, and it does not account for body composition. These, indeed, are limitations to the body mass index, which we should take into account and what should be discussed with your physician. At the same time, we should not throw out the baby with the bathwater, because it is a good screening tool. In fact, studies have shown that having a BMI in the “obesity” category, which is the BMI of 30 or greater, in your midlife will determine your quality of life later on, meaning that people who have a BMI of 30 in the middle ages – 30s, 40s, 50s – they can expect a lesser quality of life than those who are even in the overweight category.
BUT get this – the studies also show that if individuals reduce their weight by even 5 to 10%, so we’re not talking perfection here, but if they can reduce their weight by five to 10% and get themselves even from the “diagnostic obesity” category, which is a BMI of 30 or greater, into the overweight category, which is in the 25 or greater range, that they have reduced their comorbidities and they improve their quality of life scores.
So the message here is, that it doesn’t have to be perfect. Healthy weight is a range, not a number, and we know that any degree of weight loss can help improve quality of life.
What are the conditions associated with a diagnosis of excess weight?
Obstructive Sleep Apnea
We know that excess weight affects literally every organ system from head to toe. We know that obesity puts individuals at risk for stroke and another condition called idiopathic intracranial hypertension. This is a condition that is also named pseudotumor cerebri. It’s associated with elevated pressure in the cranium (the brain space) and it can cause symptoms like vision or visual symptoms, headaches, and weight loss is actually the first line of therapy and can help bring down that pressure and improve or even eliminate that condition.
Many pulmonary diseases are associated with excess weight, most commonly obstructive sleep apnea. This is a condition in which the airway is closed off periodically during sleep, giving apneas or moments in time when an individual cannot breathe. This may be perceived by the individual with awakenings. So the apneas may be so severe that the person actually is disrupted in their sleep, woken up so that they can take a deep breath, but oftentimes, an individual can experience even hundreds of apneas throughout the night that aren’t even perceived by the individual. They do not result in complete awakenings, but just micro awakenings.
Obstructive sleep apnea can be diagnosed through a home sleep study. It’s actually quite easy now to make the diagnosis. And it’s important because sleep apnea is associated with heart disease. It’s associated with stroke, heart attacks, as well as a greater likelihood to go on and develop obesity.
We know that when sleep is disrupted, for whatever reason, that puts individuals at risk for excess weight because of changes to their hunger hormones. In fact, sleep disruption makes people more hungry because hunger hormones are tweaked in the direction to promote hunger.
The good news is that five to 10% weight loss can reduce the AHI or apnea-hypopnea index. These are the numbers of apnea or awakenings people have throughout the night. It can improve the quality of sleep, reduce snoring, and get husband and wife back in the same bed because the wife or husband is no longer disrupting the other with snores. So, weight loss can be a very powerful tool to improve sleep apnea.
We also know that excess weight can actually exacerbate asthma. Believe it or not, there’s a protein or a peptide that is released from adipocytes or fat cells that migrates to the airways of the lungs and the respiratory system, causing hyperreactivity, and causing the airway to be more reactive, which is the primary culprit in asthma and asthma attacks.
We know that excess weight is associated with comorbidities of the cardiovascular system. So we have a twin endemic of obesity and type 2 diabetes. There are currently millions of individuals in the United States who have diabetes, and millions more who have pre-diabetes, or who are at risk for going on to develop diabetes. Here’s the good news, once again, that weight loss – even modest weight loss – is associated with reduced risk.
In fact, there’s a very landmark medical study called The Diabetes Prevention Program in which they took individuals who had excess weight, they were in the category of overweight, so somewhere in the range of 15 to 30 pounds of excess weight and were pre-diabetic as determined by blood tests, they randomize these individuals into three groups – diet and lifestyle group, meaning they encourage them to walk 30 minutes a day, five days a week, and to lose five to 10% of their body weight. In the end, these individuals, on average, lost approximately seven to 12 pounds. The second intervention group was told to take metformin, which is a drug that we use to treat diabetes, and the third was the control group, which got no intervention. Believe it or not, the lifestyle group reduced the risk of going on to develop diabetes by 60%, as compared to the group who took metformin, an actual drug used to treat diabetes, who only reduced their risk by 30%.
It again shows us the power of modest change. The average weight loss was approximately 10 pounds, not 20, not 30, not 50. Reinforcing the fact that even small changes to your weight and to your lifestyle, these individuals were walking 150 minutes a week or 30 minutes five times a week, but it was so impactful in terms of reducing the risk.
Other conditions such as hyperlipidemia (high cholesterol), high blood pressure (hypertension), and stroke, as I mentioned before, are all associated with obesity.
So, what about gastrointestinal issues?
Well, we know that obesity affects the likelihood of depositing fat in the viscera, which is the area in the abdomen inside the belly that surrounds the organs and within the organs. We know that visceral fat, actually, is much more harmful to our health than subcutaneous fat. That is the fat that is just under the skin, in our hips, in our arms, for example, in our buttocks. The fat inside the belly can be or is more harmful.
One of the reasons for that is that fat can be deposited in the liver, causing something called fatty liver disease, which is essentially fat that accumulates in the liver. Fatty liver or steatosis can go on to become steatohepatitis, which is an inflammation in the liver associated with the deposition of fat. And if it goes on long enough, and this is on the order of decades, steatohepatitis can go on to become cirrhosis or fibrosis, which basically is scarring down of the tissue in the liver, causing the liver to malfunction, so much so that it can require liver transplantation.
Now, I know many of you have heard about the need for liver transplant in individuals who drink excessively or for people who have viral hepatitis, so they’ve contracted a virus that affects the liver, but in fact, one of the primary indications for liver transplantation these days is steatosis, steatohepatitis, as it results in fibrotic liver disease and cirrhosis.
Once again, the first-line treatment for fatty liver is weight loss. And when we have done studies on individuals who’ve had enlarged livers, for example, there’s a really intriguing study in which individuals who were being pre opt or prepped for bariatric surgery and had fatty liver were put on a two week very low-calorie diet and showed that they could shrink the volume of the liver or the size of the liver by 25%.
Again, really profound changes that we can induce with short-term dietary and lifestyle modification.
We also know that excess weight puts individuals at risk for gallbladder disease, for example, gallstones that may require the gallbladder to be removed. It also puts individuals at risk for GERD or esophageal reflux, as well as pancreatitis.
Gynecologic System Issues
Excess weight affects the gynecologic system (the reproductive system). We know that excess weight is associated with abnormal menses. It’s associated with a syndrome called polycystic ovarian syndrome. These days, we call it PCO or polycystic ovaries, which is a syndrome usually diagnosed in younger women. It may or may not require or have polycystic ovaries as part of the syndrome.
Individuals who have an ultrasound may find cysts in the ovaries, but that’s not essential for the diagnosis. It’s essentially a condition in which there’s a relative increase of testosterone to estrogen in the body. PCO, because of that increase in testosterone, is associated with a distribution of excess weight in their midsection. Men tend to accumulate their weight in their bellies, and so do women with this syndrome, because of the testosterone. It’s also associated with insulin resistance, and then clinical features of excess testosterone, which include thinning hair, acne. It can also be associated with infertility.
I actually get a lot of patients in my medical clinic for infertility. And studies show that even 10% of weight loss- Again, imagine someone who is 200 pounds. 10% of weight loss is equal to 10 pounds. Imagine somebody who is 180 pounds. 10% of weight loss is associated with nine pounds of weight loss. A lot, but not so much, right? Nine pounds to improve health. Nine pounds, in this case, to restore ovulation and even fertility. This is what I see in my patients in the office. We get them to change their diet, get moving, lose some weight, and in fact, ovulation is restored.
What about cancer?
Cancer is the threat that so many of us worry about. The most common cancers, even breast, colon, and prostate cancer, are associated with excess weight. A study just came out recently that showed that higher weight is associated with more aggressive prostate cancer. There have been previous studies that have also shown that excess weight is associated with more aggressive breast cancers. In addition to that, excess weight puts us at risk for uterine cervical cancer, and cancer of the kidney, and pancreas, among others.
Get this – reducing your weight can reduce your risk for cancer. In fact, another cohort of patients that I get in the office are people who have recovered and are in remission from breast and cervical cancer. We put them on dietary intervention, help them with their weight, and help preserve their reduced risk for cancer.
Again, I don’t want to overstate excess weight, right? As a physician that specializes in overweight and obesity, it is very important for me to not attribute every inch, every scratch, and every ailment to somebody’s weight but these facts are true. We can reduce risk when we take care of our weight. We can’t eliminate risk and certainly, the thinnest people are still at risk or still can go on to develop diseases. But we can Just like wearing a seatbelt reduces our risk of getting into a serious situation if we were in a collision, reducing our weight can reduce our risk, too.
Skin and Joint Problems
Let’s move on to talk about the skin. Phlebitis or venous stasis, when the blood flow is impaired, can be impacted by excess weight. In these conditions the blood actually pools in the lower extremities, meaning it has trouble circulating, and getting back into the heart, and when it hangs out in the legs, we can see changes in the skin (darkening) over time.
Excess weight can affect the joints, putting strain on the joints of the lower extremities, knees, hips, and back. It is also associated with gout, which is a condition in which there are crystal formations that get deposited into the joints to cause swelling, redness, and exquisite tenderness. People will report that this joint is so tender, that even the touch of a bedsheet can be agonizing. Gout is associated with excess weight, as well as excess protein in those circumstances where a flare occurs. But once again, reducing weight puts people at reduced risk.
To summarize all this, we know that weight is not a cosmetic concern. It really is a health concern, and it is a health concern that impacts really every organ system in our body.
The more important point is that we can affect change in our own bodies and that we need not be perfect in order to be effective, meaning that modest changes in your weight (5 to 10% or as little as 10 pounds) can start to improve comorbidities, the cardiometabolic risk factors for heart disease, the apnea-hypopnea index, and get you into more prolonged and higher quality of sleep, which then will improve your hunger hormone profile and further reduce your risk of excess weight.
So, where do we start?
Often, we get inspired to make a change, and we have these grandiose plans and ideas for ourselves, and I want to remind everyone that big change starts with small steps. Small steps, when done consistently, will result in a big impact. So, take a small bite. Think about one small way in which you can make a change in your lifestyle to start achieving this big result.
Do you drink caloric beverages like soda, alcohol, or juice? Start by eliminating that drink.
Maybe, you have gotten into the habit of having snacks while watching TV. Maybe that small change is deciding that you’re going to create a stop time for your food intake. Maybe you say to yourself 8pm, 7pm, whenever it is that I finished dinner, is my end time, and I am committed to not consuming anything else for the remainder of the night. Start there.
Maybe, that change is going to be dedicating yourself to better sleep. Perhaps, your sleep has become fragmented because of excess alcohol, excess caffeine, or because you’re prioritizing activities like TV, returning emails or scrolling your phone. Remember that sleep deprivation is associated with an increase in hunger hormones, and will result in weight gain. Perhaps, that small step that you’re taking is to reprioritize your seven to eight hours of sleep per night.
Maybe, it’s starting an activity or exercise routine – as little as 5 to 10 minutes. Meet yourself where you are. Don’t promise grandiosity. Start with five minutes, 10 minutes – whatever it takes to get yourself in the habit.
And finally, maybe it’s just committing to drinking more water. We know that our thirst and our hunger pathways get mixed up in the brain. So, you commit to drinking, first, when you feel hungry, to determine if you are truly hungry at that moment or not.
There are many small steps that one can take.
Until next time.