Dr. James Manos (MD)
October 25, 2015
Treating obesity with diet, regular exercise & herbs
Note: in this text, the writer expresses his point of view. Some advice is empirical, so you should consult your family doctor beforehand.
Treating obesity with a healthy diet, calorie restriction & regular exercise
· Obese people aren’t aware that they have a decreased life expectancy than non-obese people. Namely, they die earlier!
· Obesity starts in childhood!
· Most people in Western countries, especially in the USA, are overweight or obese. The causes are 2: junk food and a sedentary lifestyle.
· Obesity is a cause of many medical problems.
Obesity increases the risk for many medical diseases such as coronary heart disease (CHD), hyperlipidemia (high blood lipids, i.e., fats), hypertension (high blood pressure), cerebrovascular accident (CVA; stroke), diabetes mellitus (DM) type 2, gallbladder stones, psychological problems (including depression), post-surgical complications, sleep apnea, pulmonary problems, increased mortality risk (for BMI >30), cancer (breast, colon, cervix, uterus, ovary), back pain, arthritis (knees, hips), menstrual problems (irregular menses and ovulatory failure), PCOs (polycystic ovary syndrome), stress incontinence and also complications in pregnancy (gestational diabetes, hypertension and pre-eclampsia and also difficult delivery with shoulder dystocia), arterial and venous insufficiency in the legs, deep vein thrombosis in special circumstances (on bedridden patients or after surgery) that predisposes to pulmonary embolism, etc.
Today obesity is a real pandemic!
· Medical causes of obesity, such as hypothyroidism or Cushing syndrome, should be sought. Drugs such as tricyclic antidepressants (TCAs) & glucocorticosteroids (such as cortisone) may also cause obesity.
· Do not forget, however, that excessive eating is associated with increased stress or depression and other psychological problems.
· ΒΜΙ (body mass index)
· Body mass index (BMI) (also known as Quetelet index) is a measure of relative size based on the mass (weight) and height of an individual.
· BMI=mass (Kg)/ (height (m))2 or BMI=mass (lb)/ (height (in))2 x 703
Category
|
BMI range – kg/m2
|
BMI Prime
|
Very severely underweight
|
less than 15
|
less than 0.60
|
Severely underweight
|
from 15.0 to 16.0
|
from 0.60 to 0.64
|
Underweight
|
from 16.0 to 18.5
|
from 0.64 to 0.74
|
Normal (healthy weight)
|
from 18.5 to 25
|
from 0.74 to 1.0
|
Overweight
|
from 25 to 30
|
from 1.0 to 1.2
|
Obese Class I (Moderately obese)
|
from 30 to 35
|
from 1.2 to 1.4
|
Obese Class II (Severely obese)
|
from 35 to 40
|
from 1.4 to 1.6
|
Obese Class III (Very severely obese)
|
over 40
|
over 1.6
|
Obesity is a major health problem. Measuring BMI helps classify obesity. BMI is estimated by weight (Kg)/ [height (m)]2. BMI 18,5 – 24,9 is normal. BMI 25 – 29,9 is overweight. A BMI of 30- 39,9 is considered obesity, and a BMI equal to or more than forty is morbid obesity.
· For your BMI, you may check the online calculator on http://www.cancer.org/healthy/toolsandcalculators/calculators/app/body-mass-calculator
· The BMI over 30 triples mortality!
· Central (visceral) obesity & waist circumference
· Europe: men>_ 94 cm, women >_ 80 cm
· South Asia: men >_90 cm, women >_80 cm
· China: men >_90 cm, women >_80 cm
· Japan: men >_85 cm, women >_90 cm
· South & Central America: use South Asian pro tem (for the time being)
· African & Middle East: use European pro tem.
· Waist circumference equal to or more than 94 cm (37 inches) for men and 80 cm (32 inches) for women increases the risk for coronary heart disease (CHD) and diabetes mellitus (DM).
· Obesity & the role of the hormone leptin
Leptin (the ‘satiety hormone’) is a hormone made by adipose cells (fat tissue cells) that helps to regulate energy balance by inhibiting hunger. Leptin is opposed by the actions of the hormone ghrelin (the ‘hunger hormone’). Both hormones act on receptors in the arcuate nucleus of the brain's hypothalamus to regulate appetite to achieve energy homeostasis (regulation). Obesity is characterized by a decreased sensitivity to leptin, resulting in an inability to detect satiety despite high energy stores. Although regulation of fat stores is deemed the primary function of leptin, it also plays a role in other physiological processes, as evidenced by its multiple sites of synthesis other than fat cells and the multiple cell types besides hypothalamic cells that have leptin receptors.
· Obesity & resveratrol (a natural substance that increases longevity)
· Resveratrol is a substance found in the skins of grapes and in certain other plants, fruits, and seeds. It is made by various plants to help defend against invading fungi, stress, injury, infection, and too much sunlight. It is being studied in the prevention of cancer and heart disease. It is a type of antioxidant polyphenol. Evidence suggests that resveratrol (found in red wine, grapes, and olive oil) may be extremely potent. Lab studies have shown that it increases cell survival and has been shown to increase the lifespan of worms and fruit flies.
· Studies demonstrated in baker’s yeast cells a longevity gene called Sir2 (silent information regulator 2), a sirtuin. This gene expands lifespan by decreasing DNA instability. In mammals, a similar gene is known as SIRT1. Many researchers support the idea that the Sir2 gene is expressed on calorie restriction, related to an increased longevity lifespan of 30% – 40% in mice and rats. Similarly, in mammals, a CR diet ends up in the increased activity of the SIRT1 gene. Resveratrol is a substance found by Sinclair that activates Sir2/SIRT1 gene in yeast, nematode worms, drosophila (fruit flies), and mice with a high-calorie intake, thus expanding their lifespan. However, other research in Drosophila (a fruit fly), yeast, worms, and normal mice didn't ascertain this lifespan extension. However, Italian researchers found that resveratrol expands the lifespan in vertebrate fish by 59%.
· Previous research demonstrated that resveratrol possesses promising properties for preventing obesity. Endoplasmic reticulum (ER) stress was proposed to be involved in the pathophysiology of both obesity and hepatic (liver) steatosis (‘fatty liver’). In a study, the authors hypothesized that resveratrol could protect against high-fat diet (HFD)-induced hepatic steatosis and ER stress and regulate the expression of genes related to hepatic steatosis. Rats were fed either a control diet or HFD for 12 weeks. After 4 weeks, HFD-fed rats were treated with either resveratrol or a vehicle for 8 weeks. The results showed that resveratrol prevented dyslipidemia (high blood lipids, i.e., fats, such as cholesterol & triglycerides) and hepatic steatosis induced by HFD. Resveratrol significantly decreased activating transcription factor 4, C/EBP-homologous protein, and immunoglobulin binding protein levels, which were elevated by the HFD. Resveratrol also decreased PKR-like ER kinase phosphorylation, although it was not affected by HFD. Moreover, resveratrol increased the expression of peroxisome proliferator-activated receptor delta while decreasing the expression of ATP citrate lyase, suppressor of cytokine signaling-3, and interleukin-1β. In conclusion, this data suggests that resveratrol can prevent hepatic ER stress and regulate the expression of peroxisome proliferator-activated receptor delta, ATP citrate lyase, suppressor of cytokine signaling-3, tumor necrosis factor-alpha, and interleukin-1beta in diet-induced obese rats, and these effects likely contribute to resveratrol's protective function against excessive accumulation of fat in the liver (Reference: http://www.ncbi.nlm.nih.gov/pubmed/26055348 ).
· Resveratrol is a natural polyphenolic compound that activates nicotinamide adenosine dinucleotide-dependent deacetylase SIRT1. Resveratrol has recently been shown to exert potent antidiabetic actions when orally delivered to animal models of type 2 diabetes. However, the tissue(s) mediating these beneficial effects are unknown. Because SIRT1 is expressed in the central nervous system (CNS) neurons known to control glucose and insulin homeostasis, scientists have hypothesized that resveratrol antidiabetic effects are mediated by the brain. A study reported that long-term intracerebroventricular infusion of resveratrol normalizes hyperglycemia (high blood glucose) and dramatically improves hyperinsulinemia (high blood insulin) in diet-induced obese and diabetic mice. These effects are independent of changes in body weight, food intake, and circulating leptin levels. Also, CNS resveratrol delivery improves hypothalamic nuclear factor-kappaB inflammatory signaling by reducing acetylated-RelA/p65 and total RelA/p65 protein contents and inhibitor of nuclear factor-kappaB alpha and IkappaB kinase beta mRNA levels. Moreover, this treatment reduces hepatic phosphoenolpyruvate carboxykinase 1 mRNA and protein levels and ameliorates pyruvate-induced hyperglycemia in this mouse model of type 2 diabetes. In conclusion, these results unveiled a previously unrecognized key role for the CNS (central nervous system) in mediating the anti-diabetic actions of resveratrol (Reference: http://www.ncbi.nlm.nih.gov/pubmed/19819963 ).
Obesity & metabolic syndrome
· Obesity is part of metabolic syndrome.
· Characteristics of metabolic syndrome:
No specific symptoms. Endothelial dysfunction
· Diagnostic criteria for metabolic syndrome: Central obesity or BMI > 30 plus any 2 of:
Hypertension – ΒP> 130/85 mmHg or specific medication
Hyperglycemia/ insulin resistance – Fasting glucose > 100 mg/dL (5.6 mmol/L) or previously diagnosed with type -2 diabetes mellitus (DM) or specific medication
Dyslipidemia: increased triglycerides > 150 mg/dL or >1.7 mmol/L) or specific treatment for hypertriglyceridemia; decreased HDL (‘good’) - cholesterol < 40 mg/dL or <1.03 mmol/L in males and < 50 mg/dL or <1.29 mmol/L in females; or specific treatment.
· Obesity, insulin resistance & diabetes mellitus (DM)
Insulin resistance is a decreased ability of insulin to mediate the metabolic actions on glucose uptake, glucose production, and/or lipolysis.
The prevalence of DM is increasing, parallel with the epidemic of obesity – it touches 8.4% of the USA population – but a significant portion of the population is undiagnosed. Fifth leading cause of death
Obesity causes insulin resistance by increasing the release rate of non-esterified fatty acids, causing post-receptor defects in insulin’s action.
Treatment of obesity
· The main way to treat obesity is through diet and exercise.
Low-calorie diet for treating obesity
· To lose weight, you should follow a low-calorie diet (there are specific calorie books, and all food products mention the calories on the label) with a target of losing 0.5 – 1 kg (1 – 2 lb.) weekly. This is achievable by a low–calorie diet, but these should not be less than 1500 calories daily.
· You may check online calorie calculators such as
To maintain your weight, you can consult the online calculator on http://www.cancer.org/healthy/toolsandcalculators/calculators/app/calorie-counter-calculator
· For converting pounds (lbs.) to kilograms (Kg) and vice versa, you may check the converter on http://www.metric-conversions.org/weight/pounds-to-kilograms.htmwww.metric-conversions.org/weight/kilograms-to-pounds.htm
· For converting height from centimeters to feet & inches and vice versa, you can use the online converter at http://www.height-converter.com/
To lose 1 pound a week, you need to cut 500 calories per day. You can do this by eating less, exercising more, or both.
To cut five hundred calories per day, you may cut 250 calories from your daily diet and burn an extra 250 calories through physical activity. For a 150 lb. (68 Kg) person to lose 250 calories, he/she may do about 30 minutes of singles tennis or 45 minutes of brisk walking.
Exercise for treating obesity
· Regular aerobic exercise helps in losing weight.
· About how many calories you can lose with exercise, you can visit the online calculator on http://www.cancer.org/healthy/toolsandcalculators/calculators/app/exercise-counts-calculator
· Right after you stop exercising, take your pulse: place the tips of your first two fingers lightly over one of the blood vessels on your neck, just to the left or right of your Adam's apple. You may also try the pulse spot inside your wrist just below the base of your thumb. For calculating the pulses per minute, count your pulse for 10 seconds and multiply the number by 6 (as 1 minute is 60 sec). Check your pulse periodically to see if you exercise within your target zone. As you get in better shape, try exercising within the upper range of your target zone.
To lose 1 pound a week, you need to cut 500 calories per day. You can do this by eating less, exercising more, or both.
To cut 500 calories per day, you may cut 250 calories from your daily diet and burn an extra 250 calories through physical activity. For a 150 lb. (68 Kg) person to lose 250 calories, he/she may do about 30 minutes of singles tennis or 45 minutes of brisk walking.
On exercising, the heart rate (HR) should not reach the maximum (220 – age) but within the target zone of 50 – 85% of the average (related to age) maximum heart rate. During the first few weeks of working out, aim for the lower range of your target zone (50%) and gradually build up to the higher range (85%). After six months or more, you may exercise comfortably at up to 85 percent of your maximum heart rate (Reference (Retrieved October 7, 2015): http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/FitnessBasics/Target-Heart-Rates_UCM_434341_Article.jsp and http://www.cancer.org/healthy/toolsandcalculators/calculators/app/target-heart-rate-calculator ).
· For an online calculator of the target heart rate on an exercise, you may visit the site http://www.cancer.org/healthy/toolsandcalculators/calculators/app/target-heart-rate-calculator
· Losing fast weight, faster than 1 kg (2 lb.) weekly, may cause health problems, such as vitamin & mineral deficiency, electrolyte disturbance, metabolic disorders such as hypoglycemia (low blood sugar), anemia by lack of iron and/or vitamin B12 & folic acid, dehydration, sexual dysfunction (such as in the anorectic women who lose their menstrual cycles), etc. Fast losing weight may also cause the skin to become loose and hang!
Dietary changes – a healthy diet for preventing & treating obesity
· A dietitian can recommend a specific diet.
· A diet shouldn’t only be with a low-calorie intake, poor on fat and refined carbohydrates, and rich in fibers, pulses (legumes), fruits, and vegetables (fibers also protect from colon and other cancers).
· Eat plenty of fruits, legumes, and vegetables.
Eating at least 5 servings of fruit and vegetables daily is essential for our health and is recommended by all doctors and WHO. You can eat steamed veggies, e.g., zucchini with oregano, vinegar, and 2 tablespoons olive oil. You should prefer organic fruits and vegetables because they have no pesticides, fertilizers (such as nitrogen - phosphorus), or chemicals. However, if cultivated beside a non–organic farm, they may be contaminated with pesticides and fertilizers.
Eating at least 5 servings of fruit and vegetables daily is essential for our health and is recommended by all doctors and WHO. You can eat steamed veggies, e.g., zucchini with oregano, vinegar, and 2 tablespoons olive oil. You should prefer organic fruits and vegetables because they have no pesticides, fertilizers (such as nitrogen - phosphorus), or chemicals. However, if cultivated beside a non–organic farm, they may be contaminated with pesticides and fertilizers.
· Monothematic diets, e.g., high protein diets, are not ideal. The best is to include a variety of nutrients with fewer carbohydrates and fats.
· High protein will disturb nitrogen balance and may increase blood urea nitrogen (BUN). It is contraindicated in people with kidney failure – chronic kidney disease (CKD).
· A healthy, active person needs about 0.36 grams of protein per pound of body weight. The average American of 150 pounds consumes over one hundred grams of protein daily, or about 0.67 grams of protein per pound, or almost twice what they need, as he/she only needs fifty-four grams!
· Foods from animals (dairy foods, eggs, meat, poultry, fish) have the best combination of amino acids and produce the least waste; these are the ‘high biological value’ (HBV) foods. Some call eggs the ‘perfect food’ because the ratio of amino acids in eggs is very close to the rate that the human body needs, and they have an HBV of nearly 1.0, which is ideal. Egg white has no cholesterol that is only contained in the yolk of the egg (Reference (Retrieved October 7, 2015): http://nephron.org/nephsites/adp/index.htm/protein_ckd.htm ).
· High-fat diets, such as ketogenic diets, are dangerous as they predispose to coronary heart disease (CHD) associated with a heart attack. It should not be used for treating epilepsy (although some studies show about a 50% reduction of seizures in 40% of young patients) instead of taking antiepileptic drugs.
· High carbohydrate diets are not healthy, as they predispose to diabetes and coronary heart disease that is accelerated by hyperglycemia (high blood sugar) and the advanced-glycation end products (AGEs) that are responsible for the vascular complications of diabetes mellitus.
· Dietary AGEs can be present in foods such as meat and butter and can form during frying, roasting, and baking, but less in boiling, stewing, steaming, and microwaving.
· AGEs are the products of non-enzymatic glycation and oxidation of proteins and lipids. AGEs, by stimulating processes linked to inflammation, are implicated in many diseases, such as diabetes, inflammation, neurodegeneration (including dementia), and aging.
· Barbecue foods are high in AGEs. They are also carcinogenic because cold cuts & cured meat contain nitrates (carcinogenic preservatives that may cause cancer, such as stomach cancer). Additionally, food cooked in carbon smoke becomes carcinogenic.
· Excess carbohydrates (‘carbs’) are the primary cause of a high-calorie diet, and their contribution to obesity is major for most people.
· Foods with a low glycemic index should be preferred.
· The Glycemic index (GI) is a number associated with a particular type of food that indicates the food’s effect on a person’s blood glucose. The number typically ranges between 50 and 100, where 100 represents the standard, an equivalent amount of pure glucose. We all need to choose foods with a low glycemic index (GI), as foods with a high glycemic index may predispose us to diabetes and cardiovascular disease. Common foods like bananas have a high glycemic index, so we should eat them moderately or less.
· For morbid obesity, there are specific drugs such as Orlistat (it decreases the absorption of fat that we take with foods). Surgery is the last solution to morbid obesity.
· Regarding operations for obesity, they are for severe morbid obesity, and some have a significant mortality rate because of complications and because the obese is a high–risk surgical patient (e.g., for deep vein thrombophlebitis). The ‘balloon’ or ‘ring’ in the stomach methods may be safer, but the problem is that the patient can eat ice cream and other liquids that pass through the stomach! The bypass operations are only for severe morbid obesity, as they may have severe surgical and after-surgery complications (including malabsorption of essential nutrients) and carry a mortality risk. The ‘gastric sleeve’ makes the stomach smaller, is safer than bypass surgery for obesity, and is efficient in many patients.
Thanks for reading!
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