All too often, obesity prompts a strenuous diet in the hopes of reaching the “ideal body weight.” Some amount of weight loss may be accomplished, but the lost weight usually quickly returns. More than 95% of the people who lose weight regain the weight within five years. It is clear that a more effective, long-lasting treatment for obesity must be found, lest obesity lead to oblivion.

We need to learn more about the causes of obesity, and then we need to change the ways we treat it.

When obesity is accepted as a chronic disease, it will be treated like other chronic diseases such as diabetes and high blood pressure. The treatment of obesity cannot be a short-term “fix,” but has to be an ongoing life-long process.

Instead of staring nearsightedly at the goal of attaining an “ideal weight,” obesity treatment must acknowledge that even modest weight loss can be beneficial. For example, a modest weight loss of 5 to 10% of the initial weight, and long-term maintenance of that weight loss can bring significant health gains, including:

 
• Lowered blood pressure  
• Reduced blood levels of cholesterol  
• Reduced risk of type 2 (adult-onset) diabetes. In the Nurses Health Study, women who lost 5 kilograms (11 pounds) of weight reduced their risk of diabetes by 50% or more.  
• Decreased chance of stroke  
• Decreased complications of heart disease  
• Decreased overall mortality

It is not necessary to achieve an “ideal weight” to derive health benefits from obesity treatment. Instead, the goal of treatment should be to reach and hold to a “healthier weight” (for more, please read the “Aim for a Healthy Weight” article). The emphasis of treatment should be to commit to the process of life-long healthy living including eating more wisely and increasing physical activity.

In sum, the goal in dealing with obesity is to achieve and maintain a “healthier weight.”

Does it matter where body fat is located? (Is it worse to be an ‘apple’ or a ‘pear’?)

Concern is directed not only at how much fat a person has but also where that fat is located on the body. The pattern of body fat distribution tends to differ in men and women.

Women typically collect fat in their hips and buttocks, giving their figures a “pear” shape. Men, on the other hand, usually collect fat around the belly, giving them more of an “apple” shape. (This is not a hard and fast rule, some men are pear-shaped and some women become apple-shaped, particularly after menopause).

Apple-shaped people whose fat is concentrated mostly in the abdomen are more likely to develop many of the health problems associated with obesity. They are at increased health risk because of their fat distribution. While obesity of any kind is a health risk- yes, it is better to be a pear than an apple.

In order to sort the types of fruit, doctors have developed a simple way to determine whether someone is an apple or a pear. The measurement is called waist-to-hip ratio. To find out a person’s waist-to-hip ratio, measure the waist at its narrowest point, and then measure the hips at the widest point. Divide the waist measurement by the hip measurement. For example, a woman with a 35-inch waist and 46-inch hips would have a waist-to-hip ratio of 0.76 (35 divided by 46 = 0.76). Women with waist-to-hip ratios of more than 0.8 and men with waist-to-hip ratios of more than 1.0 are “apples.”

Another rough way of estimating the amount of a person’s abdominal fat is by measuring the waist circumference. Men with waist circumference of 40 inches or greater and women with waist circumference of 35 inches or greater are considered to have increased health risks related to obesity.

What is the role of physical activity and exercise in obesity?

The National Health and Examination Survey (NHANES I) showed that people who engage in limited recreational activity were more likely to gain weight than more active people. Other studies have shown that people who engage in regular strenuous activity gain less weight than sedentary people. Studies on twins (twins have identical genes) showed that physical activity might actually protect the more active twin from developing obesity.

Physical activity and exercise help burn calories. The amount of calories burned depends on the type, duration, and intensity of the activity. It also depends on the weight of the person. A 200-pound person will burn more calories running 1 mile than a 120-pound person, because the work of carrying those extra 80 pounds must be factored in. But exercise as a treatment for obesity is most effective when combined with a diet weight-loss program. Exercise alone without diet will have a limited effect on weight because one has to exercise a lot to simply lose one pound. However regular exercise is an important part of a healthy lifestyle to maintain a healthy weight for the long term. Another advantage of regular exercise as part of a weight-loss program is a greater loss of body fat versus lean muscle compared to those who diet alone.

Other benefits of exercise include:

 
• Improved blood sugar control and increased insulin sensitivity (decreased insulin resistance)  
• Reduced triglyceride levels and increased good HDL cholesterol levels  
• Lowered blood pressure  
• A reduction in abdominal fat  
• Reduced risk of heart disease. A study performed in men found those with moderate activity had a 23 percent lower risk of death than those who were less active.

Remember, these health benefits can occur independently (with or without) achieving weight loss. Before starting an exercise program, you should talk to your doctor about the type and intensity of the exercise program.

General exercise recommendations:

 
• 20-30 minutes of moderate exercise 5 to 7 days a week, preferably daily. Types of exercise include walking, stationary bicycling, walking or jogging on a treadmill, stair climbing machines, jogging, and swimming.  
• Exercise can be broken up into smaller 10-minute sessions.  
• Start slowly and progress gradually to avoid injury, excessive soreness, or fatigue. Over time, build up to 30 to 60 minutes of moderate to vigorous exercise every day.  
• People are never too old to start exercising. Even frail, elderly individuals (ages 70-90 years) can improve their strength and balance.