A Weighty Issue

The topic of weight and weight gain can be a sensitive subject for most everyone. No one wants to discuss particulars and admit the scale keeps going up. But according to the Centers for Disease Control and Prevention, more than 66 percent of Oklahoma adults are overweight, and more than 30 percent are obese – making Oklahoma the sixth worst state in the nation for adult obesity rates.

Now, more than ever, is the time to start talking about the serious health risks associated with increased weight. If you’ve been ignoring the warnings of your healthcare provider, start listening. And if your doctor isn’t making your weight a priority, it may be time to take charge or find someone new, because it could save your life.

Dr. Mary Ann Bauman, medical director for Women’s Health and Community Relations at INTEGRIS Health in Oklahoma City, readily admits that discussing her patient’s weight can be a delicate issue, but she believes in taking a direct approach.

“Weight is a part of the vital signs I check during patient appointments. Our office has an automatic Body Mass Index indicator so we can quickly and easily assess whether or not a patient is overweight,” she says. “Patients are often surprised to learn that they are obese.”

A person’s BMI is a number calculated from a person’s weight and height and provides an indicator of body fatness. For adults age 18 and over, a BMI above 25 is considered overweight, while a BMI above 30 is considered obese. Only in the past decade has BMI become a part of checking a patient’s vital signs.

Bauman uses the BMI indicator to determine what her patient’s weight needs to be and then works with them to form a plan on how they can achieve their weight loss goals.

“Not every patient wants to talk about their weight, and some do get angry and don’t want to discuss it,” she says. “But as a doctor, I believe it’s my responsibility to make them aware, especially since being overweight leads to so many health problems including high blood pressure, high cholesterol, heart disease and diabetes. Many women also don’t realize that it’s a risk factor for breast cancer.”

Dr. Susie Willard with the Family Health and Wellness Clinic in Tulsa says that since BMI has become a required vital sign, it’s easier to talk with patients.

“I now discuss it along with a patient’s blood pressure, heart rate and so on,” she says. “There’s an art to medicine, and over time, you practice and develop effective ways to talk with your patients.”

However, she also believes it’s important to be a positive example.

“Physicians need to be a model to their patients,” Willard explains. “If you’re trying to be healthy yourself, it’s easier to talk to your patients about their lifestyle.”

A recent study by the medical journal Obesity found that physicians who were overweight or obese were less likely to bring up the subject of weight loss with their patients.

“I believe physicians are obligated to address and discuss their patient’s weight,” says Bauman. “How can they not be worried about it? If your doctor isn’t concerned, you might need to consider a new physician.”

In her practice, Willard strives to educate her patients on the many chronic diseases linked to obesity.

“Oklahomans are used to weather forecasts and hearing about how the weather conditions are ‘just right’ for a storm. It’s the same way with obesity,” she says. “The conditions are just right for a perfect storm of health problems.”

The serious health issues associated with obesity include high cholesterol, type 2 diabetes, high blood pressure, metabolic syndrome, heart disease, stroke, cancer and more. However, the silver lining to this ominous cloud is that people can dramatically reduce their risks through diet and exercise.

Bauman explains that many patients don’t realize how much they are eating and how the pounds can slowly add up.

“Studies have shown that overweight people underestimate their caloric intake by 50 percent and overestimate their exercise by 50 percent,” she says. “I call it the ‘weight creep.’ By eating only an additional 100 calories a day, you can gain up to 10 extra pounds in a year.”

Bauman suggests that her patients begin by writing down everything they eat and drink for at least two weeks. This helps them understand how many calories they are consuming. She also recommends programs like Weight Watchers that help people learn how to eat differently and how to make better, healthier food choices. She doesn’t believe in diet pills or quick fixes, but rather a healthy diet with regular exercise.

“People say they don’t exercise because they haven’t found an activity that they like to do, but I tell them they don’t have to like it, you just have to do it. Every day we do things we don’t like to do because they need to be done or they’re the right thing to do,” explains Bauman. “We give ourselves too many reasons not to exercise and lose weight, and by doing so, we sabotage ourselves.”

Willard regularly shares a success story of her patient, Jenny, who has lost more than 100 pounds. She has Jenny’s “before” and “after” photos hanging in her office to serve as an inspiration for others.

“I tell people the only difference between the two photos is how much she moved and what she put in her mouth,” says Willard. “A simple step that everyone can take is to make a decision to move more and eat less.”

Bauman explains that too often people have the habit of thinking their stomach needs to be full all of the time. Instead, she says when a craving hits, people should try drinking water or taking a walk – they will soon find that the hunger pains have subsided.

“It’s not about depriving yourself,” she adds. “It’s about learning why you do what you do and then changing those behaviors and habits. I had a patient who lost 40 pounds because she learned that it was okay to feel hungry.”

Bauman is also quick to point out that to make progress, you can’t beat yourself up or give up every time you make a poor food choice or skip exercise.

“Don’t berate yourself. It isn’t about shame. It’s really about being consistent,” she says. “Exercise will help to raise your metabolic rate so you will use your calories more efficiently, but unless you are training for hours every day, you still need to cut calories. I always tell people that I recognize that losing weight is not going to be easy, but losing even one pound a week can make a big difference. In a year, you will have lost 52 pounds.”
 

Not Just For Adults

As our nation’s childhood obesity rate continues to rise – more than tripling in the past 30 years – the medical community is offering its resources to help children become healthier and calling on parents to take part.

Within the state, OU Children’s Physicians recently opened the Pediatric Exercising and Eating Responsibility Clinic (PEER) focused specifically on childhood fitness and healthy eating habits.

Dr. Ashley Weedn, PEER Medical Director and OU Children’s Physicians pediatrician, believes without intervention at the clinical level, “we risk losing part of a generation to a host of health problems linked to obesity.”

“National studies indicate that nearly 30 percent of preschool-aged children are already overweight; 12 percent of these children are obese,” said Weedn. “Children with excess weight in early childhood have an increased risk of being obese as an adult; therefore, being aware of your child’s weight status at an early age is important.”

Weedn adds that the American Academy of Pediatrics (AAP) recommends body mass index (BMI) screenings for all children beginning at age two, and that with this screening parents and doctors have an opportunity to talk about appropriate weight gain and establishing healthy behaviors early in life.

When helping a child adopt a healthier lifestyle, the key to success is making it a family affair. According to Weedn, having obese parents greatly increases the risk of obesity for the child.

“While obesity can be a sensitive topic for some parents, the importance of addressing family perceptions of weight and behaviors leading to unhealthy weight are the first steps to health promotion for the child and family,” she says.

That’s why the PEER clinic takes a family-based approach. The recommendations for the child apply to the entire family. And just like adults, the causes of childhood obesity are diverse.

“While there are multiple factors involved in excess weight gain, the most common underlying causes of obesity are related to behaviors, including overeating, eating unhealthy foods, drinking too much sugar and lack of physical activity,” said Weedn. “As a result of these behaviors, we are seeing a number of medical conditions in obese youth, once only seen in adults. Type 2 diabetes, high blood pressure, elevated cholesterol levels and liver problems are just a few of the conditions that are now commonly diagnosed in severely obese children.”

Fighting this epidemic on a national scale, the AAP has also adopted the “5210” campaign to help promote healthy behaviors for children and teenagers. The recommendations are for the whole family and include:
5: Eat five or more servings of fruits and vegetables daily for the entire family.
2:  Decrease screen time (TV, computer, video games, etc.) to less than two hours per day.
1:  Encourage physical activity, at least one hour of activity daily for children and teenagers.
0:  Eliminate or limit sugar-sweetened beverages (juice, soda, sports drinks).

Weedn also suggests the following tips for parents:
– Breastfeed exclusively for the first six months of life, which helps decrease the risk of being overweight in childhood.
–Eat breakfast daily, and avoid skipping meals.
–Strive to eat meals as a family, and limit fast food to once a week.
–Monitor portion sizes.
–Avoid using food as a reward or punishment.
–Eat slower; if finished with first serving, wait 20 minutes, eat a non-starchy vegetable or meat if still hungry; wait another 20 minutes and eat a non-starchy vegetable or sugar-free popsicle. – RF

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