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Obesity and Weight Management

Please help me

07/06/2006

Question:

I am male/48 years. I have HBP on Losartan Norvasc Atenolol. In 1986 at the age of 32, I was only 59 kg. In 1999, I had psoriasis and was given Dexona ( steroid) as a result of which I started weight gain and I am 115 kg. My height is 178 Cms. I am vegetarian non alchoholic non smoker non tobacco chewer. I am ver much disturbed with my personality. What should I do. Diet and exercise failed. I do not take onion or spicy food. What should I do. Can you suggest. My mother was very obese and dies of diabetic coma at the age of 59. I have impaired glucose tolerance.

Answer:

Don't despair. You are definitely heavier than you should be, but you do not need to get back down to 59 kg to be healthy. Your BMI is currently at 36.3 and ideally it should be under 25 (your BMI at 59 kg was only 18.3), which means aiming for a weight around 80-82 kg.

I'm unclear if you are still taking the Dexona. Steroids appear to alter metabolism, which is probably the start of your problem. A reduced basal metabolism (BMR) meant the amount of food you were eating became too much and your weight gain began. Unfortunately, the weight gain is fat instead of lean body mass (muscle), and fat doesn't take as many extra calories to maintain it as muscle does. So now you have a lower BMR and a higher percent of body fat. Your goal should be to reduce the percent of body fat, which can come partly with weight reduction and partly by including exercise/physical activity that encourages muscle building (thereby appearing to change some of your fat to muscle). One pound of muscle is more compact than one pound of fat (making you look thinner at the same weight), and requires up to 10 times more calories to maintain than 1 pound of fat.

You say you have tried diet and exercise, but how many calories in the diet and what type of exercise? Too few calories may have put your body into starvation mode, slowing your BMR even further, which means that you don't lose weight or the weight you lose is lost as lean body mass and you regain it very quickly as fat (slowing BMR again). Also, the exercise you were doing may not have been as effective as something else. Aerobic exercise like walking and running burns calories while you are doing them but doesn't do a lot to change your lean body mass (increase muscle), so you need to include strength exercises also that will encourage muscle growth. Greater lean body mass (muscles) will increase your BMR.

If you go to ChooseMyPlate.gov  you will find that the calorie level for a moderately active 48 year-old male of normal weight is 2400 calories. Moderately active is 30-60 minutes of moderate physical activity BEYOND regular daily activity. Moderate physical activity is defined as activity that burns 3.5-7 kcal/minute (walking briskly, mowing the lawn, walking, dancing, swimming, or biking on level terrain).

Now that you have gained the weight, you need to create a calorie deficit of 3500 calories to lose one pound. Most people are most successful by creating this deficit with a combination of lower calorie intake and increased physical activity. Increased physical activity also has the additional benefit of reducing emotional stress, and it sounds like your current weight is causing you emotional stress. If you reduce your calorie intake to 1900 calories per day from 2400, you will have shaved off 3500 calories in a week. If you increase your physical activity to burn another 500 calories per day, you will lose another 3500 calories. The Dietary Guidelines for Americans suggest that this will mean being moderately to vigorously active for 60-90 minutes per day beyond normal daily routines.

If by chance you have tried to combat your weight gain by cutting calories WAY down (to 1000-1200) you may have put your body into famine mode as I mentioned earlier. When this happens your body is extra-efficient at using the calories it gets by slowing your basal metabolism, which means you burn fewer calories while at rest than someone whose metabolism is higher. To kick up your basal metabolic rate you will need to eat more than the 1000-1200 calories (go to 1800-2000) AND increase your physical activity. The increased physical activity, especially if it involves some muscle strengthening, tends to change your body composition to a lower fat level and higher lean body mass. This increases your basal metabolic rate. (Lean burns more calories than fat.)

Finally, data from the National Weight Control Registry of individuals who have successfully lost weight and have kept it off (for up to 10 years - the length of time the registry has existed) suggest that the most successful weight management regimen includes breakfast every day. I find that a serving of a high protein, high fiber cereal (like Nature's Path or Kashi brands) with skim milk and fruit (sometimes dried and sometimes fresh) is a good beginning to the day. It will 'hold me' for 5-6 hours, so that even if I eat breakfast at 6 or 6:30 I can last until noon. If you say to yourself, "I'm not hungry when I get up," then change your evening eating habits so you are ready to eat. This probably means no eating after dinner.

Even a 10% reduction in body weight might be enough to improve your glucose tolerance, so think in small steps. Start with a 10-15 kg loss. Then re-evaluate what you are doing. Portions of food begin to creep up with time, so keeping periodic food records may help you monitor your food intake better. Good luck to you.

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Response by:

Sharron   Coplin, MS, RD, LD Sharron Coplin, MS, RD, LD
Former Lecturer
Food & Nutrition
College of Education and Human Ecology
The Ohio State University