Medical weight management can involve many factors to lifestyle counseling, nutritional support, prescription medication, and surgery.  Weight issues are a common complaint that many people have to deal with.  Sometimes it is difficult to lose weight on your own and you require more help than you can provide yourself with.

Many times it involves just knowing where to begin and what factors may be involved.  A thorough evaluation by your doctor to determine if there are aspects in your genetic make up or physiology that are making it difficult for you to lose weight.  Then having a nutritional counseling session to determine if specific nutrients are needed or even how to eat healthier may be helpful.  Then adding in an appropriate exercise routine to limit injuries and to enhance weight loss may be helpful.   

Medical Weight Management

There are two terms used when discussing weight management – overweight and obesity.  Both of these terms refer to overall body weight, but differ in where the extra weight may be coming from.  Overweight is having the extra weight from muscle, bone, fat and/or water.  Obesity is having the extra weight due to an excessive amount of body fat.  A way to measure this is through the body mass index (BMI), which is based off of height and weight to give general guidelines for healthy body mass.

The difference between overweight and obesity can be time when gradually a person starts to eat more calories than they use, genetics overtake metabolism, hormonal issues affecting metabolism change, and decreases in activity.  An individual who is overweight or obese is at an increased risk for developing chronic conditions such as: diabetes (type 2), heart disease, high blood pressure, stroke, gallstones, breathing problems, arthritis and some cancers.  Just losing even 5-10% of the weight can delay or prevent some of these diseases.

When managing weight many factors come into play.  Genetics can not be changed, but they can be managed and understanding the genetics involved can be helpful.  Things that are easier to change are lifestyle habits such as staying active and eating healthier.  Sometimes this is easier said than done and extra help may be needed such as weight loss medications or surgery.

Issues Leading to Being Overweight or to Obesity

For most people, being overweight or obese is simply caused by taking in more energy than they expend.  This is energy out of balance.  Basically the energy put in through food and drinks does not add up to the energy put out through exercise.  Daily we all expend a certain amount of energy to get through the day to keep us breathing, digesting, thinking, and getting us to point A to point B.  This is the minimum amount of energy that we require for our day.  When we take in more than this amount of energy the energy in does not equal the energy out.  This is generally not a problem, unless over time the energy in is frequent enough that it starts to be stored in the body as fat.

Many Americans are becoming more physically inactive at work and at play.  Many people are spending more hours in front of televisions and computers instead of going for a walk outside.  Many would rather drive the car around the block to the grocery store instead of taking the five or ten minutes to walk there.

Another issue facing many is that their environment does not always promote a healthy lifestyle.  Some neighborhoods do not have sidewalks or parks for children to play in.  Our work schedules many times involve many long hours of commuting or being sedentary.  Restaurants serve oversized food portions that could easily feed two or more people.  In some neighborhoods the access to healthy foods is limited by cost or geographic location.

If all the above lifestyle issues are reasonably changed and an individual still has a hard time losing the weight something else may be a predominant factor.  Genetics do play a role on weight and health.  The tendency to being overweight or obese can run in families.  Genetics can affect the amount of fat that is stored in fat (adipose) tissue and where on the body the fat is most likely to be stored.  The chances of children being overweight increases if one or both parents are overweight or obese due to both genetics and behaviors passed on from parent to child.

Genetics and environment also affect some health conditions that can lead to being overweight or obese.  The most common health problem that can lead to weight loss is hypothyroidism or a low functioning thyroid gland.  The lack of thyroid hormone in the body will cause its metabolism to slow down leading to fatigue and weight gain.  There are also, estrogen and androgen linked health concerns that can lead to weight gain such as polycystic ovarian syndrome (PCOS), adrenal dysfunction, menopause, and andropause.

There are other health related issues that are more related to situations or environment than genetics.  Stress is another health factor that can lead to weight gain.  High levels of a hormone called Cortisol can lead to abdominal weight gain and eventually fatigue also.  Stress can also lead to insomnia that several studies have linked to the development of weight gain.  There are hormones, like leptin, released during sleep, which help to control appetite and metabolism.  In cases of little to no sleep leptin is suppressed and another hormone called ghrelin is released stimulating hunger.

Emotional eating is a major cause leading to overeating and sometimes food addictions.  The pleasure centers in the brain release feel good hormones when we eat.  When this is over stimulated, a drive to eat more can occur especially under periods of stress or depression.  It is also important if this is present to identify the triggers responsible for the emotional eating and not just to treat the underlying factors.

There are also certain medications that can cause weight gain.  Corticosteroids like prednisone is one medication that can cause significant weight gain in people.  Many drugs used to treat depression or seizures can also cause weight gain in individuals.  These medications tend to slow down metabolism, increase the appetite and can cause water retention.

Health Risks Related to Being Overweight or Obese   

Cardiovascular (Heart) issues are the primary concern in overweight or obese individuals.  Weight gain is related to the formation of fatty plaques inside the walls of coronary arteries.  Coronary arteries are the blood vessels that supply nutrients and oxygen to the heart muscle.  The build up of plaques in these narrow vessels leads to a reduction of blood flow to the heart tissue, increasing the risk of heart attack, hypertension and congestive heart failure.  These fatty plaques can fracture forming a blood clot that if it travels to the brain can cause a lack of oxygen to nervous tissue known as a stroke.

Type II diabetes and metabolic syndrome are common health problems in overweight or obese individuals.  Diabetes is cells are no longer responding to the insulin that is being made to get blood glucose (sugar) into the cell or that the pancreas begins to drop the level of insulin it is making.  In both cases the blood glucose levels in the body start to rise leading to blindness, kidney disease, heart disease and stroke.

Metabolic syndrome or Syndrome X is a group of risk factors linked to individuals who are overweight or obese that increases the chance of developing one of the above conditions already mentioned.  This syndrome occurs when at least three of the following issues are present:

• A waist to hip ratio > 0.9 in women and > 1.0 in men or a BMI of > 27.3 kg/m2 in women and > 27.8 kg/m2 in men.  Having extra fat in the waist area is a greater risk factor for heart disease than having extra fat in other parts of the body, such as on the hips.
• Abnormal blood fat levels, including high triglycerides and low HDL (good) cholesterol.
• Higher than normal blood pressure of greater than 140/90 mmHg after sitting for five minutes.
• Higher than normal fasting blood sugar levels over 100 mg/dL.

Some other health concerns of individuals dealing with being overweight or obese include:

• Increased risk for certain types of cancers like colon, breast, endometrial and gallbladder cancers.
• Osteoarthritis from the extra strain on the joints of the knees, hips and lower back.
• Sleep apnea, which is a condition where a person stops breathing for short periods of time during sleep.
• Reproductive issues due to menstrual irregularities and infertility in women
• Gallstones can develop

Body Mass Index (BMI)   

This is a common general guideline used to determine if an individual is overweight or obese.  The BMI is an estimate of body fat.  The higher the BMI the higher the risk is to your health.  Normal weight is a BMI of 18.5 to 24.9.  Overweight is 25.0-29.9, obesity is 30.0-39.9 and extreme obesity is considered anything above 40.0.

Dietary Strategies

Successful weight loss strategies include setting realistic goals and making small lifestyle changes over time.  Drug therapies and weight loss surgeries may be added in certain situations where risks are so high that rapid weight loss needs to occur or in situations where an individual needs significantly more help.  

The first step is to set a realistic weight loss goal.  Most individuals get discouraged early on because they set unrealistic goals and place so much pressure on themselves that they fail.  The best way to lose weight is slowly.  A loss of one to two pounds a week is both do-able and safe.  This will also increase your chances of keeping the weight off later on by allowing lifestyle changes to become more ingrained into your every day life.  Expect to only loose 5-10% of your current body weight over six months with the added goal of keeping it off.  Your focus should be more on eating healthier and being more active.

Remember calories (energy) in needs to be less than calories (energy) out.  Generally to lose one to two pounds a week a decrease in 1,000 to 1,200 calories a day for women and 1,200 to 1,600 calories a day for men is necessary.  Very low calorie diets should be avoided unless recommended by your doctor with regular monitoring.  The goal here should be to eat healthier, not to starve yourself.  You should still enjoy your meals, but the key is to learn to choose foods that help you loose weight instead of gaining weight.

A healthy diet gives your body the nutrients that it needs every day, but not too many calories that promote weight gain.  A healthy diet may be limited due to funds and availability.  If this is the case then make decisions based on nutrition, not what is wanted in the moment.  Limit junk food and increase whole grain foods, vegetables, fruits, and protein sources.  Fresh fruits and vegetables are preferred, but when not available frozen or dried can be substituted.  This is what entails a healthy whole food diet that avoids processed foods that contain extra calories, preservatives, and added sugars.  A professional educated in nutrition may be helpful to help you put together a grocery list and meal plan if needed or even help point out resources on how to cook whole foods.

Another dietary consideration is incorporating healthy fats into the diet.  Fat is an essential nutrient that the body needs to maintain healthy skin, hair and nails.  Good fats can also decrease inflammation in the body.  The foods rich in omega 3 and 6 are considered healthy fatty foods such as fatty fish (wild salmon), olive oil, and nuts.  Fatty foods to avoid are those foods high in saturated and trans fatty acids such as fatty cuts of meat, poultry skin and lard.

The last thing to think about is portion size.  This is the amount of food that you choose to eat for a meal or snack.  Cutting back on over portioned sizes of meals is a good way to eat fewer calories and try to restore balance to the energy in to energy out.

So the bottom line is to try to eat a more whole food, less processed diet.  Try to get in seven or more colors of food in a day and brown and white do not count as colors.  Focus on lean protein sources at each meal to maintain blood sugar (glucose) throughout the day.  Drink plenty of water or flavored water with no added sugars if needed.  Then to really bump up your metabolism eat small meals more often.

Exercise Strategies

Staying active throughout the day helps with weight loss, strengthens the body, slows bone loss, increases energy, reduces stress, and promotes well-being.  For most individuals who are overweight or obese starting any exercise routine can be difficult in terms of injury avoidance and motivation.   It is important to start slowly and build up the intensity over time.  Starting with 5-10 minutes a day of walking more or taking the stairs builds up your endurance.  Choose activities that you enjoy and fit into your life easily.  Then over time, working up to an intelligent exercise routine.

It can be helpful to keep a record of not only what you eat, but the exercise you do to help keep you inspired.  You can also seek support from friends and family members in taking an exercise class, going to the gym or walking around the park.  Then reward yourself for meeting your goals with something other than food like a massage, a movie, or time.

Intelligent exercise routines are exercise routines that optimize weight loss both during the exercise and after by enhancing the release of hormones in the body, which are chemical messengers that determine metabolic action.  Hormonal signals determine the fuel our metabolism will use: sugar vs. fat.  An optimal state of hormonal balance can enhance the utilization of the body's fat stores.  

There are several studies that have shown that when exercise is done in a way to deplete sugar stores such as during high intensity exercise the resulting build up of lactic acid signals the release of testosterone and growth factor to enhance muscle physiology and start using fat stores to repair the body.  Low intensity activity in combination with stress and high blood sugar will not result in anything but a steady state to weight loss.  Once an individual is able to start a short duration high intensity work out in combination with a weight-training program that uses full body movements with little risk for injury it should be added on to enhance any weight loss program.

The body uses both fat and sugar at all times, but lifestyle choices can increase certain hormonal messengers that can determine the amount of each fuel available at any given time to be used.  Diet and exercise programs can then be designed to enhance the release of optimal levels of hormones to accelerate weight loss.

Medical Involvement – Hormone Evaluations

There are many hormonal issues that affect weight loss.  These are generally considered when an individual is having other symptoms not directly linked to the weight or if an individual is having a really difficult time loosing weight despite dietary and exercise changes.  These need to be evaluated and treated in order to be able to loose weight.

Thyroid and adrenal imbalances are the most common hormonal problems that result in weight gain.  Generally blood sugar problems such as Metabolic Syndrome or Diabetes are a result of years of weight gain.  Problems with estrogen and progesterone balance in a female’s body can also contribute to weight gain at certain phases of life such as menopause.  Loss of testosterone can lead to muscle wasting and retaining fat tissue.

Medical Involvement – Weight Loss Medications

Weight loss medications may be an option for some individuals dealing with significant weight issues.  These medications should be considered after making lifestyle changes as an additional part of the treatment program that includes diet, physical activity, and behavioral changes.  

There are several over-the-counter products that claim to help aid weight loss.  Some of them are helpful, while others may not be so helpful.  It is best to consult with your doctor about any weight loss supplement.  Some of the over-the-counter products can cause some serious side effects that may be detrimental to your health and weight loss goals.

Medical Involvement – Weight Loss Surgeries

Weight loss surgery may be an option for people with extreme obesity defined as a BMI of 40 or greater when other treatments have failed.  It’s also an option for people with a BMI of 35 or greater who have life-threatening conditions such as severe sleep apnea, cardiomyopathy (enlargement of the heart) or severe type II diabetes.

There are two common weight loss surgeries available.  There is the banded gastroplasty where a band or staples are used to create a small pouch at the top of the stomach limiting the amount of food and liquids the stomach can hold.  The other surgery is the Roux-en-Y gastric bypass where a small stomach pouch is created with a bypass around part of the small intestine where most of the calories you eat are absorbed.  This surgery limits food intake and reduces the calories your body absorbs.

Both of these surgeries can cause nausea, bloating, diarrhea, faintness, and malabsorption of nutrients.  Lifelong medical follow up is required following both surgeries to deal with the resulting problems that can arise.

Weight Loss Maintenance

Maintaining weight loss over time is the most challenging aspect of weight loss.   A weight loss is considered a success a loss of at least 10 percent of the initial weight and no increase in weight by more than 6 or 7 pounds in 2 years.   You also must keep a lower waist circumference—at least 2 inches lower than your waist circumference before you lost weight.

The key here is to maintain the lifestyle changes that were made to help with the weight loss.  These changes are a way to a new life and better health.