Battle of the Bulge by Alison Sims, M.D.

Board Certification: Internal Medicine

Unfortunately, as a leading developed country, the United States is losing the battle against obesity. It is a serious problem that not only increases the prevalence of many chronic diseases, but it also increases the healthcare costs of many people who cannot afford to get sick. Healthcare spending outpaces all other expenses, and from 1980 through 2009 U.S. Healthcare spending grew from 9% of Gross Domestic Product to 18%. This huge national expense is multifactorial, but reduction of your own health care costs is simple and begins with you and your daily choices.A 2005 review of health care costs found that only 4 conditions account for 74% of all costs of health care in the United States: cardiovascular disease, cancer, diabetes, and obesity. Amazingly, if one chooses to live a healthy lifestyle then 80% of cardiovascular disease, 80% of diabetes, 60% of certain cancers, and 90% of obesity can be avoided. In 2005, an obese person compared to a non-obese person was found to incur $2,741 more in medical costs annually. Consider that statistic as you budget for your family.Two simple measurements are used to determine if you are in a healthy weight zone. First, the BMI (Body Mass Index) is calculated using kilograms and meters and the formula is simply weight/height squared. You can also go to any reputable health website for a calculator, such as the one at U.S. Department of Health and Human Services http://nhlbisupport.com/bmi/ to just plug in your numbers. There are also many apps for your cell phone that calculate BMI. Second, central obesity increases the risk of cardiovascular disease and is defined as waist circumferences greater than 94 cm (37 in) in men, and waist circumferences of greater than 80 cm (31.5 in) in women, in addition to waist-to-hip ratios greater than 0.95 in men 0.8 in women.

The following are danger-zone weight categories:

• Overweight= BMI 25 – 29.9
• Obese= BMI 30-39.9
• Severely or Morbidly Obese= BMI 40-49.9

With each higher category, the risks of preventable diseases and premature death increase.  A simple calculation plus a tape measure can send you on your way to being motivated!

A few of the health problems that result from being overweight or obese are reflux esophagitis and gastroesophageal reflux disease (GERD), lower limb circulatory stasis (swelling), abdominal hernias, type II diabetes, hypertension, high cholesterol, coronary heart disease and heart attacks, hypertension, stroke, arthritis of the weight-bearing joints, gall bladder disease, sleep apnea, and cancers of the endometrium, breast and colon. It is all very sobering.

Just paying for the medications to treat all of these conditions is a nightmare, and living with the discomfort of these ailments is even worse. Your quality of life is poor when you cannot walk without pain, have shortness of breath, chest pain, abdominal pain, back pain, cancer surgeries and chemotherapies, heart surgeries, and you’re losing sleep due to apnea and pain. It is amazing to think it all starts with you, and your choices.

Contrary to the old beliefs that slow and steady weight loss is the best way to go, a New England Journal article in January of 2013 reviewed the evidence-based facts and found that the more intense and highly structured exercise programs, like The Biggest Loser, are the most successful. Following a vigorous exercise program and eating a highly restricted diet is the most reliable method for reaching a healthy goal weight and keeping the weight off for 4 years or more. It is still the same equation of intake of food energy needs to be less than output of physical energy, but the recommendation is to be a lot more serious and extreme about it. Check out the internet for great websites for guidance and tracking tools. A few that are highly regarded are Weight Watchers and Body for Life which feature food intake plans and exercise plans. Get your balance sheet going and be truthful with yourself. There are also many apps out there for tracking your food and exercise on your mobile phone while you are on the go, such as Lose It!

However you decide to do it, be accountable and responsible for your health and your future health care costs. You can do it…and at any age too!  For instance, my very own mother was motivated to get healthy at the age of 70! With the help of a trainer to teach her how to lift weights, and good old paper and pencil to keep to 1,000 calories a day, she dropped over 40 pounds and 5 dress sizes in a year, and kept it off!  She is now 75 years old, and still looking fabulous in her new size 8 wardrobe.  She continues to do water aerobics, weight training, and group exercise classes faithfully, in addition to counting calories. She inspires me!  Be a good role model to your children, and they will follow your lead.