Breaking the Obesity Cycle

by G. John Mullen, DPT 2011 | mullen@myhousecallmd.com

The United States is the most obese nation in the world. Awesome…well done, America. 30.6% of Americans are believed to be obese, 6% higher than the next country, ironically, our Americanized neighbor… Mexico (3)! It is estimated 50% of Hispanics born since 2000 will become diabetic. Mississippi currently holds the crown as the fattest state in the fattest union and has been for the past 5 years, with obesity estimated at 32.5%3. Mississippi also holds the award for fattest children at 44.4% of 10-17 year olds (3). Five states have a current adult obesity percentage over 30%3. To top it off, obesity rates have more than tripled in the past 30 years! These obesity rates are out of control and are a huge weight on the United States budget. On the other end of the spectrum, Colorado is the thinnest state in the union with an obesity rate of 18.9% and is the only state with an obesity rate under 20% (3).  The take home message: America has a weight problem.

Where is all this weight coming from?

The cause of obesity is relatively simple: weight gain occurs when caloric intake exceeds caloric expenditure. Despite the simplistic nature of obesity, weight maintenance and loss are thought of as difficult or impossible tasks. Roughly 25% of American adults report no leisure time activity and 60% report activity levels less than the value shown to reduce their risk of disease (5). No wonder we’re overweight! To add insult to injury, overweight individuals are more inclined to be inactive, with 33% of men and 41% of women reporting inactivity (5). At the same time, roughly 50% of women set a New Year’s resolution to lose weight2. We, as a society, acknowledge the problem and are committing to fixing it each January 1st but seem to fail over the course of the year.

What does it take to lose weight?

Federal guidelines suggest a minimum of 150 minutes a week of moderate-intensity exercise to obtain “substantial health benefits” (4). These health benefits are not associated with weight management, but rather with lowering rates of chronic disease. A recent publication in the Journal of American Medical Association followed 34,079 healthy US women from 1992-2007 studying their activity level and associated weight gains/losses. This study concluded that (amongst women consuming a “normal” diet) physical activity was associated with less weight gain (5 lbs) in women with a BMI lower than 25. The “activity level” was defined as 60 minutes of daily moderate-intensity activity for the duration of the study (4). However, only 45% of women in America are estimated to have a BMI of 25 or less. This study does a great job looking at activity level for weight management, but does not tell us about the volume of exercise necessary for weight loss.

Weight Loss vs. Weight Management

The Harvard study discussed above looked at women with an average age of 54.2 years with no medical complications (cardiovascular disease, cancer, etc.) (4). Women with a BMI of 25 were able to maintain their weight within 5 pounds of their weight at the beginning of the study if they exercised with moderate-intensity activity for 60 minutes a day throughout the study. Moderate-intensity exercise includes bicycling, callisthenics and fast walking (~3.0 MPH or 55-69% of maximal heart rate). However, these same protocols were not successful for weight management in females over a BMI of 25, which constitutes more than half of Americans! This research suggests that overweight or obese women need to change one of the two variables associated with weight management: decrease caloric consumption or increase caloric expenditure. The most important piece of a weight management program is consistency. As stated, many New Year’s resolutions include weight loss goals (fitness centers see an exponential membership increase during January), but the volume of people in the gym returns to normal within a month. The intent is correct but the execution falls short. There are many theories for this. We believe that lack of interest and enjoyment plays a huge role in the gym attrition rate between January and March. If someone does not like riding a stationary while bike watching CNN report another Earthquake in a third world country or another vandalism case by their neighborhood, then it is highly unlikely they will exercise consistently. If we don’t like it and we don’t have to do it, we don’t do it. It’s called human volition. The American view of exercise needs to shift dramatically from a chore to a hobby. The Harvard study used METS (metabolic equivalent) to assess activity level and determined a total of 14 MET hours per week or 3 MET hours a day was sufficient in weight management for women with a BMI of 25 or less. As stated, activities with a 3 MET or higher rating include biking, fast walking, etc. 3+ MET activities also includes various hobbies not typically viewed as exercise: canoeing/kayaking, dancing, ice/roller skating, hiking, gardening and racquetball to name a few (full list of activities with their MET ratings). If you perform these activities at a more rapid pace (really start cruising with that paddle!) these activities can reach the upper echelon of METS. The take home message: Make exercise fun. If you don’t, you’ll quit. If you do, you can potentially burn more calories than you would boring yourself to death on a stationary bike watching Larry King.


Weight loss is a tougher nut to crack and is often person-dependent. Common sense makes it sound as simple as increasing caloric expenditure, but exercising greater than one hour a day is unrealistic for many and leads to failed goals and the aforementioned NYE resolution abandonment. Often times, physical activity is not sufficient in weight loss due to the multivariable nature and complexity of the problem. Many of these issues are related to diet.

Diet is the number one contributor to weight loss. Here are a few simple tips for those trying to lose weight (be sure to stay tuned for more from our staff dietitian):

  • Do not limit yourself to strict caloric restriction diets. The math is complicated and the stress at each meal is unnerving. This approach is hard to consistently maintain leading to failed goals and disappointment. Strict diets can decrease metabolism making the body more likely to gain weight once the diet is discontinued. Instead, monitor diet and decrease consumption of high caloric foods. For example, you can eat four bananas or one McDonald’s double cheeseburger…they have the same number of calories. We guarantee that eating four bananas will be just as filling as a double cheeseburger and the four bananas cost less and have more vitamins than the McDonald’s double cheeseburger.

  • Monitor drink consumption. Energy drinks, frappuccinos, etc. contain high quantities of unfilling calories. Replace these high calorie, high cost options with….water! Simple and effective.

  • Prepare your own food and eat foods that require some work. When was the last time you ate an uncooked carrot? It takes a while to consume and requires a lot of chewing. Increasing the amount of chewing can trick the mind regarding the amount of food being consumed, decreasing hunger.

These three tips are easy to perform and are, most importantly, cost efficient. Some additional factors affecting your ability to lose weight include:

  • Sleep: Inadequate sleep impairs hormones (ghrelin and leptin) that regulate hunger and satisfaction following food consumption. One study found people who slept less than 8 hours a night had lower levels of leptin (controlling satisfication) and higher levels of ghrelin (controlling hunger) AND higher levels of body fat (1).

  • Stress: Cortisol is a hormone produced in response to stress. Cortisol release causes insulin release resulting in increased hunger. The take home message: Relax! You can use multiple stress reduction techniques including deep breathing, meditation, visual imagery, and exercise. Take your pick.

We all know that weight management is an issue in America as obesity rates continue to rise. An undeniably effective approach to weight loss is exercise. The goals is a calorie expenditure > calorie intake. Remember that exercise should be a hobby and not a chore! Find activities you enjoy and stick with them. Set realistic goals that target three areas: appearance, health and consistency. If exercise alone does not achieve your weight goals, diet, sleep and stress can also be manipulated to make your weight goals a reality.

Questions? E-mail John: mullen@myhousecallmd.com

References:

  1. Bouchez C. How Sleep Affects Your Weight. Webmd.com. 2007.

  2. Losing Weight Is One Of The Most Popular New Year’s Resolutions. Medical News Today. 2005.

  3. F as in Fat 2009 – Trust for America’s Health. Healthyamericans.org. 2009.

  4. Lee I, Djoussé L, Sesso H, Wang L, Buring J. Physical activity and weight gain prevention. JAMA. Mar 2010;303(12):1173-1179.

  5. Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Kaplan JP. The continuing epidemics of obesity and diabetes in the United States. JAMA JAM Aabbr. Journal of the American Medical Association 2001;256:1 195-1200.

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05 2010

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