Weight Matters – Achieve and (Maintain) a Healthy Body Weight

A healthy body weight reduces your risk of illness and can increase your life expectancy. Be kind to yourself during your weight loss journey. Losing weight is hard. Give yourself credit for your efforts and stay focused on the positive.

Is My Weight Healthy?

If you weigh too much, your doctor might say you are overweight or obese, but what does that mean? These are terms that are used in medicine to describe when your weight is above the recommended range for your height. This puts you at increased health risks. To determine if your weight is healthy, your doctor will calculate your BMI. While the BMI is an imperfect tool, it is a useful indicator of health for most people. The BMI is a weight for height ratio. This means that the BMI goes up the more you weigh, but down the taller you are. The medical risks and remedies of being underweight are discussed separately.

A healthy weight is about more than just your appearance. A healthy body weight reduces your risk of certain illness and can increase your life expectancy.

BMI (kg/m2)	Interpretation
Below 18.5	Underweight
18.5-24.9	Healthy Weight
25-29.9	Overweight
30-39.9	Obese
40 and above	Severely Obese

BMI with Interpretation

What Are the Risks of Unhealthy Weight?

Health Risks Associated with Overweight and Obesity:

• High blood pressure
• High cholesterol
• Diabetes
• Sleep apnea
• Heart attack
• Stroke
• Arthritis
• Depression and anxiety
• Cancers, specifically uterine, esophageal, stomach, liver, kidney, bone marrow, pancreas, colon, gallbladder, breast, ovary, and thyroid.

There are many health risks associated with being overweight or obese. The risk increases as the degree of obesity increases.

What Causes Weight Problems?

Reasons for being overweight:  

• An imbalance between activity level and food intake.
• Family history
• Medications such as steroids and certain antidepressants.
• Medical illnesses, such as Cushing’s disease and polycystic ovary syndrome.
• Medication side effects.

It is not yet clear whether chemical exposures or differences in our intestinal bacteria (microbiome) contribute to weight imbalances. Research is ongoing.

What Can I Do to Get To A Healthy Weight?

It is always good to start with a medical evaluation. Your doctor will check for two things. She will check to be sure your weight is not caused by a medical problem. She will also check to be sure your weight is not causing any medical problems. For example, if you are overweight, your doctor may want to check your cholesterol as high cholesterol is more likely if you are overweight.

Once your medical assessment is complete, you and your doctor will discuss your eating habits and physical activity level. These two habits are inextricably linked to weight. No matter your weight problem, behavioral counseling is beneficial.

Low calorie diet and high physical activity will lead to weight loss. A high calorie diet and low physical activity will lead to weight gain.

What Do I Need to Do if I Am Overweight or Obese?

If you are overweight or obese and it is not due to a medical problem, you and your doctor will discuss your eating habits and physical activity. If you are severely obese to the point where you are unable to exercise, your doctor may recommend surgery for weight loss. There are also medication options for weight management.

If you are severely obese to the point where you are unable to exercise, your doctor may recommend surgery for weight loss.

What Do I Need to Know About Physical Activity?

It is important to recognize that our normal every day activity requires physical activity. The degree of physical activity varies according to your daily routine. Activities that require you to sit are called sedentary activities. During these activities your body uses a minimum amount of energy. Activity that requires you to be on your feet or walking forces your body to use more energy.

Increasing your physical activity through a modification of your daily routine is one of the most efficient and sustainable methods for weight management. 

Exercising is one type of physical activity. But any type of movement can help improve your health, in general, and lose weight. This means moving, rather than sitting. Not only will this activity burn calories and help you lose weight, it also can help to decrease your risk of many medical problems, such as:

• Heart attacks
• Strokes
• Cancers of the bladder, breast, colon, uterus, esophagus, kidneys, stomach, and lung.
• Dementia, including Alzheimer’s.
• High blood pressure
• Type 2 diabetes
• Depression
• Falls and related injuries
• Postpartum depression

The physical activity recommendation for adults from the US Department of Health and Human Services is to get at least 150-300 minutes of moderate-intensity aerobic activity weekly, and some type of muscle-strengthening activity at least 2 days a week.

In order to meet the aerobic exercise guideline, you would need to exercise about 30 minutes, 5 days a week. Alternately, you could do more or less on any given day, as long as it adds up to at least 150 minutes per week.

Examples of Aerobic Type Activities:

• Brisk walking.
• Running
• Dancing
• Swimming
• Bicycling
• Anything that gets your heart rate up including sports like basketball and soccer.

Examples of Muscle Strengthening Activity:

• Weight Lifting
• Core Exercises
• Pilates
• Yoga
• Floor Strengthening Exercises- such as push-ups, squats, planks, leg lifts.
• Climbing

Before starting any form of vigorous exercise, be sure to check with your doctor to ensure that activity is safe for you. You don’t have to wear a heart rate monitor while working out. You can assess your level of exertion based on your breathing.

With moderate intensity exercise, as your heart rate increases, it will be difficult to carry on a regular conversation, though you should still be able to talk.

If you have children, engage them in your physical activity. Keeping active is an important aspect of your child’s health.

If the recommended goals are beyond your reach right now- that’s OK. A guideline is not a rule, it is just a guideline. Do what you can at this moment in time. Any amount of activity improves your health. So start slow. You will notice an increase in your strength and stamina and your overall health.

Determine a goal of increasing duration or intensity. Choose the goal that works best for you and stick with it.

You may find that exercising improves your mood, lowers your blood pressure, and improves your sleep. With all those benefits beyond weight loss, exercise and physical activity are well worth the effort!

If you don’t have time to exercise, or are unable to do more vigorous exercise, try to incorporate exercise into your current routine.

Exercises Built Into Your Routine

• Take the stairs instead of the elevator.
• Park farther away from your destination.
• Propose “walk meetings” instead of sit down meetings at work. This means that you go out and walk while you talk for your meeting.
• Dance more! Never miss an opportunity to dance such as when watching TV or doing chores.
• Walk, walk, walk! Walk while talking on the phone, get up from your desk and walk intermittently, even if walking in place.
• Transform TV time to activity time. Try walking in place, doing yoga, weights, stretches, core or floor exercises. If exercising during TV watching causes too much of a heartbreak then commit to exercising during only one TV program.

Physical Activity for Urban and Apartment Dwellers

When your physical space, neighborhood or weather is not conducive to outdoor activity consider these options:

• Run in place
• Butt Kicks
• Jumping Jacks
• Lunges
• Stair Climbing
• Planks
• Push Ups
• Sit Ups
• Free Weight Exercises
• Dance

Which Is The Best Diet For Me?

There are all sorts of diets out there, and if you are overweight, you may have already tried some of them. What they all have in common is decreasing the amount of calories that you eat. There is not one “best diet” for everyone. A common experience is that you will try a diet and lose some weight on it, but then after you go off the diet, you gain the weight back. This is usually because you returned to your normal, higher calorie, food intake after you stopped the diet. Success requires a lifestyle change, meaning something you are going to incorporate into your life, than something you do for a certain period of time and then stop.

The best way to lose weight is to find some healthy changes you can make to your regular diet that are lower calories but are changes that you can live with long term.

A reasonable weight loss goal is 1-2 pounds per week. Do not get frustrated with small weight fluctuations. This is normal. Weight fluctuations may be related to salt intake and water retention. If your weight goes up one day, it does not mean your dietary efforts aren’t working. Focus on changes over each week to determine if you are heading in the right direction.

Get help if needed. Weight loss is not easy, and change is hard.  Discuss your goals with your physician or a dietician. A dietician can help you make healthy changes that fit with the type of foods you like to eat. It takes planning, effort, and time to see results.

A counselor can also be a helpful resource on your weight loss journey. Much of what we eat is unrelated to hunger and more in sync with how we feel. Food becomes the default medicine, counselor and comforter. Speaking to a counselor can help to develop alternative coping strategies.

Rather than approaching a wrong food choice with judgment, it may be more helpful to ask yourself, “why am I eating this right now?”

Unresolved issues such as anxiety, depression, eating disorders, and childhood trauma are common and can often be related to unhealthy eating patterns.  Counseling is needed for treatment of these medical problems.

When Should I Consider Medications For Weight Loss?

Diet and exercise are the most important tools for weight loss. However, medication is an option for some people. Be aware that the medications do not work without a healthy diet and exercise. They are not without side effects, and are, therefore, only recommended for people with significant weight problems. If you are thinking about medications, it is definitely time to engage your doctor, if you haven’t already. Your doctor will look at all your medical problems and other medications and how those interact with each other to come up with the best overall plan for your weight management, including the best medication option for you. Unfortunately, many people do regain the weight they lost when they go off weight loss medications–which is why continuing with a healthy diet and exercise plan is so important.

If you do not lose 5% of your weight within 3 months, usually your doctor may take you off the medication.

The criteria your doctor will use for whether your weight problem is severe enough to warrant medications is based first on your BMI. If your BMI is 30kg/m2 or higher, medication may be helpful. If your BMI is at least 27kg/m2, and you have weight-related health problems, such as diabetes or high blood pressure, then you may also be a candidate for medication. This is because losing 5-10% of your body weight may lead to significant improvement in your weight related medical problems.

Medications are available as prescription, over-the-counter, and herbal/nutritional supplements.

Prescription medications include orlistat, liraglutide, phentermine, phentermine-topiramate, and bupropion-naltrexone. Another prescription for weight loss, lorcaserin, was taken off the market in early 2020 due to concerns about cancer risk. Another popular weight loss medication, fenfluramine, was taken off the market in 1997 when it was found to be associated with damage to heart valves. Most people who take weight loss medications experience nothing more than mild side effects. However, there is potential for more serious side effects and your doctor will need to look at your other health problems and medications to help decide what is the best course of treatment for you.

Over-the-counter medications include orlistat. It is the same medication available as a prescription, but in a lower dose, sold under the name Alli. This medication interferes with your body absorbing fats from your intestine, so some of the fats just pass on through and out with your stool. High levels of fat in your stool can cause side effects such as cramps, gas, diarrhea, stool leakage, or oily stools. Observing a low fat diet can minimize these side effects.

Herbal/nutritional supplements for weight loss are not recommended. However, they are discussed here so you can learn about them and you can make the best decision for yourself. Some of these are not recommended as they have been found to be unsafe, and others have not been studied carefully and it is not known if they are safe or effective. Here are some to avoid:

Weight Loss Supplements to Avoid:

• Ephedra. Ephedra was a popular ingredient in many weight loss herbal supplements. And it is a stimulant and was found to have serious side effects including death and is no longer available in the US.
• Emagrece Sim (“the Brazilian diet pill”) has been shown to contain prescription drugs.
• Bitter orange can increase your heart rate and blood pressure.
• Human chorionic gonadotropin (hCG) is a hormonal injection treatment that has been shown to NOT be effective.

• Most other herbal/nutritional weight loss products do not have enough data to show if they are safe or even effective. When both the risks and benefits of a drug are unknown, that drug is not recommended.

There is no “miracle pill” for weight loss. Be leery about products that promise rapid weight loss with no change in diet or exercise. If you aren’t sure if something is legitimate or not, talk to your doctor.

When Should I Consider Weight Loss Surgery?

Just like with medications, there are BMI criteria for weight loss surgery. To be a candidate for weight loss surgery, you also need to have already tried a diet and exercise program. To be considered for weight loss surgery, your BMI must be above 40 kg/m2, or over 35kg/m2 with a serious medical problem related to your obesity such as diabetes or sleep apnea that might improve with weight loss. Sometimes weight loss surgery may be considered if your BMI is over 30kg/m2 and you have multiple obesity-related conditions or a serious obesity-related condition such as uncontrolled diabetes.

Criteria For Weight Loss Surgery 

BMI (kg/m2	Obesity Related Medical Condition
40	No obesity related medical condition necessary.
35	At least one obesity related medical condition necessary.
30	At least one serious obesity related medical condition or multiple less serious conditions present.

Surgery is never something to be entered into lightly for any condition as all surgery has risks of complications including infections, bleeding, injury to other structures, blood clots, and rare anesthetic side effects including death. With bariatric, or weight loss, surgery, there will also be changes in how you eat and live for the rest of your life. You need to be very motivated to make your health and weight management a priority in order for surgery to be a good option for you.

Some of the types of surgery include gastric bypass, gastric sleeve, gastric balloon and others. Your surgeon will decide which of these would be best for you.

You should look for a doctor and surgeon who is board-certified and has specific training and experience in weight loss surgery. These doctors are often associated with weight loss centers. While weight loss surgery isn’t for everyone, it may be an option worth considering if you are very obese, have obesity-related medical problems, have been unable to lose weight with diet and exercise and are willing and able to commit to working on your health long-term.

Talk to your primary care physician about whether surgery is something you should consider. Your primary care doctor will be able to help you find a bariatric specialist, if you both determine that is what is needed.

If you decide on weight loss surgery, be sure to find a surgeon who is board-certified and has specific training and experience in weight loss surgery.

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Written by: myObMD team |Editor: Dayna Smith MD |Reviewed: December 18, 2020

Copyright: myObMD, 2020

Glossary:

• Addison’s disease is a condition where your adrenal glands don’t function properly
• Adrenal Glands- glands that sit on top of your kidneys and release hormones. 
• Atherosclerosis- the accumulation of fatty material in your blood vessels that leads to heart attacks, strokes, and other vascular disorders.
• Bariatric is a medical term that refers to the treatment of obesity. For example, a bariatric surgery is a surgery for obesity to help with weight loss.
• Celiac disease is a condition where you are allergic to gluten. Eating gluten leads to damage to the small intestine from an autoimmune reaction.
• Calories measure of the amount of energy your body gets from burning food.
• Carbohydrates are the sugars or starches in your diet.
• Cushing’s disease is a condition where your adrenal glands are overactive.
• Esophagus is the tube that runs between your mouth and your stomach. Food goes through your mouth, to the esophagus, then your stomach and lastly your intestines and rectum.
• Hyperthyroidism – an overactive thyroid gland.
• Inflammatory bowel disorders include Crohn’s disease and ulcerative colitis. These are both autoimmune disorders where your own immune system attacks your intestines leading to an inflamed colon, called colitis.
• Microbiome refers to all the natural microorganisms like bacteria and fungus that live inside our bodies. Such as the normal flora in the intestines.
• Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects females. It causes irregular periods and infertility, and elevated levels of male hormones.
• Sleep apnea is a condition where you have episodes of not breathing during the night.
• Whole foods are foods that are not or minimally processed, and without artificial additives.