|
Health Options
Alan Titchenal |
Physicians urged to
join war on obesityToday's issue of the Archives of Internal Medicine includes an article titled "The Escalating Pandemic of Obesity and Sedentary Lifestyle" -- a call to action to physicians to become actively involved in reversing the growing epidemic of obesity in America.
The article provides detailed guidelines that many physicians may soon use to determine if their patients have a healthy body weight and to work with overweight patients.
Question: What criteria will physicians use?
Answer: A weight-to-height ratio called body mass index (BMI) is one criterion. Physicians following these guidelines will measure waist circumference. Heavier body weight in combination with a larger waistline will trigger weight-loss prescriptions rather than a casual comment to lose weight.
Q: What are the cutoff values for being classified as overweight?
A: Those with a BMI higher than 25 are considered overweight and in need of a "prescription" to increase physical activity and make changes in their diets. Those with a BMI over 30, or a BMI over 25 plus waist size over 40 inches (men) or 35 inches (women) will be given similar recommendations and referred to a nutritionist for assistance with weight loss.
Q: Are the new proposed guidelines for weight loss realistic, and will they work for everyone?
A: The new guidelines recommend losing between a half-pound and two pounds per week. This translates into decreasing food intake by about 500 calories per day or increasing exercise by 500 calories per day or adjusting both diet and exercise to equal a 500-calorie deficit per day.
The specific guidelines will depend on a person's level of obesity and whether he or she has related health problems. For those with a BMI around 30 who fail to lose 10 to 15 pounds in three to six months, the guidelines recommend a discussion of drug therapy to battle the fat demon. For patients with a BMI over 35, the doctor may discuss surgical approaches.
Q: What will a typical weight control "prescription" likely include?
A: Practical tips on how to increase physical activity and decrease caloric intake.
Q: Are there alternatives?
A: Last week, the "Health Options" column reported on how a strong genetic predisposition to obesity can make fitting into standard body weight guidelines like waging a war with your genes. Next week, "Health Options" will explore an alternative view of weight management called "Health at Every Size." Some health professionals believe this approach may be more appropriate for those with genetically based obesity.
See the Columnists section for some past articles.
Alan Titchenal, Ph.D., C.N.S. and Joannie Dobbs, Ph.D., C.N.S. are nutritionists in the Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, UH-Manoa. Dr. Dobbs also works with the University Health Services and prepares the nutritional analyses marked with an asterisk in this section.