How can you tell if you are overweight?
A ‘muffin top’ of flabby fat spilling over your waist is a vital warning sign.
Fat carried around the stomach, known as ‘central obesity’, is more strongly associated with serious health problems than fat deposited in other parts of the body. Excessive fat at the waist is risky because it releases a large amount of fatty acids into the blood, which affects metabolism; it also contributes to a range of other conditions, including some forms of cancer.
Central obesity is the main risk factor linked with the metabolic syndrome, a cluster of dangerous symptoms that predisposes an individual to cardiovascular disease and diabetes. The Metabolic Syndrome started as a concept rather than a disease. It has been called by a variety of names, including ‘Deadly Quartet’, ‘Insulin-Resistance Syndrome’, and ‘Syndrome X’, but nowadays the term ‘Metabolic Syndrome’ is used.
Over the past 20 years there has been a striking increase in the number of people with the Metabolic Syndrome in parallel with the global epidemic of obesity and population
ageing. It is estimated that about 30 per cent of Australian adults aged 25 years and over have Metabolic Syndrome, and they are twice as likely to die from and three times as likely to have a heart attack or stroke than those who don’t.
People with this syndrome also have a fivefold greater risk of developing Type 2 diabetes, one of the most common chronic diseases worldwide, which already affects about 90 000 West Australians. In the Nurses’ Health Survey involving about 85 000 American women 34–59 years old who were free of diabetes and cardiovascular disease at the
commencement of the survey, a positive relationship between obesity and the risk of developing Type 2 diabetes was seen in the 16 years of follow-up.
Medical experts don’t know exactly what causes the Metabolic Syndrome but both central obesity and insulin resistance are acknowledged as significant factors. Insulin resistance occurs when cells in the body become less sensitive and eventually resistant to insulin, the hormone that is produced by the pancreas to facilitate glucose absorption. When the pancreas is no longer able to produce enough insulin to process the glucose, it builds up in the blood and increases the risk of a person developing Type 2 diabetes.
Waist circumference is a guide to determine whether a person has central obesity and can be easily measured using a tailor’s tape measure. The waist is measured at the midpoint between the lowest rib and the top of the hip bone. A healthy waist measurement is less than 94cm for men and 80cm for women – a larger waist indicates central obesity.
According to the 2005 International Diabetes Federation (IDF) definition, for a person to be diagnosed as having the metabolic syndrome, they must have central obesity plus at least two other risk factors: raised triglycerides, or fats, in the blood; reduced HDL (or ‘good’ cholesterol); high blood pressure; and an elevated fasting blood glucose level.
The IDF recommends that primary management of the Metabolic Syndrome should emphasise lifestyle therapies. This is best achieved by a combination of weight loss, regular exercise and a healthy diet. Research has shown that just losing seven to 10 per cent of initial body weight is sufficient to improve waist circumference. Waist reduction of between five and 10 centimetres in women is a useful guideline to obtaining real health benefits. Sedentary habits like watching television or working at the computer should be replaced by more active pastimes such as walking, jogging or swimming on most days of the week. A balanced diet is advised that is low in saturated fats, sugar and salt, but rich in the four Fs – fish, fowl, fibre and fruit.
Because the Metabolic Syndrome is so common, it is vitally important to recognise it early so that individuals may be targeted for risk factor and lifestyle management.
The first step is really simple – watch your waist!
This dastardly plague is in epidemic proportions across Australia and is threatening to become one of the leading causes of death and illness. Certainly the economic cost to the nation is huge.
Lose it!
The priority for anyone with Metabolic Syndrome and insulin resistance is to normalise weight as quickly as possible. In most cases this gets rid of the resistance to insulin. There is a number of different ways of achieving this. The principles of treatment are to reduce calorie intake (easier said than done) and increase calorie consumption through exercise.
Many people are in a difficult position of being unable to exercise because of either injuries, low back pain or joint pain from osteoarthritis. Because they are overweight, the low back pain and joint pain is often much worse than usual and this provides a real and sometimes convenient excuse to not exercise.
It is possible to reduce calorie consumption by joining an organisation such as Weight Watchers. The principle here is one of supportive psychology, encouraging sensible eating habits and gradually increasing exercise. Weight Watchers has done a tremendous job for many people over the years and long may they continue to do so!
Weight Watchers isn’t for everyone however. Some people prefer to do their weight loss on their own. I encourage many couples to consider a meal replacement program such as the Tony Ferguson meal replacement program, available through Terry White’s Chemist. The principle behind this is that the Tony Ferguson meal replacement sachets, which cost approximately $2.50, contain inert substance which fills you up and stops you feeling hungry. The calories which are contained in it are low GI and are thus released slowly, preventing the pangs of hunger that you get after a high GI meal. The advantage of the Tony Ferguson meal replacement program is that the pharmacists at Terry White’s Chemist are extremely motivated and offer an excellent program of support with regular weekly weigh-ins. I have had well over 100 patients on the Tony Ferguson program and most of them have lost a significant amount of weight.
Other reasons for the success of the Tony Ferguson program include the excellent range of flavours, which includes soups as well as milkshakes, and some sort of fancy technology which is able to give the meal replacements a pleasant creamy texture. Tony Ferguson has also produced a range of lactose-free sachets. Generally you replace two meals a day. Although the pharmacists advise that these be any two meals, I tend to advise people to replace breakfast and the evening meal. I think people are generally more likely to eat a healthy lunch whereas at night time we tend to pig out and slump on the sofa watching the television rather than burn off the calories we have just eaten.
Gastric banding, otherwise known as Bariatric surgery, is a further option. This helps remove some of the (sometimes failing) willpower from the equation. In this procedure a gastric band is placed around the upper stomach to create a pouch. The nerves in the upper stomach are the ones that tell the brain when the stomach is full. Consequently, when food is eaten and the pouch is full (but not the whole stomach) that tends to switch off the craving for food. There are also some physical limitations in how much food can physically be eaten because of the restriction in room. The band is adjusted over time by the surgical team to increase or decrease the amount of food allowable depending on weight loss.
Dedicated Bariatric surgeons work in Perth at St John of God Hospital, The Mount Hospital and Mercy Hospital. The Bariatric surgeons generally have teams that support them such as dietician, exercise physiologists and psychologists to help with the whole weight loss process.
These are just some of the most effective ways of achieving weight loss. Generally I would recommend a combination of the above, where a dietary modification program takes place in conjunction with exercise. Bariatric surgery can fill a great role for people who can get started on their weight loss but find it impossible to drop below a certain barrier. Your GP can advise you on services available and on the various techniques. Further information can be found at www.virtualweightlosscentre.com
I have not made any great mention of miracle tablets that are supposed to help people to shed weight. Some of these tablets block food absorption in the gut but do so at the expense of profuse diarrhoea. The fat restriction that has to be achieved to prevent the diarrhoea is pretty much good enough to help you lose weight anyway. Tablets that suppress the appetite are reasonable for short-term loss but are not recommended for any ongoing weight loss. They tend to be somewhat addictive and effects are not sustained. The weight loss is often very rapidly put back on.
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