Tag Archives: overweight

I’m Overweight.

Dr. C

Or at least you would think so if you looked at my body mass index (BMI). I have written about the very imperfect science of the BMI scale before here on my blog, but I thought it deserved to be revisited. BMI is basically a height to weight ratio that comes up with a number designed to make it easy for clinicians to decide if a person is overweight or obese. Before the BMI scale was invented it was hard to assess someone’s weight and say that it was appropriate because height is also an important factor in weight. BMI combined those two.

Calculating BMI is relatively simple. You need your weight in pounds and your height in inches. Take your weight and multiply it by 703. Take your height and multiply it by itself (height squared). Now divide the first number by the second number and you have your BMI. To see my calculations or do your own click this link. My BMI falls in the “overweight category” with a score of 26.2. However, my body fat percentage is about 18%. This is well within the acceptable range for a 33-year-old man. (And I clearly do not look overweight!)

BMI misses many things when calculating whether someone is at the proper weight.

The problem for some people, like athletes, it does not take into account muscle mass. A person that is heavily muscled will always be overweight according to the BMI. As a matter of fact, I have been considered “overweight” since college despite always being is relatively good shape. If we look at professional level athletes, most of them would be considered obese!

I understand that not everyone is an elite athlete. What about the elderly? BMI is not ideal for them either. In the United States that equates to about 43 million people. Many times an elderly person will fit nicely into the BMI by being considered “ideal weight” for their height. This can be significantly misleading. Why? In the elderly muscle mass begins to drop. It happens to all of us. However, with this drop in muscle mass comes a drop in weight. As weight is lost a person is likely to fall into the “ideal weight” category even though they should be concerned about muscle mass loss. This loss in muscle mass causes a loss in strength and stability, increasing the risk of falls and increasing the risk of osteoporosis. Another problem with muscle loss is the change in your body composition. As muscle mass is lost one’s body fat percentage increases. Body fat percentage is a great indicator of health. The lower it is (within reason) the healthier you are, generally speaking.

BMI also fails to take into account many other health factors like diet, exercise, inflammatory markers, nutrient status, stress load, chemical exposure, social well-being, mood stability, and a whole host of other things we know have a large impact on our health. However, it is still widely used as a primary assessment of one’s health. As I said, it’s an imperfect science. In my opinion, it’s so imperfect it should be eliminated.

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The Obesity Gene

Is there really an obesity gene? I think the answer is yes and no.  First the yes.

There are likely genes that predispose someone to being overweight or obese.  It is not just one gene but perhaps 10 or 50, or maybe 1,000.  I don’t think we will ever be able to say for certain what specific genes are the “obesity genes.” Certainly it is more difficult with something like this because metabolism is so complex.

The answer to our question might also be no.  While our genes are responsible for many things, the environment plays a huge role.  Diet and exercise are potent modifiers of our genes.  Someone who is genetically predisposed to being overweight may not be overweight with proper diet and exercise.  And if that’s true then, in a sense, being overweight is not genetic.

For more information watch the video below.

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Do Weight Loss Supplements Work?

Losing weight is a goal many people have.  Most would like it to happen quickly and with little effort.  For that reason, many turn to over-the-counter weight loss supplements that have very little evidence behind them.

I’m a big supporter of the supplement industry, but weight loss supplementation is one area that reputable nutrition companies stay away from.  This is for a very good reason – weight loss supplements don’t work.

See my video below talking about three popular weight loss supplements.

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Body Mass Index – Don’t pay any attention to it

The Body Mass Index, or BMI,  is used to ascertain whether someone is overweight, obese or at the correct weight for their height.  It’s used by health professionals across this country as a guide for their patient’s health.  It’s wrong.

The reason for this blog is a conversation I had with a good friend of mine.  He also happens to own a gym and is a very talented and knowledgeable trainer/fitness coach.  We were discussing it in relation to his clients and my patients and how people are often times misled by the numbers they see when they use the BMI scale.

BMI was designed to be used as an easy tool for clinicians to assess their patients in terms of body weight relative to height. Before the BMI scale was invented it was hard to assess someone’s weight and say that it was appropriate because height is also an important factor in weight.  BMI combined those two.

How to calculate BMI:

The formula is simple.  You need your weight in pounds and your height in inches.  Take your weight and multiply it by 703.  Take your height and multiply it by itself (height squared).  Now divide the first number by the second number and you have your BMI.  Here is an example.  We’ll use my numbers.  I am 201 pounds and 71 inches tall.

201 lbs x 703 = 141,303
71 in. x 71 in. = 5,041
141,303/5,041 = 28.03

So my BMI is just over 28.  This puts me in the overweight category, actually moving close to obesity.  Wait…what?

If you look below you can see the classification system used for BMI.

You will see that anything above 30 is considered obese.  Technically anything above 29.9 is obese.  If we use this scale, I am only 13-14 pounds short of being considered obese.  People who know me will tell you that I do not look obese.  They will also tell you that I do not even look overweight.  So what’s the catch?

That is the problem with using BMI to assess health.  It doesn’t take into account many factors.

The problem for some people, like athletes, it does not take into account muscle mass.  A person that is heavily muscled will always be overweight according to the BMI.  As a matter of fact, I have been considered “overweight” since college despite always being is relatively good shape.  If we look at professional level athletes, most of them would be considered obese!

I understand that not everyone is an elite athlete.  What about the elderly?  BMI is not ideal for them either.  Many times an elderly person will fit nicely into the BMI by being considered “ideal weight” for their height.  This can be significantly misleading.  Why?  In the elderly muscle mass begins to drop.  It happens to all of us.  However, with this drop in muscle mass comes a drop in weight.  As weight is lost a person is likely to fall into the “ideal weight” category even though they should be concerned about muscle mass loss.  This loss in muscle mass causes a loss in strength and stability increasing the risk of falls and increasing the risk of osteoporosis.  Another problem with muscle loss is the change in your body composition.  As muscle mass is lost one’s body fat percentage increases.  Body fat percentage is a great indicator of health.  The lower it is (within reason) the healthier you are, generally speaking.

So does it work for anyone?  Yes, there are some people that it works for.  If a person is sedentary and eats a poor diet it may accurately depict your current weight status (ideal, overweight or obese).  There are, however, better ways to assess health.

Then how do I know if my weight is appropriate?

The best way to assess your weight status is to perform body composition.  This gives us a percentage number based on body fat.  For example, if you weigh 200 lbs and 50lbs of that is from fat, your body fat is 25%.  Below is the ideal body fat percentages for men and women.

The gold standard for measuring it is the caliper test or skin fold test.  A pinch of skin is precisely measured by calipers at several standardized points on the body to determine the subcutaneous fat layer thickness. These measurements are converted to an estimated body fat percentage by an equation.  It is most reliable when taken over time and it must be done by the same person to be accurate.  Techniques can vary from person to person and may change the results.

The other way to measure it by bioelectrical impedance.  You are hooked up to electrodes that are spaced far apart on your body; usually on each hand or on a hand and a foot.  An electrical signal is passed between the electrodes and the resistance to the current flow is measured.  This is a painless process.  Fat and muscle have different resistance rates so the machine can estimate the body fat percentage based on that.  It is affected by hydration levels so be sure to be hydrated when you take a test like this.  This is a very accurate method and does not depend on a person’s technique as the skin fold test does.

The best way to get your body fat to the desired level is a healthy diet and exercise.  You want to increase muscle mass and decrease fat.  This is done by weight training and short duration, intense circuit type workouts.  All of this can easily be done at any local gym.

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Obesity Costs U.S. $168 Billion

Obesity 001

Image via Wikipedia

Two-thirds of Americans are overweight.  This means that two out of three people in this country have at least one significant health risk factor.  Not only does that shorten one’s lifespan, but it costs a lot of money too.

New research out of Cornell University and Lehigh University suggests that the total medical costs associated with obesity now tops $168 billion.  This accounts for 17% of total medical costs in the U.S. every year.  The new research also states that being obese adds about $2,800 to a person’s yearly medical expenditures.

Of 33 countries with advanced economies, the U.S. is the fattest.  Roughly 200 million Americans are overweight or obese and the epidemic is getting worse.

So not only is obesity dangerous for your health, it takes money out of your pocket! The question remains – what do we do about it?

Diet

My solutions are simple but they go against some of the traditional thoughts on diet in particular.

First, people must be taught how to eat correctly.  No more low fat, low cholesterol stuff.  I have many patients who are surprised when they begin my diet program to see it includes things like eggs, steak, cheese and whole fat yogurt.  They are used to physicians telling them to avoid fat or you’ll get fat.  Physiologically it doesn’t make sense and it doesn’t play out that way when people eat a diet rich in healthy fats.

I always encourage people to eat a diet low in refined carbohydrates and high in healthy fats and proteins.  Some people are hesitant because they are afraid they’re cholesterol will go up or they will actually gain weight.  After I assure them this won’t happen and they try the diet, they are ecstatic with the results.  No only do people lose weight, but they’re blood work improves too!  They see improvements in cholesterol levels, inflammatory enzyme levels and in blood sugar regulation to name a few.

Learning how to eat correctly is hard for some people at first because of all the misinformation out there.  Here’s a good rule of thumb for you – if it’s packaged don’t eat it.  Now this rule doesn’t always apply.  Somethings that are packaged are ok.  For example, if you buy a package of roasted almonds you’re good to go.  But most things that are packaged are high in refined carbohydrates and unhealthy fats and should be avoided.

Another good rule of thumb is to shop around the edges of the grocery store.  That’s where you’ll find the meats, veggies, fruits and nuts and seeds.  You’ll also likely find the breads…skip that part.

Meals should always have a good source of protein (chicken, fish, beef, etc.) and should always have a fruit or a vegetable.  Here’s what I’ve had for my meals so far today plus a good example for dinner:

Breakfast:
3 eggs, a yogurt and about 20 grapes.
Lunch:
Chicken breast, about 20 olives and a recovery drink (I had just gotten back from the gym and that will take me to my next point!)
Dinner:
I haven’t had dinner yet today but I’ll give you last night’s meal as a good example
Turkey and sausage meatloaf stuffed with cheese and sun dried tomatoes with stir fried Brussels spouts and onions.

Food is critically important.  No amount of exercise or supplements is going to make up for a poor diet.

Exercise

Are you seeing a theme yet?  On my blog you will see the words diet and exercise over and over.  It is because they are the most important things you can do to stay healthy.

You must exercise at least 3 times per week for about an hour.  This is critical.  People often ask me why they must exercise “so much.”  In my opinion, 3 hours a week is not a lot but I do understand that people are busy.  You are not too busy for this.  You can’t afford to be too busy for this.  I have also had people say to me that their parents never exercised and lived to be into their 80’s and 90’s.  This may be true but we must take into account that their activity level was most likely higher than our current activity level.  Fifty or sixty years ago our forms of entertainment were much different.  We didn’t watch as much TV, or play video games, or sit on our mowers to mow the lawn.

Your current fitness level will determine your program.  I suggest that if you are not used to exercising or want to get the best results possible, consider getting a good trainer to coach you through a program.  It is the best way to stay consistent with an exercise program because it makes you accountable to someone else for your exercise.

Your program should be a blend of muscle building exercises and cardiovascular fitness.  Without both you miss out on the unique health benefits that each provides.

This is the only way we are going to solve the obesity epidemic in this country.  There are no quick fixes and there certainly isn’t a pill that’s going to magically make us all healthy.  This is something we must all take responsibility for.  If we do that we can make a difference.

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Fast Food Chains To Offer Statins With Their Meals?

Below is a blog post from cnn.com.  It simply amazes me that a peer reviewed journal would suggest that fast food companies offer statins with their meals to offset their horrible health effects.  See my comments at the end of the article.

CNN Blog Post

A new report in the American Journal of Cardiology suggests that fast food restaurants should offer statins – a popular class of cholesterol-lowering medications – alongside their unhealthy food.

“We propose that the fast food industry is well placed to offer advice and supplements to counteract the cardiovascular harm arising from the foods they purvey,” the report said. “These companies already have an infrastructure for providing a variety of condiments… A generic statin could be added to the panoply of items in the self-service tray at little additional cost.”

The study – which likened taking a statin before eating to putting on a bike helmet before biking – was based on analyses of other scientific studies, and concluded that taking the drugs could offset the risk of eating fast food just enough to render the food harmless.

“Most of the primary prevention statin regimes we examined, with the exception of pravastatin, had the strength to counteract the increase in risk caused by an unhealthy diet; or eating an additional 36 g[rams] of total fat or 2.8 g[rams] of trans fat per day – approximately equivalent to a Quarter Pounder with cheese and a small milkshake,” the British researchers said in the study.

But Dr. Ralph Sacco, president of the American Heart Association, says that not only isn’t the solution that simple, it could be dangerous.

“There are other things regarding obesity that are important that a statin won’t neutralize, such as diabetes and high blood pressure,” Sacco said. “Even though we agree statins have a lot of good evidence in reducing cardiovascular and stroke risk, there are certain risks with any medications.”

The risks are relatively infrequent but include liver damage, muscle cramps and long-term muscle damage.

The British researchers concluded that the risks of eating fast food are much greater.

“Statins have been shown to be safe even at high doses,” the report says. “The documented safety record of statins is substantially better than that of fast foods, which carry not only direct cardiovascular risks, but other risks due to obesity.”

But regardless of whether the benefits do in fact outweigh the risks,  Sacco says there are far better ways to reduce the negative effects of obesity.

“If you can control it with diet and exercise, that would be our preference rather than having to take a medicine.”

Dr. Court’s Comments

This is perhaps the most ridiculous recommendation I have ever seen from a mainstream medical publication.  They are suggesting that fast food chains offer cholesterol lower medications, called statins, with their meals to offset the negative health effects they have on human physiology. This is the pinnacle of not taking responsibility for one’s health.  Why take responsibility if you can take a pill to supposedly offset the detriments to your health from eating the most unhealthy foods in the world?

Statin medications are not as safe as Big Pharma would like you to believe. Statins are HMG-CoA reductase inhibitors, that is, they act by blocking the enzyme in your liver that is responsible for making cholesterol (HMG-CoA reductase). The fact that statin drugs cause side effects is well established—there are now 900 studies proving their adverse effects, which run the gamut from muscle problems to increased cancer risk.

For starters, reported side effects include:

  • Muscle problems, polyneuropathy (nerve damage in the hands and feet), and rhabdomyolysis (a serious degenerative muscle tissue condition)
  • Anemia
  • Acidosis
  • Sexual dysfunction
  • Immune depression
  • Pancreas or liver dysfunction, including a potential increase in liver enzymes
  • Cataracts

These side effects hardly seem harmless and to give them as an option with your value meal from McDonald’s is outrageous.  It is a great marketing ploy by the pharmaceutical industry to get as many American’s on statins as possible.  Think about it.  Wouldn’t this kind of strategy significantly increase sales of statin drugs?  Of course it would.  And where do we start and stop giving them to people.  Does a 3 year old eating a happy meal get a statin to go with it?  What about people who are already taking statins?  Do they just take extra because you really never can get to much medication can you?  The slope is a slippery one and I cannot believe this has even been suggested.

I was happy to see the president of the American Heart Association take the other side of this story.  He mentions that statins do nothing to offset the other health complications of fast food like diabetes and high blood pressure.  This is true.  You can’t take a statin to avoid diabetes.  What he doesn’t mention is the fact that those kinds of food – food high in refined sugar – are notorious for raising inflammation in the body.  When you raise inflammation you raise the risk of heart disease, stroke, cancer and osteoporosis to name just a few.  You can’t control inflammation by taking a statin.  Some new research does suggest that statins lower one of the inflammatory enzymes called CRP.  But that’s just one.  There are others that are still detrimental to one’s health.

This kind of a recommendation is dangerous.  Period.  It is also irresponsible for the American Journal of Cardiology to publish such information.  It plants a dangerous seed.  This kind of a recommendation encourages people to continue to make poor decisions regarding their diets.  It gives them an excuse to continue to destroy their health under the pretense that they are offsetting their bad decisions with a pill.  Instead, we should be encouraging people to make healthier choices regarding their diet and lifestyle.

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Eat to live, don’t live to eat

Eat to live, don't live to eat

The title of this blog is something that is so simple yet people have such trouble actually abiding by it.  I first heard this quote from a trainer that I work with.  I hear him say it from time to time to other clients when I’m in the gym.

Many people struggle to attain the health goals that they want to achieve.  Whether those goals are losing weight, lowering cholesterol levels or just getting into better overall health, the foundation for those goals is a healthy diet.

Diet is a four letter word.  I’m not sure if you’re aware of that.  When people hear the word diet, they cringe.  They immediately think  it means you have to eat very little, and the food that you’re allowed to eat must taste terrible.  I am here to tell you that does not have to be the case.

When I talk about diet I mean diet in its most basic meaning.  The first definition of diet listed in the dictionary is as follows:

Diet (n) – food and drink considered in terms of its qualities, composition, and its effects on health.

It’s not about breaking down what you’re eating a cutting a bunch of it out to lose weight.  It’s about the quality of the food that you are putting into you mouth and how it will affect your overall health.  It truly is about your habits with regard to food.

When patients come into my office diet is always something that we modify.  Patients come to see us for a wide range of conditions, but dietary change is almost always necessary.  There is the occasional patient that already has a perfect diet, but they are few and far between.

Patients are very motivated at first to change their eating habits because they are very motivated to feel better.  As they get into their programs motivation dwindles and people begin to miss their comfort foods.  It really is amazing how much people depend on food to make them happy.  It should not be that way.  Food can certainly be a source of joy.  There is nothing better than a good piece of steak or a tasty chicken breast sometimes.  However, if foods become your only enjoyment there is a problem.  Food should be nourishment, not your sole source of pleasure.

Patients, even when they are achieving the results they desire, complain about the dietary changes they’ve been forced to make.  Of course the alternative is to continue down the path they were on, eat as they wish and continue to feel bad.  Either way they feel trapped.  This is where the mind set needs to switch.  They need to finally realize that they need to eat to live, not live to eat.

If a person can understand that concept, accept it and then apply it, dietary changes are easy.  You are eating to be healthy and therefore happy.  Not the other way around.  Patients that have the hardest time changing often do not accept this concept.  They don’t want to give up ice cream, candy, cakes, etc. because they get enjoyment out of consuming them.  There are physiological reasons for this of course, but even when those are addressed the mindset does not change.  If one can decide to use food as a tool to get healthy rather than a tool to be happy changes occur much faster.

Remember this concept: food is fuel for our bodies.  We need it to function.  We need it to live.  We can certainly enjoy it, but it should not be a tool to make us happy.  We should view food simply as something that can nourish our bodies and make us healthy.  Viewing it this way makes it much easier to make good choices.  Inevitably people who choose “comfort foods” make bad choices.  When was the last time you heard that someone over ate chicken breast? It doesn’t happen.  People over eat the bad stuff like donuts, chips or ice cream because they are eating for joy, not for nourishment.  Abiding by the eat to live, don’t live to eat mantra will serve you well because it will help you make the right diet choices for the right reasons.

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