Obesity is considered a public health crisis
in the United States and for good reasons.
So, today, we’re going to be discussing
a little bit about the epidemiology
of obesity as well as its definitions.
And then we’ll move quickly into
the best dietary for obesity which is
always a very controversial subject.
And there have been some new innovations,
new medications are available
for the treatment of obesity
and the application of bariatric surgery has absolutely
exploded in the United States over the past five years.
So, we’ll be talking about some of the pluses
and minuses of those treatments as well.
So, just to start with a little bit of epidemiology.
Currently, over one-third of US adults are obese.
And after remaining steady for
a number of years, about seven years,
that percentage increased in the last
measurement period between 2011 and 2014.
17% of children and adolescents have obesity.
That level increased a lot between 2000 and 2010
and has since leveled off a bit.
But one thing we do see and
is very persistent is that
African-Americans and Latinos
have higher rates of obesity
compared with white Americans.
And so, it's worthwhile just to think
about the definition of obesity a little bit.
Underweight is less than 18.5 kg/m².
Normal weight, 18.5 to 25.
Overweight, 25 to 29.9.
And then, obese is 30 kg/m² or more.
Now, this is in itself a little
bit controversial because
that's applied to a general
population in the United States.
There has been a push to maybe redefine these levels,
maybe lower these thresholds,
particularly for people of Asian descent.
So, that’s something to pay attention to
and you may want to,
depending on your practice,
actually maybe change that application
a little bit and those thresholds.
What about effects of diet?
I think one of the more popular diets
traditionally has been a low-fat diet,
which can work to reduce body weight.
In clinical trials, the average reduction is about 5 kg.
That’s something significant.
Or 11 pounds.
However, a low carbohydrate diet in systematic reviews
is generally more effective than low-fat diet alone.
So there, you can achieve an average
body weight reduction of about 7 kg.
So, there’s more of a benefit.
And overall – and this is something that’s
surprising to many patients and clinicians too.
Dietary fat really doesn't have
a large effect on weight loss.
It’s really about carbohydrates
and the concentrated calories
that come in processed carbohydrates
and sugar sweetened beverages.
Those are the key targets
in improving body weight.
And I think that in counseling
patients about their body weight,
which I do all the time,
do understand that diet is
a very personal issue.
It has emotional attachments
and cultural attachments
beyond just being something
you do to maintain your energy
and promoting whatever bodyweight you have.
So, you have to respect that from your patient's
perspective before you start counseling.
And that's why I always begin with the
patient's values and opportunities.
There's something in there that
they don't really care about,
maybe it’s sugar sweetened beverages,
maybe it's some sweets that they’re eating
or maybe it's going to fast food three times
a week that they want to break that habit anyway,
start with that.
Start with using your patient's motivations
and find some opportunities to make small changes.
There are patients out there
who can go on a fasting diet
and eat zero carbohydrates for a few weeks.
And really, their weight will improve dramatically
and then they can stick to something beyond that.
That’s a highly-motivated patient
who is a little bit more advanced.
I find that that patient is in the minority in my practice,
a very small minority.
Instead, I try to capitalize
on the small opportunities,
take the stuff that the patient really doesn't care
about eating too much or drinking too much,
and start with that.
Replace it with a healthy habit
and try to always promote this positively,
like this is – instead of drinking
this sugar sweetened beverage,
try some extra water.
It will hydrate you and make you feel better,
plus you are spending less money,
And so, really try to get back behind
the patient's values and be positive.
This a great opportunity for team-based care.
It’s a lot more effective
if I'm providing that information as well as
well as a health coach and a dietitian and their family
and the patient really believes in it
too because they’re always at the
center of the patient care team.
And don't forget about exercise.
Adding exercise to a nice easy-to-tolerate diet like
a Mediterranean diet or a low carbohydrate diet
is going to result in probably three extra
kilograms of weight loss as well.
When you start to put that together,
10 kg – 10, 12 kg of weight loss,
that's going to start to make a difference
in things like diabetes and hypertension.