Yo Mama So Fat She Ate Jenny and Craig

alright, so none of us love everything about our bodies. most of us can pinch an inch and aren't totally thrilled with the number on the scale. i myself could use a little less muffintop-ness and some good ol' fashioned suzanne summers' butt sculpting.....(when the scuba dive shop owner guessed my weight the other day, i was appalled that he would guess such a high number... and then impressed with his accuracy when i weighed myself the next day. d'oh! maybe he should have been a carny worker.)

ANYway....i have more conversations with patients, friends, colleagues every day about weight loss than anything. all the zillions of diet plans out there , new globo gyms popping up on every corner, theories on health and weight and the different cultural aspects of body images.....there really is a lot to say about it. (and i'm not EVEN going to get into the whole underweight= pretty model/celebrity thing where the winner of America's Next Top Model this year was lauded for her courage to overcome adversity in life as a freaking SIZE 10 plus size model...here i'm just talking about weighing to much).

we in america have a lot of health advantages over other places- clean(ish) air and water, abundant agriculture, excellent health care and even some preventative health care, and lots of research and public awareness on both healthy living and risky lifestyle choices. but i think maybe we have a bit too ample a supply, are sedentary with all of our leisure activities and time-saving shortcuts and have skewed our perspective of what body size is 'normal.' believe it or not, 66% of americans are overweight (BMI 25-29). and a full 1/3 of americans are clinically obese (BMI >30). these criteria are defined by BMI (body mass index), which you can calculate for your own self, if you're curious. the definition of morbid obesity varies, but is considered by the W.H.O to be a BMI of >40. for example, someone who is 5'9" and weighs 275# is clinically morbidly obese.

so because most americans are overweight, most of the patients we see at the clinic and hospital are overweight/obese. some are even hundreds of pounds overweight. a "normal" middle-aged patient seems to have at least an extra 30-60 pounds. but there are regular folks, professionals with active careers and busy lives lugging around an extra 100+ pounds. clearly, the higher the BMI, the more associated problems, but all extra padding has its consequences....all of the following health problems (comorbidities) have proven association with being overweight:

-diabetes -high blood pressure -high cholesterol -coronary and cerebral artery diseases (heart attacks, strokes) -peripheral vascular disease -sleep apnea -asthma -joint problems -some cancers -fertility issues -erectile issues -the list goes on

....which means the good news is, losing the weight can bring back health! i love the show "the biggest loser." it's a reality show where contestants are competing to lose the largest % of body weight. i remember one particular success story for the discussion of his medical status- he was a guy in his 40's who was maybe 120 pounds overweight and on something like 8 different meds/day. in losing 100 pounds he cured his type II diabetes, asthma, and hypertension and greatly improved his cholesterol levels. losing that much weight is not an easy task, to be sure. but he just gave his heart, kidneys, brain, eyes, EVERYTHING years of healthy living. and notice i said "cured" instead of "treated" since he is by all definitions rid of those problems since their underlying source was his obesity. amazing.

so....how's weight loss happen? after all, we still have to eat for survival since we haven't yet invented some sort of nutritionally dense pill formula to get us all our daily nutrients (thank God!)....so it's not like other addictions/indulgences....it's not like we HAVE to have cigarettes or cocaine and that stopping them all together will harm us. so how do we do it... what is moderation? is that like 3 homemade chocolate chip cookies instead of the 12 that i would like to eat? is that like cooking in olive oil instead of lard? is that like foregoing bacon for celery?

this is already the longest post ever, so i'm not going to go into too many details. suffice it to say that a low fat, low calorie, high fiber diet with aerobic exercise a few times/week is a good start. i think i've shown you my love for the weight watchers program before. i really think those lessons are good ones for life, but there are other good programs out there, too. diets where you starve yourself from all of one food group don't usually last, are painful, and often have negative health consequences. balance really is key. leave me a message if you want to talk more about any of this.

but i do want to make note that while fast food gets a bad name, our portion sizes and fat/calorie content in restaurants in america is shocking. honestly, there's a new burger at that royal burger restaurant called the Loaded Steakhouse Burger (Angus beef, cheese, loaded baked potato topping, bacon and steak sauce) that contains 55 gm fat and 970 calories. if you're on a 2000 calorie diet (which is way too much for most of us), that is 100% of your daily fat allowance and almost half of your daily calories. and are you full after that? is that enough to 1/2 satiate you for the day? and it's not just the big ticket items....it's the sneaky things that will get you....there are 290 calories in a large regular Coke, and (this is a travesty, but true) 370 calories and 11 gms fat in a little mini value size chocolate shake. yikes!

so that's what's on my mind. i am taken aback by the patients who will pay to take a dozen meds a day and consider bariatric surgery (gastric bypass) but won't go for a walk or cut back on food intake. they're killing themselves and going broke to support their weight, basically. it's sad. and frustrating. and i really don't mean to be insensitive- i know there are no quick fixes and that weight loss/gain can be a vicious circle and that often times there are social, psychological, and historical elements involved. but let's try.

ONE LAST THING, i promise. my husband is my hero. i know i've bragged about him before, but it's compulsive. i can't help it. he is 30 and at about 22 decided to take his lifelong obesity into his own hands. he was 90 pounds overweight at that time. through a vegetarian diet, weight watchers and exercise he has lost 70+ pounds. it took every bit of those 8 years and when he started, he could only walk/run 1 mile at a time. now he has competed in several 5 and 10k runs, a triathlon, and is currently training for his first full marathon (26 miles of insanity). he can't let up, always has to be diligent, but he's kept the weight off. he is young and healthy and fortunately has no health problems associated with his obesity, but he really did save his own life. impressive.

alright. ENOUGH! (....don't even let me get started on smoking...we'd be here all night.....)



**if you're interested in the money side of things, emedicine says in their article on "Obesity" that: "The annual cost of managing obesity in the United States alone amounts to approximately $100 billion, of which approximately $52 billion are direct costs of healthcare. These costs amount to approximately 5.7% of all US health expenditure. The cost of lost productivity due to obesity is approximately $3.9 billion, and another $33 billion is spent annually on weight-loss products and services."