Articles

Obesity, Weight Loss

Introduction

What should I know about Obesity?

Everyone knows what it means to be overweight. From early age on, children can tell the difference between "fat" and "thin" people. They also get the clear message that fat people are apt to be less popular. Body weight is one of the most basic issues of human life. Self-esteem, acceptance among peers-- and perhaps lifelong success or failure—are, unfortunately, all tied to our physical appearance.

No one wants to be fat. Thin is in, especially today. The prevalence of slender, even skinny models in advertising is ample evidence of our society’s attitudes about body weight. While being overweight is certainly unhealthy, the fear and loathing attached to body fat can also be detrimental when it leads to eating disorders such as anorexia. But consternation over the impact of obsession with thinness on our national psyche, especially where young people are concerned, should not obscure the obvious fact that too many Americans are overweight. Everywhere you look, people are fighting the "Battle of the Bulge." And it is certainly a positive trend that many of us seem more health-conscious these days.

Medically speaking, not all overweight people are obese. Obesity is defined as weight that exceeds 15 percent of normal weight for height and body type. "Morbid" obesity exceeds 20 percent of optimum weight. The long-term health implications are well known, in fact, obesity is considered an outright disease. Life expectancy may be decreased in overweight and obese individuals. (1) An obese person is at high risk for a number of serious health problems, including heart disease, high blood pressure, stroke, varicose veins, psychological stress, osteoarthritis, high cholesterol, and diabetes.

The detrimental health effects of obesity are more than just a matter of weighing too much. Body composition--the amount of fat in the body compared to the amount of lean muscle--is also important.

While obesity is clearly a health threat, we should not lose sight of the fact that we need fat to stay healthy. Body fat performs many vital functions: fat provides readily accessible energy during short periods of fasting and it serves a structural component of organs, the nervous system, the brain, and muscles. We require fat in the diet to absorb the fat-soluble vitamins: vitamins A, D, E, and K.

The distribution of body weight is a key part of the equation. Excess abdominal fat in particular has been shown to increase the risk of some diseases. "Apple" shaped women--women with 30 inch or larger waists and more or less equal waist and hip measurements--appear more susceptible to heart disease and diabetes than "pear" shaped women. (2) The most harmful fat is the deep "visceral" fat that cushions the abdominal organs. Visceral fat is linked to higher levels of LDL cholesterol--the plaque-forming cholesterol--and lower levels of the good HDL cholesterol. Excess fat puts an extra burden on the liver, perhaps making it less able to metabolize cholesterol effectively. (3) Too much visceral fat also favors high blood sugar and increases the risk of diabetes. (4)

Body weight and composition are to a large degree determined by the "basal metabolic rate" (BMR), the amount of energy the body burns while at rest. The BMR is a measure of how efficiently the body converts calories into heat. It comes down to the basic laws of thermodynamics: energy consumed as calories must equal energy used up. If not, we gain weight.

Why is exercise so important? Yes, we burn calories through physical activity. But there is more to it than that. Exercise builds lean muscle. As the ratio of lean muscle to body fat increases, so does the BMR. The higher our BMR, the more calories we burn. A safe and effective weight-loss program is one that combines calorie cutting with exercise to maintain lean muscle mass.

Body function influences body weight in other ways. Obesity can be caused by metabolic disorders of the endocrine system. The pituitary, the thyroid, and the adrenal glands all play a role in regulating metabolism. Under activity of the thyroid and pituitary can disrupt metabolic function and contribute to obesity. A disease of the adrenal glands called "Cushing’s Syndrome," where the adrenals overproduce certain hormones, is another cause of obesity. High blood sugar (glucose), tissue resistance to the blood sugar-lowering effects of insulin, and impaired glucose tolerance—the characteristics of diabetes—all favor excess body fat, which in turn depresses the basal metabolic rate.

According to some theories, obesity may have genetic origins. This is bolstered by studies showing that two obese parents are at greater risk of having children with adult weight problems. (5) On the other hand, learned habits and poor dietary choices in childhood could have as much to do with this as heredity. (6) , (7) After all, many people with overweight parents successfully manage their weight in adulthood using diet and exercise. Given the astonishing number of overweight Americans, the root causes of obesity are probably more behavioral than genetic.

Overeating and lack of exercise are the principle behavioral factors that lead to obesity. As technology and transportation dominate the 21st century, lifestyles have become increasingly sedentary. (8) Societal pressure to produce and succeed leaves less time to plan and prepare wholesome meals. Add the ever-present ads for processed, high fat, high-sugar junk foods, and it is easy to see why obesity is so commonplace. At the same time, science is learning more about the physiology of obesity. Body fat, it has recently been discovered, contains a hormone called "leptin," that may be an internal anti-obesity factor. (9) Leptin appears to play a role in appetite control; when nerve receptors for leptin are stimulated, appetite is suppressed. A relationship has been found between obesity and a deficiency of leptin or malfunction of leptin receptors. (10) While the evidence is still preliminary, the leptin-obesity connection has been strengthened by positive results using synthetic leptin and leptin receptor-enhancing drugs on animals. (11)

Statistic

World Health Organization, 2005.

  • Worldwide, there were more than 1.6 billion adults (age 15+) that were overweight and at least 400 million adults were obese.
  • WHO further projects that by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese.
  • Globally 20 million children were overweight.

Malaysian Association for the Study of Obesity, 2003.

  • In Malaysia, adult males, 15.1% were overweight and 2.9% were obese while in adult females, 17.9% were overweight and 5.7% were obese.

New Zealand Ministry of Health, 2003.

  • In New Zealand, one in three adults is overweight and one in five adults is obese.

Singapore Ministry of Health, 2004.

  • Singaporean adults (aged 18 to 69 years), 24.4% were overweight and 6.0% were obese.
  • There were more obese Singaporean females (6.7%) than Singaporean males (5.3%).
  • Prevalence of obesity in children 6-7 years old was 10.8%, those aged 12-13 years was 14.7% and those aged 15-16 years was 13.1%.

International Association for the Study of Obesity, 2004.

  • In South Africa, 29 % of men and 56% of women were overweight, including 9% of  men and 29% of women were obese.
  • Among young people aged 13-19 years 17% were overweight (including obesity) affecting more girls (25%) than boys (7%).

National Center for Health Statistics, 2002.

  • 64% of adults age 20 years and over are overweight or obese (129.6 million Americans)
  • 30% of adults age 20 years and over are obese (61.3 million Americans)
  • 15% of adolescents age 12-19 years are overweight
  • 15% of children age 6-11 years are overweight

Signs and Symptoms

[span class=alert]The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.[/span]

Obesity is a continually growing problem in most industrial nations. Obesity is also difficult to diagnose due to the lack of any specific, definite definition of the disorder.

The body mass index (BMI) is a widely used formula to calculate obesity because body fat is considered within the calculated result. To calculate body mass index for a given height and weight, use the following formula:

BMI = weight in kilograms (pounds divided by 2.2) divided by the square of the height in meters (inches divided by 39.4).

Guidelines created in 1998 state that the BMI must be 24 or less in order for one's weight to be considered healthy. An individual with a BMI 25 to 29.9 is considered overweight. Obese individuals have a BMI greater than 30. (12) Body mass index is associated with overall mortality. Studies have indicated that the greater the BMI in the individual, the greater the risk of death from all causes. Smoking and the presence of heart disease, cancer, or other disease increases the risk of death even more in both men and women. (13)

Treatment Options

Conventional

Every year, Americans spend billions of dollars on gimmicks, diet plans, surgery, and drugs for weight loss. Losing weight, for some people, is a lifelong struggle. All too often, the Battle of the Bulge turns into a lost war.

The first step is to address any metabolic functional disorders. Once these have been ruled out, weight loss should begin with the fundamentals: consuming less energy than one expends and increasing lean muscle mass through exercise.

As more discoveries are made about the physiology of obesity, hope improves for the millions who fight being overweight. The following medications are generally reserved for the morbidly obese, although the desire for a "magic bullet" for weight loss has pressured some health care providers into prescribing them inappropriately:

    Stimulants (Amphetamines) have been prescribed for many years to increase basal metabolic rate and expedite weight loss. However, these drugs have a number of unpleasant side effects, including dry mouth, nervousness, insomnia, and hyperactivity. More serious effects include high blood pressure, irregular heartbeat, and dependency. Today, use of amphetamines has been strongly discouraged through various state laws.
  • Sibutramine is a selective serotonin and noradrenaline re-uptake inhibitor that aids in weight loss by increasing appetite-suppressing neurochemicals. In clinical trials, sibutramine has proven effective in improving weight loss, reducing body mass index, and decreasing waist size. (14) Side effects reported include dry mouth, constipation, and tachycardia. High blood pressure is a serious risk factor associated with taking sibutramine, so individuals with hypertension should use with extreme caution. (15)
  • Orlistat is a drug that works by blocking absorption of dietary fat. It works by inhibiting the enzymes that digest fat, preventing the breakdown of ingested fat. The undigested fat is removed in the feces. Orlistat can block up to one third of the fat consumed in food. A recent clinical trial reported that after one year of treatment, people on orlistat lost an average of 8.5 percent of body weight. (16) Significant reductions in total serum cholesterol, LDL cholesterol, and VLDL cholesterol also occurred. Because orlistat blocks fat, it also reduces absorption of the fat-soluble vitamins (A, D, E, and K). Fat-soluble vitamin supplementation is required to prevent depletion of these nutrients. Side effects include increased frequency and urgency of bowel movements, oily discharge, fatty stools, and bowel incontinence.

Nutritional Suplementation


Conjugated Linoleic Acid (CLA)

Conjugated linoleic acid (CLA) is a type of fat found in beef and dairy products that helps reduce body fat. Studies on CLA have researchers thinking it may be a key obesity-preventing nutrient. (17) CLA is necessary for the transport of dietary fats into cells. Once they have entered the cells, fats can be used to build muscle and produce energy. Results of studies indicated that CLA reduced body fat mass and increased lean body mass in healthy overweight adults. (18) , (19) In one study, CLA-enriched diets reduced body fat 43 to 88 percent in mice. (20) These results indicate that CLA reduces body fat by several mechanisms, including a reduced energy intake, increased metabolic rate, and increased utilization of fats for energy.

Beef and dairy products once contained approximately 3 percent CLA. However, there has been nearly a 70 percent reduction in the amount of CLA in the food supply in the last 40 years, due to changes in how cattle are fed, and the switch from whole milk to low fat or skim milk. Some researchers suggest that the disappearance of CLA in the food chain is one of the reasons why Americans have continued to become fatter.


Chromium

Chromium is an essential trace mineral that plays an important role in the metabolism of carbohydrates and fats. As a helper for insulin, chromium enhances insulin’s ability to transport glucose into cells, where it serves as fuel for metabolism. Favoring the conversion of glucose to energy reduces the amount of glucose that gets converted into body fat. (21) In addition to its effects on glucose, insulin, and lipid metabolism, chromium has been reported to increase lean body mass and decrease the percentage of body fat. Chromium’s known actions should at least in theory translate to promoting weight loss. Yet chromium’s role in weight loss remains controversial. Chromium has increased lean muscle mass in animal studies, but it has not been proven to work in humans as yet. (22) Chromium seems to promote weight loss only when there is an actual chromium deficiency.


5-Hydroxytryptophan (5-HTP)

5-HTP is a cousin of the amino acid tryptophan. In the body 5-HTP serves as a "precursor"-as starting material so to speak-for serotonin. One of the body’s main neurotransmitters, serotonin has a major influence on appetite and eating behavior. Taken as a supplement, 5-HTP has been used successfully to decrease carbohydrate intake and promote weight loss. In one double blind study, 19 obese female subjects volunteered to take 5-HTP every day for five weeks. The study was designed to evaluate the effects of oral 5-HTP on feeding behavior, mood state, and weight loss. The study participants were not required to restrict their diets in any way. At the end of the five weeks, the women had reduced appetite and food intake. (23)

In another 5-HTP study, 25 overweight individuals with type 1 (insulin-dependent) diabetes were enrolled in a double-blind, placebo-controlled trial. The subjects took either 750 mg of 5-HTP or a placebo for two weeks, again, with no change in diet. After two weeks, those on 5-HTP had significantly reduced their daily intake of fats and carbohydrates. Body weight also decreased. This research lends weight to the importance of serotonin in controlling calorie intake. 5-HTP may be especially useful in helping diabetics stick to their diets. (24)


Pyruvate

Pyruvate, a molecule found in every cell, plays a critical role in cellular machinery that generates energy for the body. Because it is relatively unstable, pyruvate is not suitable for use as a supplement. Combined with calcium, pyruvate is both stable and well absorbed. Supplementing with calcium pyruvate can increase the amount of energy the cell uses up, helping to even the balance between energy consumed and energy expended that is so important for achieving the ideal body weight.


Chitosan

Chitosan is a type of fiber that binds to fat molecules in the gastrointestinal tract, preventing them from being absorbed. Chitosan is derived from the "chitin," a long-chain molecule found in the shells of shrimp, crabs, and other shellfish. The best way to use chitosan is to take 2 to 3 grams along with a minimum of eight ounces of water immediately before eating a fat-containing meal. The chitosan then absorbs much of the fat in the meal, before it can be absorbed into the bloodstream. Chitosan should not be taken together with other fat-soluble nutrients such as vitamin E, vitamin A, beta-carotene, or CLA, because it will prevent them from being absorbed as well. While the scientific evidence for chitosan is still preliminary, reports from people using chitosan as a weight-loss aid are encouraging.

Herbal Suplementation


Garcinia

Garcinia is the fruit of the Garcinia cambogia tree, an evergreen native to the mountains of Western India. Flourishing in areas as high as 6,000 feet above sea level, Garcinia cambogia, known in India as "Malabar tamarind," bears a reddish-yellow fruit that resembles a small pumpkin. Various extracts and preparation containing Garcinia fruit are used as culinary spices. Garcinia is reputed to help make meals seem more filling, which gives a clue to its recent usage as a weight loss supplement.

Garcinia contains an ingredient called "hydroxycitric acid," or HCA for short. HCA is similar to the familiar citric acid found in citrus fruits, but with a major difference. HCA, based on extensive research done in the 1970's by a major drug company, has a unique effect on the way the body processes calories. HCA appears to inhibit the conversion of calories into body fat. Like citric acid, HCA is safe and non-toxic.

Garcinia has no effect on the nervous system. Unlike appetite suppressant drugs, garcinia is not a stimulant. It is reported to promote energy and increase metabolism. (25) , (26)

In addition to decreasing the amount of fat produced by the body, Garcinia does reduce appetite, in a unique and interesting way. Appetite control is directly related to the amount of glycogen, which is stored glucose, in the liver. When the liver’s glycogen stores are filled, the appetite control center in the brain turns on, telling us not to eat. Not surprisingly, obese individuals tend to have lower glycogen levels and higher levels of fat. HCA inhibits a key enzyme that converts carbohydrates to fat, promoting glycogen storage in the liver. (27) , (28) In one small study, individuals taking garcinia along with chromium and a low fat diet had three times greater weight loss than people on a low fat diet alone. (29) However, a more recent study reported no benefits in the management of obesity in human subjects taking 1,500mg of garcinia per day. (30) One comment about this trial is that the dose may have been too low. In any case, the evidence from human studies done so far is not convincing for the use of garcinia by itself.


Guggul

Guggul is a gummy resin tapped from a small tree native to arid regions of India and Pakistan. Guggul has a long and storied history of traditional use in the Ayurvedic medical system. The herb is even mentioned in the Vedas, the ancient Hindu scriptures believed to date back anywhere from 3,000 to 10,000 years. Guggul is said to have anti-arthritic, carminative (anti-gas), antispasmodic (muscle-relaxing), diaphoretic (promotes sweating), and aphrodisiac properties. (31)

An Ayurvedic medical written sometime around 600 B.C. touts the use of Guggul for a condition translated as "coating and obstruction of channels." (32) In the early 1960's, an Indian medical student doing her doctoral research was impressed by what seemed to be an accurate description of atherosclerosis, the clogging of arteries by fatty plaque. A study on rabbits fed guggul along with a cholesterol-raising diet was undertaken. After two years, rabbits given guggul had normal blood fat levels and no arterial plaque. This caught the attention of other researchers and more studies followed. After nearly two decades of trials showing that guggul consistently lowers both cholesterol and triglycerides, guggul extract was approved for marketing in India in 1986 as a cholesterol-lowering drug. (33) Lastly, guggul reportedly stimulates thyroid function, which may lead to blood fat lowering and weight loss. (34)


Bladderwrack

Bladderwrack is a rich source of iodine, and is traditionally used in weight loss and hypothyroidism. (35) , (36) The low incidence of goiter in maritime people has been attributed to the iodine content in bladderwrack. (37) Bladderwrack also contains potassium, magnesium, calcium, iron, zinc, and other minerals. (38) Historically, bladderwrack has been used in the dairy and baking industries, due to its gelling properties. Bladderwrack is thought to stimulate the thyroid gland, thus increasing basal metabolism.

One note of caution: over dosages of iodine may lead to symptoms of hyperthyroidism, including weight loss, fatigue, and frequent soft stools. These symptoms were reported in a 72-year-old female after six months of taking a commercial kelp product. (39) Another report of a 24 year old woman developing thyroid goiter after taking a proprietary product containing 0.4-0.5mg/day of iodine for three months. (40) To avoid potential iodine toxicity problems use seaweed supplements that list the iodine content on the label.


Ephedra/Ma-Huang

Ephedra has been used traditionally for thousands of years in China for kidney and lung problems, colds and flu, fever, chills, lack of perspiration, headache, nasal congestion, wheezing, and cough. (41) , (42)

Ephedra supplements have been under intense scrutiny in the past few years due in part to the irresponsible use of ephedra products by some individuals, and also due to the inappropriate advertising of ephedra products by some manufacturers. Some ephedra- containing products have appeared on the market that should most definitely be avoided. These include so-called "street drugs" such as "herbal ecstasy." These products claim to increase energy and enhance sexual activity. They can be dangerous; a recent laboratory animal study of one of the "herbal ecstasy" showed that it is a stimulant with an amphetamine-like effect. (43) This is unfortunate, because it only gives herbal medicine a bad name.

Ephedra was actually banned in Texas in 1996 following approximately 500 adverse events reported over a two-year period from the use of dietary supplement products containing ephedrine and associated alkaloids (pseudoephedrine, norephedrine, and N-methylephedrine). (44) Many State Boards of Pharmacy have impending action against the sale of ephedra-containing products. Some of these reported adverse events were due to abuse as stated, yet some were also from healthy individuals and individuals with pre-existing health problems.

Still, ephedra has been used for thousands of years without significant health problems. When taken responsibly, ephedra can be a safe and beneficial herb. Individuals with pre-existing healthcare problems should only use ephedra-containing products under the supervision of a physician. Individuals should also have regular check-ups with their doctor when taking this supplement. Be aware of the potential for abuse with the use of this dietary supplement.

Ephedra contains "ephedrine," a natural but potent alkaloid similar to the pseudoephedrine found in over-the-counter antihistamines. (45) Ephedrine is a nervous system stimulant that can cause side effects like rapid heartbeat and high blood pressure. (46)

Products containing ephedra and the alkaloids ephedrine and pseudoephedrine are said to increase weight loss by suppressing appetite and increasing fat metabolism. Combined with caffeine, its fat-burning effect is even stronger. (47) , (48) A laboratory animal study reported that the combination of ephedrine and caffeine promoted weight loss through an increase in energy expenditure, or in the more obese animals, a combination of an increase in energy expenditure and a decrease in food intake. (49) Another study showed a synergistic effect of adding aspirin to ephedra weight loss formulas for burning fat and normalizing body composition. (50) Ephedrine plus caffeine produced a decline in total cholesterol levels and maintained HDL levels in another trial. (51) These results are only preliminary and more research is needed to identify combinations that are safe and effective. These clinical studies have used pure ephedrine isolate from the herb. Ephedra contains anywhere from 30 to 90 percent ephedrine. A standardized ephedra extract should contain approximately 8 mg of total ephedrine alkaloids. (52)

Diet & Lifestyle

    Include aerobics and even more specifically weight training routine to build muscle mass. Muscle mass burns more calories per gram of weight. Try to live an active lifestyle; take stairs instead of escalators when possible. Drink a minimum of eight glasses of water daily. High fiber diet. Reduce or eliminate high refined sugar and refined carbohydrate intake. These foods tend to be calorie dense and nutrient poor. Eliminate trans fatty acids from the diet. Do not over indulge in carbohydrate rich foods. Eat plenty of fresh fruits and vegetables. Chew food thoroughly. Stop eating when the first feeling of satiety takes place. Try not to eat large meals before bedtime.

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