Being too heavy can carry so many health risks. ThePassionatePharmacist takes a look at being overweight, with a wink of the eye to Madison Avenue.
by Joe Goldstein, R.Ph.
The U.S. National Heart, Lung and Blood Institute (NHLBI) informs us that a normal Body Mass Index (BMI) for adult men and women is between 18.5 and 24.9. The BMI is a ratio that is calculated using you weight and your height. If you have a BMI less than 18.5, you are underweight. A BMI between 25.0 and 29.9 is considered overweight. People with a BMI of 30 or more are classified as obese.
You can calculate your BMI using a little math. BMI equals your weight, in pounds, multiplied by 703, divided by your height, in inches, squared.
When I last weighed myself, I tipped the scale at 220 pounds. I stand 5 feet and 9 inches tall, meaning I shrunk one and three-fourths inches in the past few years.
For me, the formula looks like this:
220 x 703 /69 x 69, or 154,660 / 4761, or 32.48.
You may find the BMI Table at the end of this post easier to use. My BMI is 32.5 (actually 32.48). BMI is further classified as class I, II or III. Body Mass Index is not the only measure we look at when determining our health risks in relation to body size. BMI may not be an accurate measure for body-builders; for the elderly and frail; and not for children who are still growing. We also look at waist circumference. If your waist circumference (above your hips) is over 40 inches for men, or over 35 inches for women, your risk of diseases increases. These diseases include diabetes, heart attack, stroke, other cardiovascular disease (CVD), and hypertension (high blood pressure). Extra weight also puts strain on your muscles, bones and joints. It can interfere with your sleep. The chart below shows your risk relative to your BMI and waist circumference. By reducing your BMI and/or your waist size, you can reduce your disease risk. Simple? Yes. Easy? HaHaHa!
Classification of Overweight and Obesity by BMI, Waist Circumference, and Associated Disease Risks
|Disease Risk* Relative to Normal Weight and Waist Circumference|
|Men 102 cm (40 in) or less
Women 88 cm (35 in) or less
|Men > 102 cm (40 in)
Women > 88 cm (35 in)
|35.0–39.9||II||Very High||Very High|
|Extreme Obesity||40.0 +||III||Extremely High||Extremely High|
* Disease risk for type 2 diabetes, hypertension, and CVD.
+ Increased waist circumference also can be a marker for increased risk, even in persons of normal weight.
Losing weight is not easy. One would think it shouldn’t be too difficult. Reduce the amount of food you eat, and watch the types of food. And exercise. After all, weight loss should be a simple mathematical formula: calories in greater than calories out equals weight gain. Conversely, if you burn more calories than you take in, then you should lose weight. For some bizarre reason, this logic doesn’t always work!
Weight loss is a complex process, with many factors involved. First, why are overweight people carrying those extra pounds to begin with? I have been “husky” since I can remember. In the second grade I weighed 69 pounds, the heaviest child in my class. It’s likely that I was too heavy because my mother had no sense of proper nutrition. While she made sure our meals were balanced with protein, carbohydrates, and vegetables, there was no sense of portion control. There was no disciplined eating. Saturated fats abounded. Cakes, cookies, ice cream and candies were the desserts. Sugar-laden drinks were always on the table. Eating fruits was encouraged, but again without portion control. As a kid, I easily drank one to two quarts of whole milk every day, and had frequent second helpings of dinner, usually consisting of meat and potatoes.
Ethnic cooking, I believe, also contributed to my unhealthy diet. Foods were cooked and baked at home, rarely store-bought, and the ingredients always included fats or sugar or both. Those two ingredients are what make foods taste good. Even today, prepared foods usually contain sugar or fat to enhance their flavor.
When I married in 1976, I weighed just over 200 pounds. Keeping my weight relatively stable was a constant challenge. I was a smoker, and that helped with my weight control. When I stopped smoking in 1992, my weight shot up, eventually peaking at 262 pounds. I have no regrets that I stopped smoking, and have been smoke-free since then. I gained so much weight because I needed something to do with my mouth and my hands. Shortly after I stopped smoking, food began to taste better, as my taste buds came back to life. It took a long time for me to change my eating habits, and it’s a work in progress. A year ago my weight dipped below 200, but several months of inactivity, all my fault, have seen it creep back up.
I mentioned Madison Avenue, because we are all inundated by ads in print, on TV, on the Internet. Many of these ads that promote a weight loss program talk of the huge weight loss enjoyed by some of their clients, including celebrities. They claim to have lost up to 100 pounds by following these programs. What you may not see is the disclaimer, in fine print, that informs you that these results are not typical, and that your results may vary. The actress Goldie Hawn observed, in the movie Protocol (1984), that if someone sells you a diamond for ten cents, you’re probably getting something that’s not worth even a dime. That’s not to say every weight-loss program is worthless. You just need to be cautious, and know what you’re getting. Advertisements are designed to get your attention, and some imply that you will have huge successes. And you might, but dramatic results are not usual. Are you getting the services of a physician? A nutritionist? A dietician? A psychologist? A nurse? An exercise physiologist? Are you being sold a meal plan? What support are you getting? The buyer must beware! I’m not telling you to avoid these groups and companies. I’m telling you to be cautious and selective, and read the fine print.
Americans want everything as quickly as we can get it. We want instant gratification. We do not want to wait. We want our pounds to fall off. We want to be slimmer in just days. Well, it doesn’t work that way. Weight goes on much easier than it comes off. Crash diets, starvation, food and water deprivation are all too unhealthy, and can be dangerous. And “diet pills”, whether by prescription or over the counter, are never the right answer. A proper combination of healthy diet change, appropriate exercise, professional behavior modification, and lots of support are key in helping to take weight off and keep it off. And let’s not forget patience.
Proper nutrition is essential. The U.S. Department of Agriculture (USDA) has developed a nutrition “plate” to help people understand and satisfy their nutritional needs.
ChooseMyPlate.gov is a web site sponsored by the USDA to help steer people toward proper nutrition. The information is excellent, and filled with very useful information. But no matter how good or how thorough this, or any web site is, do not begin a weight loss program before consulting with your physician. This is necessary to make sure your body is ready for changes brought on by diet and exercise. Follow his or her advice.
Exercise does not have to be rigorous. Gentle exercises are sufficient, especially when starting out. It’s generally accepted that in order to realize a cardiovascular benefit, exercise, needs to be sustained for at least 20 minutes. Well, 20 minutes is a goal you can aspire to after you build your strength and endurance, and lose some more weight. And just a 5-10% weight loss will significantly improve your cardiovascular health. Progress is often made in baby steps. Do too much too soon, and you are sure to fail.
What if you can’t exercise in a traditional sense? What if you’re wheelchair bound? Any additional movement or use of your muscles will use up extra calories, and the effect is cumulative. That means however many calories you use continue to add up. If you’re limited in what you can do, try, with your doctor’s permission, sitting in a chair and lifting your legs. Or your arms. Lift a hardcover book. Do each for a few repetitions, then stop. Do it again tomorrow, but increase by one repetition. After a few weeks you’ll gain strength, and maybe lose some weight.
Ask your doctor about changing your eating habits, and about how you cope with stressful situations. Resist the temptation to take medication for stress or anxiety. Try breathing exercises. Try to visualize something pleasant (your “happy place). Get a puppy! Ask for the support of your family, friends, coworkers. That doesn’t mean they should harass you, or tease you, or shame you. Guilt is a powerful motivator, but I don’t recommend it.
Don’t worry if you don’t meet your goals, or if you slip up, or go off diet for a day or two. You’re only human, and you are allowed an occasional mistake. Having an ice cream cone is okay, as long as it is the exception and not the rule. Snack on carrots, or celery, two of my favorite snacks. Mix it up a little, and dip them in hummus, or plain Greek yogurt. Air-popped popcorn is a good snack, if your doctor clears it (no butter, oil or salt). And make sure you are drinking enough water. Not soda, or coffee, or tea. Just have 8-10 glasses of water every day (check with your doctor). The other beverages are fine, but they are not a substitute for out-of-the-bottle or from-the-tap clear water. It fills you, and helps rid the body of toxins wastes, including fats.
Measure your progress regularly, but don’t make any decisions based on what your scale tells you. Scales can vary, and so can your weight through the day (diurnal changes). A better indicator is the way your clothes fit.
More than two-thirds of American men and women age 20 and older are overweight or obese. We are also raising a generation of obese children. The causes include some of the nutritional factors and eating habits already discussed. Also included are inactivity, use of computers, phones and online games, and television use. Both adults and children may have diseases that lead to obesity. Genetics often play a role. And some medications can cause weight gain in some people. The first step in losing weight is to admit that a problem exists, and be determined to do what is necessary to try to correct it. The second step is to see your physician to rule out and underlying medical causes, and identify restrictions. With your doctor’s help, you can healthily and successfully shed the weight.
Body Mass Index Table
|Body Weight (pounds)|