Autor: markyoung

~ 14/05/10

obesity

 

Yesterday I attended the 6th Annual McMaster Bariatric Conference put on by the Centre for Minimal Access Surgery.  The topic was obesity management and talks ranged included those discussing the risks associated with obesity as well as lifestyle, pharmacological, and surgical management of this condition.

 like myself so interested in the topic of obesity?  For me, body weight is more of a continuum than a distinct divide between lean and obese.  All of us are somewhere on that continuum and (based on statistics) most of us are more towards the obese end than the other.   

 

Moreover, almost 95% of people who lose a significant amount of weight by the usual commercial weight loss practices (i.e., get ripped in 12 weeks) will gain it back plus some additional pounds leading us closer and closer to being la rger and larger throughout our lives.  And I still believe that whether you’re 20 pounds away from your fat loss goal or 100 we are all subject to the same environment, marketing, and dieting practices.  While surgery (if we use it at all) might be used for the most severe cases, conservative management can probably benefit anyone looking to lose body fat permanently.

 

Here are a few notes I took at the conference that I’ll likely expand upon in an upcoming post:

 

- If your BMI is over 25 you are considered overweight.  If your BMI is over 30 you are considered obese (Class I).  OVer 35 is Class II obesity.  Over 40 is Class III.

- BMI does not account for muscle mass so lifters may not be truly obese.  However, if they are carrying excess fat around their midsection, there is still reason for concern.

- The total number of obese people in North America is levelling off.  However, the number of people with class 3 obesity is growing.

- Current statistics on obesity likely underestimate the number of obese because people with normal weight obesity (normal body weight, but high fat percentage) is not included.

- Normal weight obesity results in metabolic issues similar to having a BMI over 30.  These are the people we call “skinny-fat”

- The only group in North America in which obesity rates are still climbing is 6-9 year olds.

- Studies have shown that parents and phsyicians are unable to accurately determine when a child is obese.  In some studies as few as 18% of parents thought their children had weight problems when they were clinically obese.  Doctors didn’t fair much better.  You can’t treat what you don’t diagnose. 

- The best predictor for adult obesity is childhood obesity.

- 90% of obese kids have a lipid abnormility (high cholesterol or triglycerides) and 50% have hyperinsulinemia.

- 20% of obese children are likely to have a heart attack and 15% will have Diabetes by age 38.

- Obesity is second only to smoking as a risk factor for Cancer.

- Some people have now created the term “Diabesity” because of the strong link between Diabetes and obesity.

- Obesity is a chronic condition very much like hypertension.  When treatment is stopped, the condition reappears.

- Body weight is related more to “screen time” than to the amount of exercise you do.  In other words, turn off the computer and television.

- Frequency of activity breaks is related to weight loss more than total amount of activity time.

- A 5-10% body weight reduction shows improvements in lipid profiles, blood sugars, and various other obesity related disorders.  This should be the goal when health is the primary outcome.

- 50% of people on a suitable lifestyle plan (exercise + diet + behaviour modification) can maintain 5% loss at one year.  In other words, you need to treat only two people to achieve this result with one.

- 20% of people on lifestyle plan can maintain 10% at one year.  Need to treat 5 people to get one who does this.

- Lifestyle alone tends to maintain 5% weight loss, lifestyle + pharmacology allows 15%, and gastric bypass around 50% weight loss.

- People who do not lose weight while following a 900 calore per day VLCD (very low calorie diet) will likely not lose weight effectively with surgery.  Possibly due to genetics?

- Although many blame obesity on genetics, the number of genetic mutations that actually occur to cause such conditions likely only accounts for 5% of obese people.

gastric-bypass

- The most common form of weight loss surgery is the Roux en y Gastric Bypass.  The stomach is reduced to a small pouch (about 2 tablespoons) and the pouch is attached at a point further down to bypass the first part of the small intestine.  The procedure is restrictive (small stomach) and malabsorptive (bypassing absorption in the intestine).

- Gastric banding is an alternative type of surgery where an inflatable band is placed around the stomach.  This surgery is reversible, but gastric bypass is not.

gastric-banding

- Gastric bypass is significantly more effective for weight loss than banding.

- Bypass surgery results in an almost immediate remission of Type II Diabetes in most patients.

- Pregnancy is discouraged for 2 years after weight loss surgery.

- After surgery a patient must never consume carbonated beverages again.

- Bariatric surgery requires supplementation to prevent nutrient deficiencies although they are still common.

- Depending on where the surgery is done, 3-40% of bands require removal (usually due to weight regain).

- In patients with BMI over 40 gastric bypass has a 20-35% failure rate at 10 years (again due to weight regain)

- Effectiveness of revision surgery is equally as high, but complications (leaks, infections, etc) are 2.5 times more common.

- Gastric bypass is also more effective than banding in children.  The youngest to date was age 9.

- Craniopharyngioma is a condition of the pituitary that can cause uncontrollable eating in children.  Surgery helps maintain weight.

- One presenter said that gastric bypass was “the real solution to childhood obesity because nothing else really works”.  He was a giant dink.

- Bariatric surgery is the most studied surgery in history.  The screening for this surgery is intense and includes surgeon, nutritionist, social worker, and phsychiatric consults to ensure suitable mental status to maintain weight loss.  Tests for obstructive sleep apnea and other issues are common as well.  Heart and brain surgery has much less screening.

- Patients who are not compliant with managing blood sugars or taking meds probably won’t follow post surgical instructions.

- ADHD has a strong relationship to obesity.  Sometimes treating ADHD causes patients to lose weight.

- Binge Eating Disorder is now officially a diagnosis in the DSM.

- Depression can cause cravings for carbohydrates which increase serotonin.  Screen and treat for depression when necessary.

- The incedence of previous sexual abuse is very high in obesity.

- The higher the BMI, the greater chance of having a history of mental health issues.

- There are increased rates of divorce after bariatric surgery.  Assessment makes sure support systems are secure prior to sugery.

 

My hope is that these points will make for a great discussion.  Thoughts?

15 Comments »

  1. [...] This post was mentioned on Twitter by Mark Young. Mark Young said: The Truth About Medical Obesity Management. Notes from a conference yesterday. Really makes you think! http://shar.es/m4vDX [...]

    Pingback by Tweets that mention Mark Young Training Systems » » The Truth About Medical Obesity Management -- Topsy.com — May 14, 2010 @ 10:31 AM

  2. Obesity is a chronic condition very much like hypertension. When treatment is stopped, the condition reappears. (This could not be any more true!!) Great article!

    Comment by mark — May 14, 2010 @ 11:47 AM

  3. Great notes!
    I think one of the major messages to take from all this is that obesity is just part of a bigger problem. Some have gone as far as to label it a symptom of other problems in these patients, given that many cases involve factors that extend well beyond the scope of just poor lifestyle choices (as illustrated by a number of your notes regarding mental health, previous traumatic experiences, etc…). Thus, as is the case in physical rehabilitation, it’s important for us to treat the source of the problem and not only the more obvious symptoms.

    Comment by Alejandro — May 14, 2010 @ 3:00 PM

  4. “The best predictor for adult obesity is childhood obesity”

    - A sad statement when we are unable to determine if a child is obese to begin with!

    “as few as 18% of parents thought their children had weight problems when they were clinically obese. Doctors didn’t fair much better.”

    “A 5-10% body weight reduction shows improvements in lipid profiles, blood sugars, and various other obesity related disorders.”

    - Good news when you hear,

    “50% of people on a suitable lifestyle plan (exercise + diet + behaviour modification) can maintain 5% loss at one year and 20% can maintain 10% at one year.”

    -But I have to repectfully disagree with whom ever drew the conclusion:
    “you need to treat only two people to achieve this result with one” or “Need to treat 5 people to get one who does this.”

    - Averages don’t work like this!

    “One presenter said that gastric bypass was “the real solution to childhood obesity because nothing else really works”. He was a giant dink.” (He really is!)

    - I have to disagree with this nonsense – someone make him read the lifestyle information again

    Comment by Stephen — May 15, 2010 @ 9:08 AM

  5. Your body weight is pretty much set, give or take 20 lbs.

    Only people who are extremely motivated can lose 50-100 lbs and keep it off for years.

    Comment by Anoop — May 15, 2010 @ 10:10 AM

  6. @ Mark – Thanks for the comment!

    @ Alejandro – I totally agree that being overweight or obese is a symptom of something else. While behaviours like eating excess calories and lack of activity can make someone obese, I think the real key is to find out WHY the person overeats or is inactive. Various factors can influence these behaviours and addressing these will treat the cause. Performing surgery without addressing the cause often results in weight regain or other destructive behaviours including suicide.

    @ Stephen – I agree that the biggest issue with childhood obesity is knowing when it actually exists. Even in adults doctors rarely write the diagnosis of obesity in their medical charts. If something is not documented as a problem what do you think are the odds it is being treated?

    The “number to treat” data came from a guy who has studied a 15,000 person sample at his clinic so his sample is fairly representative of this population. Although stats don’t work exactly as he proposed, I would suggest that he’s possibly on the right track.

    @ Anoop – I’m not really a fan of the metabolic set point argument for body weight (especially if someone is morbidly obese). If someone is 400 pounds it should be actually really easy to lose and maintain a 10% (40 pound) weight loss. And if there is a set point, when is it determined? And by what? Genetics certainly can’t account for everyone who is overweight and obese.

    Comment by markyoung — May 15, 2010 @ 3:03 PM

  7. Since we agree that obesity is often times an indicator of other underlying issues, what role do you think the strength and conditioning coach/trainer plays in that situation? Given that many still have difficulty mastering the intricacies of their own field, how can they go about being an active player in the treatment of widespread obesity?

    Other general info about obesity not to forget:
    Physiologically, once fat cells have developed they can no longer be destroyed without outside interference. That is, changes in body fat come from losses in fat cell size, not number. Thus, an obese child steps into the adult life with a proportionally larger number of fat cells, which forcibly need to always be minimally stocked, than the average child (knowing that fat cell hyperplasia can occur more significantly at certain times, like puberty for example).

    Cheers,

    Comment by Alejandro — May 16, 2010 @ 3:22 AM

  8. Great question! I plan to address this in a post soon.

    Comment by markyoung — May 17, 2010 @ 11:27 AM

  9. According to Friedmann – who discovered Leptin-,

    “Classically, a genetic contribution to a human
    trait is quantified by comparing the trait’s
    variation between identical and non-identical
    twins. Using this approach, the heritability
    of obesity — percentage of variation
    due to genetic factors — ranges between 70%
    and 80%. These values exceed those for most
    other traits that are commonly accepted to
    have a biological basis, including diabetes,
    heart disease and cancer. Indeed, the only
    trait with consistently higher heritability
    than obesity is height.

    Now they usually call it a settling point concept instead of a set point. And the 5-10% is reasonable, though a 40lbs loss for a morbidly obese will still leave them in that category. We are now slowly accepting the 5-10% as a good number because we know there is a huge genetic factor and is almost impossible to get people to normal BMI levels and keep them that way.

    Comment by Anoop — May 17, 2010 @ 6:45 PM

  10. Great quote!

    My understanding is that the 5-10% guideline wasn’t established because people couldn’t maintain more, but because research was done to determine the minimal amount of weight loss necessary to improve health. That said, we now know (thanks to Dr. Robert Ross) that health markers can be improved without ANY weight loss if moderate exercise is performed.

    Whether people CAN physiologically keep the weight off and whether they are willing to do the work required to do so are two different issues.

    Comment by markyoung — May 18, 2010 @ 2:51 PM

  11. I think part of the reason was how it has been very clear in research that 70-80% of the people who lose weight put the majority of it back.

    I agree. Exercise has an independent effect.

    Comment by Anoop — May 18, 2010 @ 7:38 PM

  12. As a fitness consultant, I assess clients regularly who would be categorized as “skinny fat.” While they don’t appear to be obese, and most are content with their shape, they are putting their long term health in jeopardy by not realizing the importance of developing lean muscle mass. Many of these obese healthy weight individuals are endurance athletes or enthusiasts. Who overemphasize cardiovascular endurance for health and weight management and devalue resistance training and lean mass development for optimal health and metabolism.

    Comment by Dan Daly Jr, CSCS — May 25, 2010 @ 8:38 PM

  13. I absolutely completely agree. Just how long does it take for information to reach the masses…really?

    Comment by markyoung — May 26, 2010 @ 5:08 AM

  14. Band surgery is very effective, the problem is staying motivated long term and not cheating by eating foods that bybass the band. chocolate for example, and ice cream. It’s important to stay motivated and determined.

    Comment by Hypnoguy — December 14, 2010 @ 11:17 PM

  15. “ADHD has a strong relationship to obesity. Sometimes treating ADHD causes patients to lose weight.” This is undoubtedly true, but it’s a side effect of ADHD drugs. These drugs are amphetamine salts, and they cause the patient to lose his or her appetite. Adderall is amphetamine/dextroamphetamine, and Desoxyn is actually methamphetamine. They were very popular as weight loss drugs decades ago, but obesity is no longer an approved indication because of their addictive potential.

    Comment by Sarah — April 27, 2012 @ 8:45 AM

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