The Thick of It

WORDS Dr. Kendall Wagner, Chaffee Crossing Clinic
IMAGE Sharomka /Shutterstock

Mar 1, 2023 | Featured, Health


Signs of spring are everywhere and for many of us this time of year brings a welcome opportunity to venture outside. It’s also an opportunity to begin our outdoor exercise regimens that may have been hampered by the bitter cold. These regimens are important as they are a key factor in preventing obesity and improving our overall health and wellbeing.


Obesity is the single most important factor driving chronic disease in the United States and is also a growing global problem. Just how detrimental is obesity on the body? It is estimated obesity is likely to result in a five-to-ten-year reduction in life expectancy! Current data estimates that one third of adults in the U.S., and twenty percent of children and adolescents are classified as obese. Obesity is defined as a Body Mass Index (BMI) score greater than thirty. In pediatric patients, obesity is seen when a child’s weight is at or above the ninety-fifty percentile for his or her age. You can easily calculate your BMI online at nhlbi.nih/gov.

Unfortunately, obesity is directly related to the onset of high blood pressure, elevated cholesterol, diabetes, asthma, sleep apnea, and musculoskeletal abnormalities. Interestingly, even many types of cancer seem to be more prevalent or progressive in obese patients.

More alarming, many of these conditions begin to appear even in patients who are classified as overweight, meaning a BMI score greater than twenty-five and not quite in the obese category. Even a modest amount of weight reduction results in a lower risk of cardiovascular disease, reduction of high blood pressure, and improvement of sleep apnea.

While even a five percent reduction in weight results in significant health benefits, more importantly, progress, even though small, early in the weight loss journey may stimulate further interest and determination to continue losing weight. This is key as we examine the underlying reasons for obesity. As fat cells increase, chronic low-grade inflammation in the body also increases. This low-grade inflammation is an important driver of insulin resistance, the key factor of Type 2 Diabetes. That same inflammation may damage blood vessel linings, allowing clot-forming cholesterol to invade the wall of the blood vessel leading to increased risk of heart attack and stroke. Because fatty tissue has been shown to secrete both hormones and certain signal molecules; colorectal, pancreatic, uterine, and breast cancer have all been shown to be increased in obese patients.

Given the risks resulting from obesity and the magnitude of benefits achieved by even a modest amount of weight loss, there is a great focus on weight management in individuals experiencing both obesity and overweight conditions. By far, the most important aspect to weight loss and weight management is lifestyle modifications. These changes may then need to be supplemented with pharmaceutical or surgical options in discussion with your physician.

The first step in lifestyle modification and your weight loss journey is setting a goal. This goal should be attainable and actionable. Usually the goal should be five to ten percent of your current body weight achieved over a three-month period. Caloric reduction is absolutely necessary in achieving meaningful weight loss. A strict avoidance of fast food is recommended as it is calorically dense and nutritionally poor. A shift from prepackaged and preprepared foods to fresh vegetables, fruits, and meats prepared at the time of the meal is also helpful. Scheduling mealtimes and avoiding between-meal snacking or eating before bedtime will help reduce hidden calories in the diet. Working with your physician or nutritionist may help identify the most appropriate diet for your unique condition as there are many options such as the Mediterranean diet, whole foods diet, ketogenic diet, paleo diet, etc.

Increased physical activity is the second most important factor in weight reduction. The addition of moderate physical activity such as brisk walking for thirty to forty-five minutes at least four times per week can improve insulin resistance and increase weight loss. If able, large muscle group exercise, with resistance training such as free weights, elastic bands, machine weights, or body weight exercises for thirty minutes, three times per week is also beneficial.

In individuals with higher levels of obesity or difficulty initiating weight loss, a physician may recommend a pharmaceutical approach. Weight loss medications have historically focused on appetite suppression or increased caloric elimination. These medications are limited due to adverse side effects which cause patients to lack compliance. Recently, a new class of diabetic medications have been employed to achieve weight loss and have been used in diabetic patients to achieve glucose control. They have shown to induce weight loss in patients with and without Type 2 Diabetes. These medications decrease appetite, and thus food intake, by stimulating the hypothalamus, a structure within the brain that controls hunger and satiety. These medications have not been associated with the complication of low glucose but have been notably associated with nausea and sometimes vomiting that may limit patient use. Length of treatment needed for sustained weight control remains unknown and their high cost limits use by many patients. There are some long-term risks associated with these medications that, while rare, should be discussed with your physician prior to initiating treatment.

In addition to medication use, some individuals may decide at the recommendation of their physician to pursue surgical weight loss options. These options may include gastric banding, gastric sleeves, and gastric bypass procedures. While the surgical approach of each option differs, the result is the inability to consume the previous amount of food which results in fewer calories, which leads to weight loss. While the surgical approach can provide a long-term solution to weight management, it may also be associated with the need to follow a restricted diet, to supplement essential vitamins whose absorption is limited by the surgical procedure and may require time off work or away from other responsibilities during recovery. A careful discussion with your physician should precede any surgery to be sure your body is healthy enough for the procedure and how to best approach your unique health needs.

It is always the right time to start taking steps to improve your health! Small changes in reducing your fast food and junk food intake as well as increasing your activity will go a long way in improving your health. Spring into action today!

Kendall Wagner, M.D. is a regular healthcare contributor to Do South Magazine.
Chaffee Crossing Clinic
11300 Roberts Boulevard, Fort Smith, Arkansas

Do South Magazine

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