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How to we dertermine our optimal weight


How much should we weigh?  Different people will have different answers. A model should weigh so much, a football lineman should weigh a bit more.  Clearly, many people are focused on looks;  they would  say that optimal weight is that weight in which our appearance is best.  However, as you know, appearance can be cultural and many people resort to unhealthy behavior to look good.

From my perspective, the healthiest weight should be that weight which promotes the longest life expectancy with the minimum amount of disease.  So how do we determine this?  

Body mass index, or BMI, is one way of correcting weight for height.  It was initially described in the 1800s and than rediscovered in 1971 as a good way to measure "fatness) in a population.    You can check your own BMI with the button on the right.

Unfortunately, the BMI was never intended to be applied to individuals because it makes no allowance for muscle mass, chronic disease or differences between men and women.  It also overestimates fatness in taller people.  

One of the reasons BMI  was adopted was that it was shown to predict increased risk of diabetes, heart disease and dying. .  Originally optimal weight was originally defined as a BMI of under 27-28 by the NIH.  That was lowered in the 1990s to 25.  There was some studies that showed an increased risk health problems with a BMI of >25.  However, more recently. a studied failed to find increased heart disease when it compared a population of people, whose BMIs were 25-29,  to those who's BMI was under 25.  In fact, in the heavier group, the incidence of disease was 7% less.  It may be that the normal weight group had more people who suffered from chronic inflammatory medical conditions.  Nevertheless, the results do not clearly present a strong argument that BMIs of 25-29 are associated with health problems. 

Obesity may not have the same risk that is did for prior generations.  People living today have had different environmental exposures than our parents and grandparents did.  We did not live through the depression or dust bowl; food distribution and preservation is more reliable.  For these reasons,  more people today have never known hunger.  Evidence has shown that early life deprivations sets up long term changes in metabolism.  Once we begin to eat again, weight normalizes but diseases becomes more common.  The  diseases include diabetes and atherosclerosis.     

The point I am trying to make is that the consequences of obesity may be different for us than it was for prior generations.  Mild elevations in BMI do not mean we are unhealthy.   

I feel that the current  BMI cut-off level is too low.  The number should be higher; perhaps around the original value of 27-28.  However, even if a person has a slightly higher BMI, I would still consider them healthy and at a good weight as long as they are active and eating right.  

Another way of  determining obesity risk is to try to determine abdominal fat.  Abdominal fat is more metabolically active than body fat.  It correlates more with the risk of disease.  One can simply measure the waistline.  Men should be less than 40 inches, woman should be less than 35 inches.  When examining persons whose BMI is 25-35, larger waistlines mean more risk of disease.  In patients whose BMI is greater than 35, the increased girth has little significance.  In this group, larger waistlines mean more abdominal fat and more risk of disease.

Another way of measuring abdominal fat is to determine the ratio of the sizes of waist to hip.  It is obtained by measuring the waist just above the naval and comparing that to the circumference around the hip/buttock area.  Men should be less than 0.95 - 1.0 (different experts say different things) and women should be less than 0.8-0.85.  Risk of disease goes up after these ratios are exceeded.   

The skinny on diets

 What is the best diet?  I cannot tell you how many times I am asked this question.  The fact is that no one really knows.  Different people hawk different diets but I am unaware of the supremacy of any one diet over the others for a majority of people.

When I was growing up, fat was the main culprit.  After all it carried 9 calories per gram vs. 4 calories per gram of carbohydrates or protein.  Additionally, saturated fats were implicated in the development of high cholesterol.  This must be bad.

So nutritional experts came out with the food pyramid which relied on getting the bulk of your calories in carbohydrates.  The people making Wonder Bread were happy with this recommendation and most experts agreed.   And Americans became fatter and fatter.

Then came Dr. Atkins who gall to claim that if we cut out all carbs, we could eat unlimited amounts of protein and fat and still lose weight.  The established interests hated him; they wanted his license revoked. 

But you know what, he had a point.  Persons who maintained the diet did lose weight.  They lost more weight than persons consuming equivalent calories of a low fat diet.  If anything their, cholesterol improved.

Why is this?  It turns out that weight control is not just dependent on our calories, it is determined by our metabolism.  Our metabolism is in turn is dependent on our hormones.  We will not gain weight if our hormones tell us we are not in a fed state.  We will continue to break down fat even if there is food in our gut.

The question becomes how our hormones tell the body it is fed.  It turns out that sugar in our blood stimulates insulin and it stimulates other hormones such a glucagon-like peptide.  These hormones tell us we are fed.  It switches metabolism in the liver so it starts making fat and cholesterol.  It tells our fat cells to store this fat and cholesterol.

Dr Atkins realized that if we ate without taking in carbs, these hormones remain in low levels and our body continues to breakdown fat.  Unfortunately, anyone who ate more than a critical amount of carbs would suffer all the consequences of eating a high fat diet.  Therefore it is a more dangerous diet to cheat on.  But many people are very successful with it.

One problem is that many people, who have been on this diet have also realized they experience a lot of cravings for fruits and other carbs.  However, cravings can be controlled with medications.  Also, some people with certain health problems will need to watch their protein intake.

The Ocean Beach diet took a more measured approach allowing a modest amount of healthier carbs but it did away with the unlimited calories.  This remains a very popular diet today.

Of course, there are a number of widely used commercial diets such as Weight Watchers and Jenny Craig. They are not necessarily low-carb.  Weight Watchers will give you diet plans which tell you how much to eat, they also sell food.  It works on exchange system.  You are allowed so much protein, so much fat.  The American Diabetic association also recommends these exchange diets.  Weight Watchers also has Internet Support services

Sometimes, it is hard to plan meals; lack of planning leads to impulsive decisions which are hardly ever the best ones.  Therefore, programs like Medifast and Jenny Craig are helpful.  If you have meals with you, you can eat small, health meals throughout the day.  I personally had lost 70 lbs on medifast (and of course I put some back on).  Yet the simplicity of following this regimen was what worked for med

 However, from my perspective, a valuable aspect about  these programs is the emotional support one receives in the form of individual and group counseling.   Whatever bad habits ones tries to give up, it easier to do with counseling-either individual or group.  We feel better after a social (and emotional) connection and this has an anti-craving effect.


An Introduction to exercise

 Exercise is a major element of a healthy lifestyle.  It improves overall fitness, improves stamina and reduces systemic inflammation that leads to heart disease and stroke. Despite popular belief, moderate exercise does not contribute to significant weight loss; nevertheless, the other healthful aspects of exercise make  it a really important aspect of a healthy lifestyle.

If you are already a grown-up and not regularly engaged in exercise, it is clear that you need a little push.  You need to make it fun- a sport that you enjoy, a class which introduces a social aspect, an exercise buddy- whatever it takes to help with a prolonged commitment.  

Exercise comes in two forms: aerobic exercise like running,biking or swimming and resistance  exercise such as lifting weights.  Aerobic exercises increase heart rate and move large muscles (such as the muscles in your legs and arms) . For most people-aerobic exercise should comprise the bulk of their routine.   Choose an activity that you enjoy; start slowly and increase gradually as you become used to it. Walking is very popular and does not require special equipment. Other good exercises include swimming, biking, jogging and dancing. Taking the stairs instead of the elevator or walking instead of driving may also be a good way to start being more active.

Start off exercising 3 or more times a week for 20 minutes or more, and work up to at least 30 minutes, 5 times a week.  As you become more used to exercising, try to keep your heart rate at about 60% to 85% of your "maximum heart rate."  To figure out your target heart rate, subtract your age (in years) from 220. This is your maximum heart rate. Now, to calculate your target heart rate, multiply that number by 0.60 or 0.85.

For example, if you are 40 years of age, you would subtract 40 from 220, which would give you a maximum heart rate of 180 (220 - 40 = 180). Then you would multiply this number by either 0.60 or 0.85, which would give you 108 or 153 (180 x 0.60=108 and 180 x 0.85=153).

When you first start your exercise program, you may want to use the lower number (180 x 0.60=108) to calculate your target heart rate. Then, as your conditioning gradually increases, you may want to use the higher number (180 x 0.85=153) to calculate your target heart rate. Check your pulse by gently resting 2 fingers on the side of your neck and counting the beats for 15 seconds and multiply by four.  . Use a watch with a second hand to time the interval

Resistance exercises can be done on top of this for strength training or muscle sculpting. Push-ups and sit-ups are partly aerobic and partly resistance.  

The role of stretching in avoiding pain or injury is unclear.  The role of warming up; however, is crucial to avoid injury

Several years ago, it was demonstrated that 6 30-second intervals of maximal exercise per week was as good for fitness as 6 30-minute intervals of moderate exercise per week.  Maximal exercise would be akin to an all out sprint.  If you can talk afterwards, you did not give enough effort.  It is good to mix one or two 30-second intervals of maximal exercise amid, or after, the 30 minutes of moderate exercise 


What is a Good Approach to Healthy Nutrition?

Patients often want to know what is a good approach to nutrition.  It is best thought of in two questions: how many calories should some one eat and what kinds of foods should they eat.

The lesser question is the number of calories. I consider this the lesser question because, in the long term, a person will eat what satisfies them and will not calorie count.  Nevertheless, a good rule of thumb is to allow 12 - 13 calories per pound of desired weight for a person of moderate activity.  Men need a little more and woman need a little less.  Sedentary patients and those over fifty need about 10% fewer calories.  Active persons need 10-15% more.  To lose weight faster, 300 calories should be subtracted from that needed to maintain an ideal weight.

Of course-this brings up the question of what an ideal weight is.  Younger patients should have a body mass index (BMI)of 18-25 but for older adults, a BMI of 21-28 is more appropriate and associated with longer life expectancy.  See an on-line calculator to determine what weights correspond to these BMIs for your height. 

Weight loss, if that is your aim, is only minimally accomplished with exercise.  If you exercise for hours each day, it will help; however, moderate exercise for 30 minutes does not burn that many calories over resting metabolism.  Exercise improves fitness, stamina, health and longevity and needs to be done but its' contribution to weight loss is often minimal.  Weight loss is about reducing calorie intake. 

What is more important is the types of foods eaten.  Process foods especially processed carbohydrates  result in rapidly absorbed calories that our bodies have not evolved to handle.  Our insulin levels,as well as reward chemicals in the brain go wild.  This leads to increased hunger and increased food intake.  Even diet soda tricks our brains into wanting more and paradoxically leads to increased caloric intake from other foods.

Therefore, we want to minimize processed foods especially the highly processed carbohydrates.  This includes mainly white flour breads and pasta, but even other types of breads and flour contain lots of calories.  So aim to eat natural carbohydrates which consist of fruits and vegetables.  Meats have a bad rap.  Processed meat, like sausage, and highly fat meat, like bacon are problems but leans cuts of red meat, chicken, turkey and fish are all fine.  Cheese which is also processed should also be moderated.  Low fat dairy products and mayonnaise should be used whenever possible.  When preparing meals, the use of olive oil or canola oil over butter, margarine or shortening is also a healthier choice. Especially try to avoid hydrogenated vegetable oils which raises cholesterol.  Try to minimize frying as a way of cooking.

It is important to drink lots of water or the equivalent: diet iced tea, seltzer and certain other drinks. First, adequate hydration is best for maintaining health, minimizing  edema (paradoxically)  and making us feel good.  But even more important is that drinking water reduces feeling of hunger.  We eat less at meals.  Also, we are less like to eat as a result of thirst which often happens.

Vitamins are less important than most people think.  There is a role for folic acid (1 mg/day) and vitamin D (800-2000mg/day) and that is it. If there is a need for any other vitamin supplementation for a medical indication, it can be discussed specifically with your health provider.  A multi-vitamin cant hurt but usually confers no discernible benefit.  Many other supplements either do not  work or cause harm.  

If you are underweight, adding 300-500 calories a day in protein rich and healthy carbohydrate sources. Alternatively, adding two servings of Ensure or an equivalent nutritional supplement is a good option.

If you are overweight, structured diet plans (reviewed elsewhere) and group supports provide optimal approaches for weight loss.  Medications to aid with appetite control provide another aspect of a complete treatment approach.