Monday, February 25, 2008

Weight Loss

By Angela Zechmann, MD, MPH

2/25/08 Hello, and welcome to my blog! I am a physician specializing in weight management medicine, which is a relatively new specialty in medicine. My practice is called South Sound Preventive Medicine, located in Olympia, WA. I absolutely love what I do! Considering that obesity is now America’s number one cause of preventable premature loss of life, it is surprising that there are not many more physicians like me who specifically focus on helping people to lose weight and get healthier.

If you suffer from the disease of obesity, take heart. Yes, you heard me right, I said obesity is a DISEASE. It is not a personal failure, a lack of willpower, or laziness. It is a long-term chronic disease, and it causes in its wake many other chronic diseases, like high blood pressure, arthritis, and diabetes, to name just a few.

Obesity is a treatable disease, but it will require life-long vigilance to keep the disease under control. “Diets,” which have a starting point and an ending point, will not help, and will actually worsen the disease, because once you end the “diet” you will most likely regain all of the weight you lost, and then some. If this has happened to you, don’t beat yourself up. It is the natural history of this chronic disease.

So, how is this disease treated? Well, first of all, we must define what it is. Physicians and researchers use the standardized BMI (Body Mass Index) calculation, which is a measure of weight relative to height. The BMI is not perfect, as someone who is very muscular may have a high BMI but a low fat percentage. Click on the BMI table if you would like to measure your own BMI. Here is how to interpret the number you get.

<18.5 Underweight
18.5-24.9.1 Normal weight
25-29.9 Overweight
30-34.9 Mild Obesity
35-39.9 Moderate Obesity
40 and over Severe Obesity

Now that you know where you are at, let’s get to work.

The first thing a bariatric physician will do is to take a careful history. I have my patients fill out a graph which shows me how the weight has come on, what diets the patient has tried, and what sorts of life events have been associated with weight gain or loss. This graph is incredibly helpful. I also ask about current lifestyle: who you live with, who cooks, what sort of job you have, or if there are other stressors in your life (for example, taking care of small children or an ill parent). I ask patients to keep a food diary. I ask what sorts of illnesses they have had or currently have, and what medications they are on. Finally, I ask about the family history of illnesses.

The next step is a physical exam. Vital signs and measurements are important; Blood pressure, pulse, current weight and height, neck, chest, waist and hip measurements, and a body composition analysis, which tells us how much of the weight is fat and how much is fat-free (ie muscle and bone). I like to keep an eye on these measurement to make sure the weight loss is fat loss and not muscle loss, which is common in fad dieting.

The final step is blood testing. In my clinic, I get the bare-bones basics in the beginning. I ask patients to fast overnight, and then we get a blood sugar level, cholesterol profile and a few other labs which help me determine liver, kidney, bone marrow and thyroid function. I do not get expensive tests unless someone is having trouble losing weight.

Once we have an idea of what is going on, we can make an individualized treatment plan. There are many causes of obesity, but in general, they fall into four categories:


The next blog will discuss each of these in turn.

In the meantime, consider finding your nearest bariatric physician to learn more about how to control your disease. A good place to start is the website of the American Society of Bariatric Physicians: Just go to the tab marked “find a physician” and click on your state. A list of society members will pop up so you can find the one closest to you.