Conquering Obesity - Softcover

Levy, Lance

Softcover

ISBN 10: 1552634248 ISBN 13: 9781552634240

Publisher: Key Porter Books, 2002

For men and women who are obese, the weight loss journey is about much more than shedding a few pounds. Obesity can lead to serious health risks and problems ? both physical and psychological ? and the struggle to cope can be a frustrating, life-long endeavour. It doesn?t have to be this way. In Conquering Obesity, medical nutrition specialist Dr. Lance Levy offers a highly individual approach for dealing with weight management that recognizes obesity as a symptom of a larger, often undiagnosed, problem.

Based on more than fifteen years of experience and research, Levy contends that an astonishing 90 per cent of people with weight issues have one or more of the following underlying medical conditions:

mood disorders
chronic tiredness
chronic pain
chronic gastrointestinal difficulties
disorders of impulse regulation (binge eating disorder, attention deficit hyperactivity disorder and night-time eating syndrome)

In these cases, when the underlying conditions are treated, long-term weight loss frequently occurs without any special diets.

This updated edition includes the latest information on the links between obesity and attention deficit hyperactivity disorder, the effectiveness of cognitive and psychodynamic therapies, nighttime eating syndrome, and the non-negotiable time commitment needed to work on diet and lifestyle changes. Augmented with extensive case studies and data from Levy?s own successful practice, Conquering Obesity offers hope to anyone fighting the battle of weight management.

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About the Author:

Dr. Lance Levy, a member of the Division of Clinical Nutrition at the Hospital for Sick Children in Toronto from 1985-1994, directs a mutli-disciplinary team at the Nutritional and Eating Disorders Clinic.

Introduction
There's No "One- Size-Fits-All" Method for Losing Weight

This book is intended as a guide for anyone who is overweight and looking for sensible approaches for dealing with the problem. In these pages I describe what we currently know about the causes and management of obesity. We are on the verge of having a useful understanding of the complex reasons why people become obese, and I discuss these in some depth. It is only fair to warn you, however, that completely successful methods of weight loss are still far off, and successful long-term treatments are difficult to devise.

Let us start with two basic questions. First, what is obesity? And second, why should anyone worry about it? The World Health Organization's criteria for Body Mass Index (BMI) have recently been adopted as the universal standard for defining levels of overweight and obesity. (The Body Mass Index is your weight in kilograms divided by the square of your height expressed in centimeters.) A Body Mass Index of less than 18.5 signifies malnutrition or significant underweight, a BMI from 18.5 to 24 is normal, from 25 to 29 is overweight, and above 30 indicates obesity. Though using BMI alone as a measure of weight problems has its limitations (as will be discussed later), according to the recent Canadian Heart Health Survey, approximately 44 percent of men and 25 percent of women have a BMI of 25 to 29 (overweight). Thirteen percent of men and 14 percent of women have a BMI over 30 (obese). Therefore, if we take a BMI of 24.9 as the cutoff above which an individual is too heavy, 57 percent of men are overweight or obese and 39 percent of women are in the same category. Thus, fully 48 percent of our adult population are excessively heavy. In the United States, using slightly different cut-offs for BMI, 31 percent of adults have a BMI of 25 to 30, and 21 percent have a BMI above 30 and so are obese.

There is also a very disturbing trend in the development of weight problems in our children. In 1981, 15 percent of children were overweight or obese, while in 1998, 24 percent were overweight or obese. (The concept of an "ideal" weight raises further questions, but for now let's accept that there is an approximate "healthy" weight for most people.)

The reason we need to be concerned is that excess weight is the cause of more illness than virtually any other medical condition. Even in the poorest countries, obesity is becoming epidemic, causing significant ill health from diabetes and heart disease where these were relatively rare thirty years ago. In the western industrialized countries, many more people will have to see a doctor because of complications arising from overweight than will develop cancer! For example, 80 percent of adult-onset diabetes occurs in people who are overweight or obese. Diabetes, heart and vascular disease, high-blood pressure (hypertension), gallbladder disease, arthritis, sleep apnea (a condition where people fail to breathe adequately during sleep), and gastrointestinal ailments are just some of the health problems that can afflict the overweight person.

Not surprisingly, the medical and socioeconomic costs of obesity are high. Of all the health-care dollars spent in the United States in 1990, 6.8 percent (about $34 billion) were spent on the physical and psychological treatments directly associated with obesity. In Canada, 2.4 percent of the health care budget was spent for these problems. It is important to note that these costs are for the treatment of obesity-related problems (such as heart disease) only and do not include the additional costs that occur where, for example, wages are lost due to obesity-linked illness such as arthritis, high blood pressure, and early death. From a public-health perspective, allowing this illness to remain so poorly researched and treated has been a very costly mistake for governments. The fact that governments have begun to approve weight-control drugs for the long-term management of serious obesity is a step in the right direction. Another positive step is the search for weight-management approaches that will work with children and adolescents who will undoubtedly become fat adults if left untreated.

Obesity has increased in the past decade. There are a number of possible reasons why this is so. Several that I am particularly interested in are the use of poorly devised diets, the effects of advertising on dietary food choices, food manipulation to enhance palatability, and the role of stress in promoting weight gain. As an example of the first, the increase in overweight may be in part linked to the dietary approaches in most common use, such as the advocacy of quite low-fat diets and diets that are more than 500 to 750 calories below that needed for weight maintenance (for example, a 1200-calorie diet for a man weighing 300 pounds (136 kg) whose calorie requirement for maintaining weight would be roughly 3500 calories). This may seem contradictory, but as I explain later, low-fat diets (those with fewer than 25 percent of their calories from fat) and excessively deprivational diets can encourage weight to be regained.

It is true, too, that our society is becoming increasingly "hostile" to sensible food management, because the food industry has invested heavily to make foods as flavorful and appealing as possible and to encourage us, through advertising, to eat when we are not hungry. When food is very tasty we eat more. Since it may also be high in fat and we are not burning enough calories, we gain weight. Also, we are under more stress now than twenty years ago, and people often eat in an attempt to relieve stress and maintain energy. Last but not least, as a society we are less active now than in previous decades. Our children are particularly inactive compared to their counterparts of forty years ago. Inactivity makes it much harder to balance food intake against calories expended.

I have looked after patients with weight-control problems for the past fourteen years. The weight-loss efforts of most of these people were complicated by unrecognized and usually untreated or partially treated medical problems such as those mentioned above. Managing weight loss with a patient is one of the most challenging projects a doctor and patient can work on together. There are more failures than successes because obesity is such a complex problem. Because no two overweight people are overweight for the same reasons, simple dietary instruction and advice such as "be more active" are rarely effective. In-depth assessment and treatment are needed, particularly when a person has been overweight for a long time or is very overweight.

It is all too easy to spend a lot of time and money trying to lose weight in ways that will not work or that are almost certainly harmful, either because they predispose the dieter to more weight gain later or simply because they are unsafe. North Americans spent tens of billions of dollars last year on various weight-loss approaches, but many of the people who go to a commercial diet center regain the weight they lost within two years and often end up heavier than they were before they dieted. Research shows that only about thirty-five out of every hundred moderately obese people who undertake one of the best medically devised weight-loss plans will lose 15 percent of their starting body weight and maintain that loss after two years. Claims that are better than this are unlikely to be reliable.

The approach described in this book is radically different from that of most weight-loss programs. Instead of offering a "one-size-fits-all" recipe for losing weight, it looks at weight loss as a highly individual matter. Weight management is a complex task involving both emotional and physical factors. This book outlines some of the reasons why weight loss is hard and the physics behind why we gain or lose weight. It explains the various methods of medically evaluating a patient and of managing the weight-loss process. All weight-loss strateg

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