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Weight Awareness

Great. We’re not only dealing with colder temps, long nights, and less sunlight…but the Obesity Medicine Association has encouraged us to consider January as Healthy Weight Awareness Month.

I guess it makes sense to add this to the other resolutions of healthier eating and improved exercise habits.

What is Healthy Weight?

Being at a healthy weight means that an individual maintains a body weight appropriate for their height, age, sex, and body composition. There, in my opinion, can be over-focusing on a number. There is also evidence that measures like body mass index (BMI), while most often used, may not equally apply across all ethnic groups.

This said, it is important to note that the obesity rate has significantly increased over the last two decades, with nearly 42% of the population fitting this definition. Why is this a concern? It is what obesity is linked with. There is increased diabetes (mostly Type 2), heart disease, high blood pressure, several different kinds of cancers, arthritis, high lipids, and other issues. The other issue I remember when seeing patients is the impact on self-image, stress, and mental health.

If you go in and talk to your primary care provider, they will likely use some sort of measure to see where you are at. A normal BMI is considered between 18.5 and 24.9. This still may not be the best measure for everyone. For example, older people may have lost muscle or bone mass but still have too much adipose (fat). This is why another approach to focusing on health is to look at waist circumference. Generally, a woman with a waist measurement over 35 inches or a man over 40 inches is considered obese. Your doctor knows exactly where to take this measurement.

The other reason to talk to your doctor is the increasing awareness of the impact of social inequities. Factors like food insecurity, housing instability, stress, and discrimination can influence dietary choices as well as physical activity levels.

Approach

I agree that clinicians should always start by asking permission to talk about weight with someone. This is important, as in any area of life. You need to believe this is a concern and want to focus on it. It does not work to be shamed or pressured if you are not ready.

If you are ready, you will likely be interviewed about your “readiness for change.” This is a fancy way of seeing how motivated you are to begin this important journey. One important approach is learning what the impact of modest weight loss can have on you specifically. I am often amazed at the impact of even 10% of weight loss on blood pressure, energy, and mood.

It is very important not to be stigmatized with language like “weight problem” or “morbidly obese.” These are motivation killers. This is a form of bias and can cause someone to avoid seeking care.

As you think about your background and lifestyle, think about things like meal timing, content, portion, and how it is prepared. Sometimes, just thinking this through will spark ideas for change.

Growing up in the South, my weakness was soda. If I can focus on getting enough water so my thirst does not drive me to drink sugar-sweetened drinks, I can reduce my intake.

The other area to consider is stressors. I have found doing a food diary, which not only records what I am eating, but also how I was feeling when I was eating, is helpful. Sometimes you may see a connection between stress, fatigue, or frustration with eating. Also, just tracking, journaling, or partnering with friends or family can have a beneficial impact. Understanding hunger cues, snacking habits, and opportunities to improve physical activity may also be revealed.

It is important that your provider considers cultural preferences, financial barriers, and geographic limitations to food access when coming up with a plan. Regardless of these factors, ultra-processed and sugary foods or beverages should be limited or avoided. If you are able, simple steps like parking further away in the parking lot, taking the stairs when you can, and tracking steps with your phone can have a profound impact.

A word about GLP-1 agonist

There is a lot of press and advertising about Ozempic, Wegovy, and others. And, after working with your doctor, this may be a reasonable option for some. These medications work by stimulating the release of insulin from the pancreas and simulating GLP-1 receptors in the brain, which causes you to feel full. They also slow down how fast your stomach empties. Finally, some data shows a reduction in heart attacks.

Studies have also shown patients regained about two-thirds of their weight one year after discontinuation. However, with long-term management, sustained weight loss is possible. There are medical risks, including things like the stomach not emptying or your pancreas getting inflamed.

Finally

So, the most consistent advice you will hear from your health care providers:

  • Avoid processed and sugar-sweetened foods and drinks.
  • Track and be aware of your calorie intake
  • Self-monitor with frequent weigh-ins
  • Dedicate time to aerobic activity (heart rate up) and resistance training (weights)
  • Eat more fruits and vegetables.
  • Try to get seven to eight hours of sleep each night (reduces cravings)
  • Establish an accountability system with a group or friend
  • Prepare more meals at home
  • Focus on your mental health and manage stress.

A “normal BMI” may not be a realistic goal for many of us. The impact, as I mentioned, of small changes or modest weight loss is very real. If you make the goal better health and an improved quality of life, this makes it more achievable.

pmc.ncbi.nlm.nih.gov/articles/PMC6727309

nature.com/articles/s41591-024-02996-7 – citeas

obesitymedicine.org/resources/obesity-algorithm/

aafp.org/pubs/afp/issues/2024/0800/obesity-management.html