It's all about caloric balance or energy balance. This means if you eat more calories than your body uses, they will be stored as fat. People tend to underestimate the amount of food they eat. It is often the snack, sweets, alcohol and sodas that sneaks up on people. All it takes is an additional 500 kcal per day to increase your weight one pound per week. This is not a lot…be careful of what you eat. Similarly, if you have a deficit of 500 kcal per day, you can lose one pound per week!

Briefly, body mass index or BMI describes relative weight for height and is significantly correlated with total body fat content. Calorie or kcal is a unit of potential producing energy produced by food. Calories or kcal is used to standardize how much energy is in the food we eat. We can also use calories to measure how much energy we burn when we exercise.

Many studies support the benefit of weight reduction in improving different medical conditions. Examples are as follows: 1) reducing the risk of diabetes 2) reducing blood pressure 3) improving cholesterol 4) decreasing the risk of arthritis and most importantly, death rate is lower in those trying to lose weight, even if they did not actually lose weight. Options for weight loss include behavior modification, dietary therapy, exercise, drug therapy, liposuction and bariatric surgery.

 Top Ten Facts of Obesity

 1. Obesity is related to hypertension, diabetes, high cholesterol, coronary artery disease, gallbladder, arthritis, sleep apnea, irregular menses, cancers of esophagus, stomach, endometrium, breast, prostate, colon, pancreas, lymphoma and multiple myeloma.

2. Obesity will decrease life expectancy. Studies show those who were overweight at age 40 (BMI 25 to 30) lived about three years less. Those who were overweight at age 40 (BMI over 30) lived about six to seven years less.

3. Americans are among the fattest people in the world. Defined as a body mass index (BMI) >30, the percentage of obese men nearly doubled between 1991 and 1998, and the percentage of obese women increased by 50 percent.

4. Obesity in childhood has almost doubled in the United States in the last decade.

5. Obesity at age 18 is associated with is associated with increased mortality 20 years later. Estimates indicate an increased relative risk of approximately 1.5 for all-cause mortality and 2.0 for cardiovascular disease mortality.

6. Waist above 35 inches female or 40 inches male correlates with increase risk of coronary heart disease.

7. A drop in weight of 2.2 pounds can decrease your blood pressure by approximately 1 mmHg. Those who maintain weight loss tend to maintain lower blood pressure than those who regain weight.

8. Don't be discouraged if your weight loss slows down as you continue to try to lose weight over a period of months. This is a normal physiologic response. Early on, you tend to lose more water and sodium to balance the negative charge of the ketones being excreted by your body. Later on, your body compensates and breaks down fat instead. There are no negative charges or ketones in fat breakdown and the body does not need to excrete sodium to balance the charge. Hence, there is less water loss. But this is good! You want to achieve fat breakdown. So be patient.

9. Consider surgery if your BMI is more than 40 and traditional methods of weight loss (diet, exercise and medications) have failed.

10.  In morbidly obese patients, bariatric surgery was more effective at producing weight loss than non-surgical treatment. Studies show a difference of weight loss of 70 pounds at 1-2 years follow up and 44 pounds at 8 years follow up.

Top Ten Tips for Losing Weight

 1. To loose one pound per week, you will need to achieve 500 kcal to 1000 kcal deficit per day.

2. To lose weight, you must achieve a negative energy balance. Based on average energy requirements, females generally should eat approximately 1200 kcal/day and males 1500 kcal/day.

3. Try to eat a balanced diet of carbohydrate/protein/fat in a ratio of 55/15/30. Include fiber of 20g/day and calcium of 1,000 to 1,500 mg/day and a multivitamin tablet daily. Of course, this is only a guideline.

4. Stay away from alcohol, carbonated sodas, sweets and fast foods.

5. If you must eat out, eat smart: a) eat half of what you order, b) ask for a "to go" plate when your food comes out so you can split half, c) ask for your sauces on the side so you can use minimal amount.

6. Get a scale and weigh yourself everyday. This will keep you visual feedback daily on your progress.

7. If your BMI is over 30, consult a physician. There may be other medical conditions that may be attributing to your weight gain.

8. Exercise! Exercise! Exercise! If you're self motivated, do a minimum of 30 minutes per day. Otherwise, join programs such as Curves, 24 hour fitness, yoga, pilates, etc.

9. Choose a realistic goal of weight loss. A reasonable time line for a 10 percent reduction in body weight is 6 months of therapy.

10.  Consider acupuncture and herbal medicine as part of your plan for weight loss. In some patients, this may be very helpful.

When is drug therapy appropriate?

 1. Patients whose BMI is more than 30 or BMI is more than 27 if or other obesity-related risk factors or disease exists. Examples of such diseases are hypertension, diabetes, high cholesterol, arthritis and sleep apnea.

 2. If a patient has not lost more than 4.4 pounds after four weeks, it is unlikely that this patient will benefit from the drug. He should either switch medications or try a different approach.

 3. Currently, only orlistat (xenical) is approved by the FDA for long-term (more than one year) weight loss. Side effects include flatulence/loose stools with orlistat. Phentermine (adipex) and diethylproprion (tenuate) are approved by the FDA for short-term use, usually interpreted as less than 12 weeks. Typical weight loss on medications is about 10 to 15 pounds compared to placebo. Of course, you can lose more weight than this if you continue to diet and exercise.

 4. Prescription medications should not be used without concomitant lifestyle modifications.

Calorie sample

1 cup of white rice 200 calories
1 glass of alcohol 70 to 120 calories
1 cookie 80 to 150 calories
1 soda 120 to 150 calories
Large french fries 550 calories
McDonald double cheeseburger 490 calories
1 cup ramen noodles 296 calories
Starbucks Café Latte Grande (whole milk) 260 calories 

Obesity and Weight Loss