With about 70% of the U.S. population either overweight or frankly obese, everyone seems to be seeking ways to shed excess blubber. In the process, they often seek any way to accomplish this without the troubling to reduce caloric intake, i.e., dieting. Wouldn’t that be great, but what are the actual facts, and who is actually overweight?
In the health professions, we often use the so-called “body mass index”, (BMI) to determine the presence and amount of overweight, which is simply a way of combining height with weight to yield a single number, or index. The easiest way to find your own index is to view the chart below. Simply find your weight on the horizontal axis, then your height on the vertical axis, and connect the lines (Accordingly, you can select from either the metric or English measurement systems). A BMI of 18-25 is considered normal, 25-30, overweight, and everything over 30, frankly obese. But these numbers are only approximate, for other factors, such as proportion of your weight composed of body fat, play a role. For instance, if one is muscular with little body fat, being slightly “overweight” would not be a danger to health. The distribution of fat also is important, for accumulation of fat around the waist, rather than legs and hips, raises one’s ultimate chances of cardiovascular disease, even though total weight may be within the normal range.
This gives you an idea of whether you must lose weight and how many pounds you need to shed to achieve a BMI of 25 or below (without attempting to grow taller!). Let’s now analyze the various approaches to weight reduction with the pluses and minuses of each method.
Below are four ways that people attempt to shed pounds:
1. Reduce one’s calories though diet (ugh!), a doleful choice, but effective.
2. Resort to dietary supplements, often touted by slick salesmen, with or without medical qualifications.
3. Diet pills. There are currently four approved products on the market
4. Surgery, the most radical approach for the most massively (morbidly) obese.
THE BEST MEANS TO REDUCE
Reduction of calories by diet clearly emerges as the winner. But how do we best accomplish this? In a comprehensive analysis of 48 diets reported in the American Medical Association journal (2014), any diet containing reduced fat or carbohydrate (preferably both) could achieve satisfactory results. But these dietary modifications must be followed—both in the short and long term, to attain ultimate success. Regular exercise, while usually not producing much weight loss in itself, is an important adjunct to all diets and makes reducing easier. First you must start with a reasonable goal, say reducing by 5% of body weight over a period of one to two months. The first few pounds are usually the most difficult.
Begin by cutting portion sizes, consuming a total of fewer than 2,000 calories/day. Cook and eat frequently at home, for this provides better control of portion quantities and salt intake, as discussed in my posts of Oct 6, 2014 and July 27, 2013.
Increase intake of fruit and vegetables, for that provides satiating bulk with fewer calories per unit of volume. Reduce refined grains in favor of whole grains, and add liberal amounts of lean meats and seafood.
Eat breakfast regularly, including liberal quantities of lean proteins, as I explain in my post of August 4, 2013.
Reduce your sugar (sucrose and corn syrup fructose) intake to 10% or less of the total daily calories. This may mean total elimination of all sugary soft drinks in favor of water or unsweetened tea. I discourage the use of artificially sweetened drinks because research has not shown them to be of much help in weight reduction, for reasons that are unclear.
Unfortunately, dietary supplements are promoted as products that are safe and effective, but they are rarely either. Since they are not subjected to the rigorous study required of drugs, they are almost universally ineffective, but worse yet, they are often unsafe. Although unable to keep up with the huge number of products, the Food and Drug Administration (FDA) has recalled hundreds of weight-loss supplements that contained drugs that were usually not listed on labels.
I encounter ads almost daily touting “miracle” supplements claiming to provide weight reduction without dieting. The list goes on and on, but several notable examples are the following: Saffron extract, Garcinia Cambogia, green coffee bean extract, Hydroxycut, OxyElite Pro, MS2 Meltdown, OxyTherm Pro, Sensa, L’Occitane, HCT Diet Direct, acai berry, and yohimbe extract. None of these products have been adequately studied and any or all might be harmful. Side effects may be numerous and dangerous, perhaps most notably liver failure (requiring liver transplantation in some cases and one death of a 19 year-old-man), rhabdomyolysis (extensive muscle breakdown), and kidney failure. Very often these products contain the word “natural” or “herbal”, which suggests that they were safer than prescription medication, but nothing could be further from the truth!
Bottom line. Don’t take any weight-loss supplements. They are unregulated, ineffective, but most importantly—they could harm you!
PRESCRIPTION DIET PILLS
Before 2010 three weight-loss drugs (Fen-Phen, Acomplia, and Meridia) either had failed to gain FDA approval or were taken off the market because of serious side effects.
At present the following four drugs have been approved, but all with reservations:
The first is orlistat, provided in both prescription and over-the-counter forms, Xenical and Alli, respectively. This agent acts by blocking the enzyme that promotes intestinal absorption of dietary fat. Being relatively safe, it is moderately effective as an adjunct to dieting, but if one consumes meals with prominent fat content, it may produce excessive gas, diarrhea, and involuntary discharge of stool (you may want to avoid parties!). Moreover, it may interfere with the absorption of several fat soluble medications and vitamins A, D, E, and K. Rarely liver damage can occur.
The second drug is Belviq (lorcaserin), which promotes weight loss, apparently by increasing the brain’s sensation of fullness. In tests, this drug caused a modest weight loss averaging of 6 pounds in the first year, but after a second year most individuals gained back about a quarter of this meager amount. Side effects were common, including headaches, dizziness, fatigue, nausea, constipation, memory and attention problems, (rarely) a leaky heart valve. Belviq can also interact with other drugs; therefore, one must pay close attention to all combinations.
The third drug is Qsymia (phentermine/topiramate), which is actually a combination of two medications—the stimulant phentermine and the antiseizure drug topiramate. Some trial participants lost as much as 10% of their body weight on this agent, but side effects were significant, including palpitations, reduction of memory and attention, problems with speech, anxiety, insomnia, and depression. Side effects were so prominent that about 40% of trial participants stopped taking it.
The fourth drug is Contrave (naltrexone/bupropion), which seems to reduce appetite and cravings, again probably resulting from its effect on the brain. Small weight losses were recorded in those taking the drug, but fairly common were the side effects of nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea.
BOTTOM LINE: These drugs are not very “appetizing”, and for most of us, they are best avoided. My own take is that the first drug, orlistat, might be the safest and probably the most effective of the group, but certainly not a real champion!
LAST BUT CERTAINLY NOT LEAST: SURGERY
For those who are severely obese, with a BMI of 40 or more, or those with a BMI above 35 with a serious health condition such as type 2 diabetes, surgical procedures can provide an effective last resort for weight reduction. Currently there are four types of procedures, all of which are designed to reduce the volume of the stomach in order to produce early satiation. All these procedures result in effective weight reductions but sometimes at a hefty cost, with somewhat high procedural risks. Resulting side effects may include diarrhea, cramps, stomach ulcers and bowel obstruction, provided that one survives the initial procedure! Nevertheless, if one is severely obese, one of these procedures may be quite helpful in achieving long-term weight loss and, among other benefits, prevention of the development and complications of diabetes, which is commonly associated with such massive overweight.
If you can do it, stick to dieting!