The scientific community is still in disagreement as to whether or not obesity is a disease. While some still consider obesity a self-inflicted disease caused by poor eating habits and lack of exercise, there is growing evidence to support the claim that obesity is a disease.
According to Pi-Sunyer (2002), not only is obesity a disease but within the United States it is considered to be a condition of epidemic proportions. Statistics show that, in our country, over 20% of adults are diagnosed as clinically obese (Pi-Sunyer, 2002). The rationale that obesity is a disease is due to the fact that it causes many different comorbidities such as high blood pressure, diabetes, heart disease, etc.
Has Obseity Reached Epidemic Proportions In Western Countries?
I agree with Conway and Rene (2004) who believe that obesity is not only a condition that has reached epidemic proportions, but it is a disabling, multifaceted disease that causes changes in organ function and can come with a host of comorbidities. The excess body weight puts a strain on the heart, leading to changes in anatomical structure and the function of the organ. Obesity has also repercussions on the immune system (de Heredia et al., 2012), endocrine system (Poddar et al., 2017), and pulmonary system (Dixon & Peters, 2018). These repercussions are caused by both mechanical and functional alteration of tissues and organs.
Data Suggests That Obseity Is Associated With Several Very Serious Health Concerns
Research studies show that obesity is associated with an increased risk of developing cancer in at least 13 different organs (Avgerinos et al., 2019). Obesity is also linked to type-2 diabetes (Maggio & Pi-Sunyer, 2003), arthritis (Moroni et al., 2020). At the same time, a systematic review of scientific data that was published in 2017 shows that weight-loss interventions in the obese adult population decrease all-cause mortality (Ma et al., 2017). The same review shows that weight loss has a positive impact on cardiovascular mortality and cancer mortality (Ma et al., 2017).
Lastly, obesity’s status and acceptance as a disease are pivotal in determining its treatment, reimbursement for treatment, and the development of widespread interventions. For these reasons, I believe that obesity should be recognized as a disease.
Avgerinos, K. I., Spyrou, N., Mantzoros, C. S., & Dalamaga, M. (2019). Obesity and cancer risk: Emerging biological mechanisms and perspectives. Metabolism: clinical and experimental, 92, 121–135. https://doi.org/10.1016/j.metabol.2018.11.001
Ma, C., Avenell, A., Bolland, M., Hudson, J., Stewart, F., Robertson, C., Sharma, P., Fraser, C., & MacLennan, G. (2017). Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ (Clinical research ed.), 359, j4849. https://doi.org/10.1136/bmj.j4849
Moroni, L., Farina, N., & Dagna, L. (2020). Obesity and its role in the management of rheumatoid and psoriatic arthritis. Clinical rheumatology, 39(4), 1039–1047. https://doi.org/10.1007/s10067-020-04963-2
Our total daily energy expenditure (TDEE) is dictated by three factors: resting metabolic rate (RMR), which is the number of calories our body needs to perform metabolic functions when it is at rest; the number of calories burnt through physical activity, non-exercise activity thermogenesis (NEAT), and exercise; and the number of calories needed to digest and absorb food. This is called diet-induced thermogenesis (DIT) or thermal effect of feeding (TEF).
Total daily energy expenditure varies from individual to individual and across age, sex, total body weight, physical activity, percentage of fat free mass (FFM), also called lean body mass, versus fat mass (FM), as well as hormones; all play a role in TDEE. In general, RMR accounts for 60% of TDEE, physical activity account for 25-35% of TDEE, and DIT accounts for 5-15% of total energy expenditure.
How Is Food Converted Into Usable Energy?
The foods and beverages that we consume are combined with oxygen and converted into energy in the form of ATP. They also provide the building blocks used to make hormones and enzymes to grow and repair tissue as well as many other processes. When we eat, digest and assimilate food we burn calories. Diet-induced thermogenesis begins immediately after we eat and can last several hours, depending on the macronutrient composition of the meal. The word thermogenesis comes from the Greek θερμός (thermos) and γένεση (genesis), and it means the creation of heat. Not only does DIT create heat during food digestion and absorption, but it also (by a mechanism still not completely understood) activates the sympathetic nervous system which causes the body to produce heat in brown adipose tissue (BAT). BAT is only stimulated by cold temperatures (shivering) and food consumption.
What Exactly Is A Calorie?
A calorie is a unit of energy. It would be simple to think that a calorie is a calorie and that, therefore, 100 calories of steak are the same as 100 calories of brownies, or butter, or broccoli. But different macronutrients require different amounts of ATP to be metabolized and stored. This is why different macronutrients have different thermogenic effects, and DIT can vary greatly depending on the macronutrient composition of our diet.
Protein and alcohol have the highest thermic effects. The DIT for protein is calculated to be between 20 to 30%; the DIT of alcohol is between 10 and 30%. The thermic effect of carbohydrates is between 5 and 10%, and fat has the lowest reported DIT: 0 to 3%. This means that given the same number of calories, meals rich in protein, fat, carbohydrate, or alcohol have different effect on energy expenditure.
Studies show that postprandial thermogenesis in healthy subjects is increased 100% on a high-protein/low-fat diet versus a high-carbohydrate/low-fat carbohydrate diet. In addition, compared to fats and carbohydrates, protein consumption also provides increased satiety. Satiety scores were higher during high protein/high carbohydrate meals versus high fat meals. For these reasons, high protein diets are favored for weight loss as well as for weight maintenance.
How Does Food Effect Metabolism?
When researching the effects of food on metabolism, the next logical question to address is the following: would eating many smaller meals burn more calories than eating one to two larger meals in a 24-hour period? I found contradicting studies when reviewing the literature. Some studies showed that nibbling throughout the day caused a greater caloric expenditure, while other studies showed that consuming larger meals was linked to greater caloric expenditure. It seems that when it comes to meal frequency and metabolism the jury is still out.
There are other nutrients that stimulate metabolism and cause thermogenesis without contributing any calories. These nutrients are caffeine, capsaicin, and cold water. Caffeine is an alkaloid found in coffee beans, tea leaves, and cocoa beans. It is a stimulant and studies show that a cup of coffee can boost metabolism by 3-11%. A study also showed that caffeine may affect lean people more than overweight people as fat burning in lean women increased by 29% with caffeine consumption but obese women registered an increase of only 10%. Capsaicin is a compound found in chili peppers that stimulates metabolism and helps reduce energy intake. Finally, consuming water increases metabolism by 10-30% for about an hour. Cold water may promote an even greater caloric expenditure, as the body uses extra energy to raise the water temperature to body temperature.
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The ideal body weight, IBW, is the optimal weight based on gender and height. The ideal weight for a woman my height, 5’ 3”, is 104 to 140 pounds. Unfortunately, ideal body weight is an incomplete measurement and does not necessarily reflect the health of a person. Height and gender are the primary factors determining ideal body weight, and some calculators take age into consideration. However, build, muscular development, and body fat percentage are not taken into account. Because of this, many athletes and fit individuals may be considered overweight based on the ideal body weight, while so-called skinny fat people may be well within their ideal body weight numbers.
The Ideal Healthy Body Has Little To Do With The Pounds Displayed On The Scale
When working with clients, I encourage them to ditch the scale and measurements like IBW and to focus instead on body composition, inches lost instead of pounds lost, and, if they really want to explore body composition and have some money to spend, I recommend utilizing tools like Dexa body composition scan and whole body phethysmography.
Excess body weight and body fat have a negative impact on health, and they come with numerous health risks, from type 2 diabetes to sleep apnea. One of the systems that is negatively impacted by obesity and being overweight is the cardiovascular system. Excess body fat is a major contributor to hypertension, which is the number-one cause of stroke. It is also harmful to the kidneys. People who are overweight or obese are also at higher risk for chronic inflammation and diseases of infertility like polycystic ovarian syndrome.
Being overweight or obese is also linked to at least 13 different types of cancers (including breast, thyroid, uterus and ovaries, as well as colon and rectum cancer). While the exact mechanisms aren’t clear, some possible ways in which excess body fat contributes to cancer concern DNA damage resulting from chronic inflammation. The estrogenic effect of fat tissue most likely increases risk of endometrial, breast, ovarian and uterine cancer. Obesity is also linked to high blood levels of insulin and IGF-1, which promote tumor development by inhibiting programmed cell death. Fat cells also produce the hormones adipokines, which have the ability to stimulate or hinder cell growth. It goes without saying that maintaining a healthy body weight is foundational for cancer prevention.
The Mediterranean Diet And Healthy Body Size
The Mediterranean diet is touted as one of the healthiest of the planet. There is not one Mediterranean diet but several variations, depend on the region. While different Mediterranean countries eat different foods, there are staples consumed throughout the Mediterranean, from Italy to Greece to Spain: fresh seasonal vegetables, fish, lamb, nuts, legumes, herbs and spices, some nuts and seeds, and our stars: olives and olive oil. The Mediterranean diets avoid added sugars, highly processed foods, trans-fats, and refined vegetable oils. Water is the beverage of choice; coffee and teas are widely consumed, and wine is also included in moderation.
The Mediterranean diet is rich in fiber and healthy fats, and it is the diet of choice for heart health. Studies show that it improves lipid profiles, decreases lipid oxidation and reduces risk of thrombosis.
The Paleolithic Diet And Reaching Ideal Body Composition
The Paleolithic diet focuses on the foods eaten by our ancestors during the Paleolithic era, when humans were hunter-gatherers. While there are several variants of the diet, the Paleolithic diet (or “paleo”) removes sugar, processed foods, vegetable oils, trans-fats, legumes and grains. It includes meat, poultry, fish, vegetables and fruit, nuts and seeds. Some variations incorporate dairy. Potatoes were initially excluded, but in recent years they have been added to the list of allowed foods. The paleo diet therefore removes many inflammatory foods (processed foods, trans-fats), as well as foods that trigger food sensitivities (gluten and dairy). A 2009 study showed that the Paleolithic diet was superior to the diabetes diet in managing cardiovascular risk factor in patients with type 2 diabetes. Other studies show improvement in serum biomarkers for cardiovascular disease.
Paleolithic Diet Versus Mediterranean Diet
While both diets are beneficial for cardiovascular disease, my preference would be to start a client on the Paleo diet. I like using the paleo diet as an elimination diet. Usually, after an initial phase (lasting 1 to 2 months depending on the client), I carefully and slowly reintroduce foods allowed in the Mediterranean diet. This allows added variety which can help stave off boredom which is extremely important for compliance. Ultimately, the choice will be the client’s. It would be unwise to recommend a Paleo diet to a client who is not likely to comply with such restrictive way of eating. In my practice, clients are active participants in setting goals and how to reach them.
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