A Medical Weight Management Program with a Mission;
Optimal Performance
Introduction
To solve Obesity, we must first define the problem;
Why the Body Mass Index causes failure in weight loss programs
If we define Obesity as a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on a person’s health, leading to reduced life expectancy and/or increased health problems, then Obesity, without question, is a global epidemic. At about 35% of the total population, people with a normal body weight are a minority in the US.
The Body Mass Index, or the BMI, is the most commonly used reference tool for determining if a person is obese; BMI= Body Weight in Kilograms/Height in Meters2 or (weight in pounds x 703) divided by height in inches then divided again by height in inches. So, a person that is 68” tall and weighs 190 pounds= (190 x 703)/ 682 = a BMI of 28.8. The reference ranges for BMI are as follows:
<20 is underweight
21-24.9 is normal body weight
25-29.9 is overweight
>30 is obese
Before 1980, doctors generally used weight-for-height tables — one for men and one for women — that included ranges of body weights for each inch of height. These tables were based on weight alone, rather than body composition and were of limited usefulness. BMI became an international standard for obesity measurement in the 1980s.
The public learned about the BMI in the late 1990s, when the World Health Organization (WHO) launched an initiative to encourage healthy eating and exercise. While it is true that a person’s baseline BMI correlates with their risk of developing co-morbid health conditions and premature death, which makes it a useful tool for helping insurance companies decide how much to charge a person for a term life policy. However, it is totally misleading if used in deciding how much weight a person needs to lose to dramatically improve their health and wellbeing. For instance, consider the following scenario of two men, both 72 inches tall. One man weighs 270 pounds and has a BMI of 37, and the other man weighs 330 pounds and has a BMI of 45. Over the next year the 330 lb person loses 33 lbs, –10% of his body weight, while the 267 lb person gains 33 lbs, +12% of his body weight, so they both weigh 300 pounds and have an identical BMI of 41. Both men are well above the obesity BMI of 30; however, their health and mortality risks are quite different, and this difference underscores how educating the public about BMI misfired and actually caused a setback in the public battle against obesity. In fact, the man who lost nearly 10% of his original bodyweight in the above example, now has reduced his health and mortality risks to be more in line with a person that has normal body mass index. The man who gained more than 10% of his body weight, however, now has an extremely high risk of developing co-morbid disorders and of premature mortality. Furthermore, consider this; If the entire US population was one very large person, and this person lost a mere 7% of his collective body weight, cases of Type 2 Diabetes in the US would go down by 58%!* Researches trying to learn about people’s expectations from a medically supervised weight loss program asked participants, at entry, what percentage of body weight they would need to lose to be:
a) disappointed with the results of the program?
b) satisfied with the results of the program?
c) extremely satisfied with the results of the program?
One hundred percent of the participants answered that they would be disappointed with the results of the program if they lost 10% or less of their initial body weight; and 100% also answered that they would be extremely satisfied only if they lost 20% or more of their initial body weight. In the second phase of this study, those participants who achieved a 10% weight reduction since entering the program, again completed level of satisfaction and wellbeing questionnaires; 100% of this subgroup expressed a high level of satisfaction and a significant improvement in their wellbeing since their entry into the weight loss program.* As this study on people’s expectations from weight management programs eloquently demonstrates, weight loss goals that focus primarily on the BMI, or on reaching one’s ideal body weight, are misleading at best, and are likely to have a detrimental effect on participants’ outcomes. The fact is that fewer than half of people on a diet achieve a 10% weight loss, 90% of whom regain this weight, often more, within two years. Obese people who lose as little as 5% of their body weight, improve their general health, wellbeing and longevity, regardless of their BMI.
Thus the primary contributor to the near universal failure of weight management programs is participants failure to ever really define the problem of obesity or to make realistic, achievable and clinically meaningful weight loss goals. Consequently, they fail to recognize success even when they actually achieve it. Two entities share most of the blame for this public education debacle; our Healthcare System for their failure to effectively medicalize obesity and weight management, and seizing this educational void as an opportunity to perpetuate their campaign of myths and misinformation is the Commercial Weight Loss Industry.
End Post
Still to come in future posts:
The Rational approach to Nutrition and Physical Activity in Medical Weight Management
The Rational Use of Medication in Medical Weight Management
The Rational Use of Surgery in Medical Weight Management
Conclusion and the Future of Medical Weight Management
Mitchell R. Weisberg, MD, MP
Internist-Psychopharmacologist
Founder-CEO and Personal Physician at:
Optimal Performance MD
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