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Battling obesity

By Jane E. Brody
New York Times

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  • Are you at risk?

    The first step toward avoiding obesity problems is a simple calculation to determine whether you are at risk. The most frequently used measure is body mass index.

    • Divide weight in kilograms by height in meters squared. The National Heart, Lung and Blood Institute, among others, offers a free calculator online. A BMI of 30 or more indicates obesity, but BMI can be misleading if heavy bones and big muscles account for much of someone’s weight.

    • A simpler measure is a waistline as large as or larger than a person’s hips. Overweight typically starts at a waist of 40 inches for men and 35 inches for women.

    • The easiest assessment of all? Stand naked in front of a mirror and assess the contribution that fat is making to your body’s composition. It’s not hard to see.

    Obesity problems

    HEART DISEASE, STROKE

    Obesity can raise levels of triglycerides and LDL cholesterol and lower levels of protective HDL cholesterol. This raises the risk of atherosclerosis tenfold, fostering a buildup of plaque in arteries that feed the heart and brain. Obesity also strains the heart and can lead to heart failure.

    HIGH BLOOD PRESSURE

    Excess body fat increases the volume of blood the heart must pump to supply nutrients and oxygen. This increases the pressure on artery walls, which contributes to heart disease, stroke and kidney failure.

    TYPE 2 DIABETES

    Obesity impairs the body’s ability to use insulin to maintain normal blood sugar levels. Diabetes, in turn, is a leading cause of heart disease, stroke, kidney disease and blindness. Even being moderately overweight can lead to insulin resistance, in which the body becomes insensitive to the hormone. The condition can be reversed by weight loss.

    JOINT DISEASE

    The more weight a person carries, the greater the stress on joints and the risk of developing osteoarthritis in the knees, hips and lower back. Obesity is a major reason for the rise in joint replacements.

    BREATHING PROBLEMS

    Obesity is the leading cause of obstructive sleep apnea – breathing stops periodically during sleep, followed by an abrupt intake of air and loud snoring.

    CANCER

    Increased risk of developing cancers of the colon, breast, endometrium, esophagus, pancreas, kidney, thyroid and gallbladder.

    METABOLIC SYNDROME

    One-third of overweight and obese people have a constellation of six factors that raise the risk of cardiovascular disease: abdominal obesity, high blood pressure, high cholesterol, insulin resistance, excessive clotting factors and inflammatory compounds in the bloodstream. Abdominal fat is especially hazardous because it is metabolically active, unlike fat on the hips and thighs.



Most people know that obesity can result in serious health problems, yet many of us continue to focus on its cosmetic consequences rather than its risks to health.

This distorted view may change now that the American Medical Association has finally labeled obesity a disease, not just a risk factor for other disorders. Last month, the organization recognized that obesity is a verifiable illness that warrants more attention than physicians, patients and insurers give it.

The designation may change how aggressively doctors treat obesity, foster the development of new therapies and lead to better coverage by insurers. After all, the price of not treating obesity is in the stratosphere. Obesity-related health conditions cost the nation more than $150 billion and result in an estimated 300,000 premature deaths each year.

If the population’s weight gain is not soon capped (or better yet, reversed), experts predict that half of adults in America will be obese by 2040. The AMA has said in effect that it is medicine’s responsibility to provide the knowledge and tools needed to curb this runaway epidemic.

On June 19, James Gandolfini, the hefty award-winning actor who portrayed Tony Soprano in “The Sopranos,” died at 51, apparently of a heart attack while on vacation in Italy. Even if genetics played a role, Gandolfini’s weight contributed significantly to his risk of sudden cardiac death.

Not a week earlier, a 46-year-old member of my family who weighed more than 300 pounds died suddenly of what might have been a heart attack while dozing in front of the television. He had long suffered from sleep apnea (a risk factor for sudden death), high blood pressure and severe gout, all results of his extreme weight.

Fran Saunders, a 62-year-old Brooklynite, is determined to avoid a similar fate. At 4 feet 11 inches tall and 157 pounds, she was clinically obese. She was sent for blood tests when she complained of a vision problem that could have been related to her weight. All her lab readings — total cholesterol, triglycerides, blood sugar — were seriously abnormal. Her doctor said she was a heart attack waiting to happen. But “the bad news was a blessing in disguise,” she told me.

Though she had long been a regular at the gym, she knew it was time to get her diet on a healthier track to lower her cholesterol, her risk of developing diabetes and her chances of dying prematurely.

She now monitors what she eats and how much she exercises with a free cellphone app, My Fitness Pal. Gradual weight loss started almost overnight at a pound or two a week. Although her goal weight is 110 to 115 pounds, her blood test results improved significantly after she lost just seven pounds.

“My doctor told me that every pound I lose lowers my risk,” said Saunders. “I know it’s possible for some people to be fit and fat, but that wasn’t the case for me, and it was time to stop kidding myself.”

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