Overweight & Obesity

Healthy versus unhealthy weight ranges are often determined by body mass index, BMI. The standard definitions of these ranges are as follows.

Normal weight is defined as a BMI of 18.5 to 24.9 kg/m2.

Overweight is defined as a BMI of 25 to 29.9 kg/m2.

Obesity is defined as a BMI of 30 kg/m2 or greater.

Severe Obesity is defined as a BMI of 40 kg/m2 or greater.

Disclaimer: the above definitions may misclassify an individual with high muscle mass.

Calculate your BMI here

Why is achieving and maintaining a healthy weight important?

Many diseases (think of a disease as any disorder which causes lack of ease or discomfort in your body, and ultimately in your life) are associated with or hastened by an unhealthy body weight and/or unhealthy eating behaviors or food choices.

Hence, healthy eating and achieving and maintaining a healthy weight can reduce or eliminate many diseases.

These diseases may include, but are not limited to:

• anxiety
• depression
• insomnia
• headaches
• migraines
• sleep apnea
• high blood pressure
• high cholesterol
• heart attack
• stroke
• blood clots
• gout
• autoimmune diseases
• joint aches and pains
• shortness or breath
• fatty liver disease
• irritable bowels
• pancreatitis
• diabetes
• acid reflux
• irregular periods
• polycystic ovarian syndrome
• acne
• skin conditions
• fungal infections
• edema
• certain cancers

Did you know unhealthy dietary habits can be linked to 35% of certain cancer types?

Studies also associate unhealthy weight with an increase in mortality.

Are you an unhealthy weight and committed to becoming healthy?

The goal of achieving and maintaining a healthy weight is to improve an individuals overall quality of life by treating and preventing diseases associated with or caused by being overweight.

The next steps are generally applicable to individuals who are not pregnant, and who are determined to be appropriate for weight loss, specific diets, and moderate physical activity by their health care provider.

Building the Foundation

Changes in routines, unhealthy habits, or coping mechanisms don’t happen overnight. Achieving and maintaining a healthy weight requires taking many essential steps, each one important and unskippable.

Many people believe that medication is the best, or even the only, solution for weight loss. They often justify this by saying, “I tried ‘X’ diet or ‘X’ exercise, but I didn’t lose weight,” or “the weight came back.” However, this perspective couldn’t be further from the truth.

It has been said that implementing a change or new habit can take about 3 months of consistency at a minimum to “stick”.

The Steps

Implement one new habit at a time, and be mindful about it everyday, even after you feel secure that is has “stuck”. Do not overburden yourself with multiple life changes at one time, it will be overwhelming, and for most individuals it will fail.

Step 1: Set a realistic 90 day goal, for example: I will lose 5 lbs in 90 days.

Journal daily, for at least 5 minutes on how the day went/plans for the day, what you are grateful for, and what could have made the day better?

Write at least 1 line indicating what you will do each day in order to reach your 90 day goal, for example: I will power walk after dinner for 20 minutes (and complete it within 24 hours!).

Step 2: Maintain a regular sleep/wake cycle 7 days per week, sleeping at least 7-9 hours per day. For example, If you rise at 7 am for work everyday, do it 7 days per week, and if you lay down to sleep by 11 pm at night to get enough sleep for work, do it 7 days per week. This is very important for your circadian rhythm, and the bodies ability to reliability secrete certain hormones when it needs to, and in healthy amounts.

Step 3: Clean up your lifestyle choices and any dependance. If you are relying on any substances, such as,  alcohol, drugs, nicotine, caffeine (sodas, energy drinks or more than 1 cup of coffee per day) or sugary drinks, e.g., drinks with sucralose or “natural flavors” seek help and guidance in eliminating those substances. Nutritionists are exceptional at helping you to find the “blind” spots in your regular consumption, and finding healthy substitutes which work for you.

They can also act as an accountability coach throughout your weight loss journey, helping you stay honest with your daily nutrition choices and ensuring you meet essential dietary needs like protein and fiber along the way.

Step 4: Step 4 is a caveat where I actually recommend doing 2 things at once! Yes, it’s the classic diet and exercise, but before you roll your eyes, hear me out…

Establish a realistic routine to stay active. Ideally this routine will be scalable, e.g., increasing daily steps over several weeks to be able to achieve 12k steps each and every day at a minimum when the goal is weight loss. Once the goal becomes maintaining an ideal body weight, obtaining at least 10k steps each and every day will be the new goal.

This is going to look different for every individual depending on various factors, and is best discussed with your provider. (And if it is silver sneakers exercises from a chair a few days per week, great! That’s activity!)

Strength training 3-4 days per week is vital for building muscle, which passively burns fat. It also plays a key role in preventing the loss of muscle mass and bone density when using GLP-1 therapy. Without strength training, unintentional muscle loss can lead to weight regain after discontinuing the therapy.

Of note: In the research exercise has outperformed medications for focus, depression and anxiety, improving these conditions is an excellent recipe for  increasing motivation and energy to pursue a goal such as weight loss.

Diet

Again, everyone is different with differing dietary restrictions or dietary intolerances, but in the research eating a Mediterranean and plant based type diet between the hours of 11 am and 7 pm, with fasting and water hydration during the “off hours” has shown benefit.

Some resources:

If you are not much of a cook, or do not have the time bistroMD (and many others online) offers various diets and chef prepared meals via home delivery. Also check your local area, many cities have small businesses which offer healthy fresh chef prepared meals for various types of diets.

Establishing with a Nutritionist can also be very helpful and most insurances are covering this at 100% now.

Of note: much has changed, and what you can expect from a Nutritionist may be far different from any experience you may have had with a Dietician years ago. Many Nutritionists now focus on both a healthy diet and meal planning as well as behaviors around eating, emotional eating, etc. and this is where the real change and building a strong foundation can happen. 

A therapist may also be helpful and necessary, this is where talking with your provider and being honest with yourself in your self assessment comes in.

To Wrap Up Lifestyle Modifications and Laying the Foundation

Laying the foundation may take 3 months, or it could take 12 months or longer. There’s no “right” or “ideal” timeline, as everyone is at a different stage in life with varying access to resources. It is best to be honest with yourself in your self assessment, and to take the time you need in building a strong foundation for success.

Why rush it and risk the house crumbling and having to start over? – that is a true waste of time, and resources.

Taking the time to build a strong foundation is NEVER a waste of time.

Maintaining a healthy weight is a daily commitment and a long-term lifestyle, not a short-term effort. It’s important to set realistic expectations about both achieving and sustaining a healthy weight.

Treatment

Once you have formally laid the foundation and have a solid healthy lifestyle routine regarding diet, exercise and your mental health; and if achieving a healthy weight did not happen, it may be time to consider medications.

Pharmacologic therapy, or “medications” are a true adjunct to a proper foundation in the weight loss journey, they are not the sole answer and should not be prescribed in the absence of a a proper foundation as outlined above.

Keep in mind, no medication is free from potential side effects, and many medications have contraindications.

A few new medications, specifically GLP-1 receptor agonists, have been FDA approved for weight loss, for example, Tirzepatide or Zepbound, Semaglutide or Wegovy, and Liraglutide or Saxenda.

They have far fewer side effects than some of the older available medications, but some of the potential side effects include (but are not limited to): hypoglycemia, syncope, cardiovascular effects, thyroid cancer, hemorrhagic and non-hemorrhagic pancreatitis, gastroparesis, kidney injury/disease, gallstones, GERD, gastritis, non-arteritic anterior ischemic optic neuropathy (NAION) “eye stroke”, which can result in loss of vision. There is also risk of a serious reactions such as (but not limited to) allergic, anaphylaxis, angioedema, and acute kidney injury.

Of note: these medications can cost over $1,050-1,500 per month, and they require close monitoring, meaning visits with your provider every month on average. These effective, yet unfortunately costly medications, are often denied coverage by insurance companies.

Indications for pharmacologic weight loss therapy (including items insurance companies will ask when considering covering the drug cost):

• Candidates for anti-obesity medications have a BMI > 30 kg/m2 or a BMI > 27 kg/m2 with co-morbidities (heart disease, diabetes)
• Candidates must have tried other, less costly medications or have contraindications to them
• Candidates must have failed prior diet and exercises regimens in conjunction with their provider or Nutritionist
• Candidates must have a current diet and exercise regimen in place which is documented by their provider

and the list can go on, depending on the insurance company.