NATIONAL ALERT!

Obesity is the latest threat to our society. More people are overweight than ever before. About 65% of the population is overweight. 3 out of 5 persons are overweight and 2 out 5 are obese. Not only are these people at risk for heart disease, but for diabetes, cancer of the breast, colon and ovaries as well.

Obesity in the USA is reaching epidemic proportions in the last twenty years. Two thirds of the American adults are overweight (Body Mass Index over 26) and more than a third are obese (Body Mass Index over 29). It is not surprising that these facts coincide with the striking increase in caloric intake and decrease in physical activity in the general population during the same period of time.

Consequences of both overweight and obesity:

• Diabetes

• Premature development of Cardiovascular Disease

• Increased incidence of cancer at multiple sites for both sexes

• Higher incidence of arterial hypertension

• Respiratory Insufficiency: Pickwick syndrome (Charles Dickens in his novel, “Pickwickian Papers” written in
  1836 described a somnolent and obese young man who could not breathe well, therefore the name
  Pickwickian was applied to this condition)

• Low exercise tolerance, which in turn leads to sedentary life and further weight gain

Possible solutions for the Obesity epidemic:
     - Caloric Restriction and Exercise through strong motivation
     - Use of appetite suppressors and fat absorption blockers 
     - Surgical procedures 

The first step: TRY TOTAL LIFE STYLE CHANGE or TLC. TLC is effective, healthy, and inexpensive.

How can you achieve TLC?

• Be aware of your Body Mass Index. If the BMI is over 26 the diet has to change in quantity and quality. See BMI chart below, make a copy and keep it on the door of your refrigerator.

• If you are obese, reduce the size of food portions to half.

• Read food labels for content and quality.

• Replace saturated with un-saturated fat (animal fats for vegetable oils).

• Eat carbohydrates high in fiber content (less sugar, starch or white flour and more fiber in breads, pasta).

• Replace starch-containing vegetables such as white potatoes and rice with sweet potatoes, beans, broccoli, asparagus, and dark rice.

• Be aware of trans-fatty acids or hydrogenated oils currently advertised as “healthy”. Actually they are more damaging than animal fats.

• Avoid sweetened drinks (pops) , excessive alcoholic drinks intake, pastries, cakes, white bread, and ice cream.

 

Body Mass Index Table To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given Weight. The number at the top of the column is the BMI . Click here to see the table.

 

Our children should be trained to prefer 1% milk over soft drinks; to  bypass the junk food stands that serve hamburgers, hot dogs, French fries, and shakes. Stop by the fruits stand instead. Remember a common “lunch” such as a hamburger, fries and shake, add up to over 2200 calories for only one meal, while the rest of the world lives on 1200 to 1500 calories for 24 hours.

Drastic steps: therapies to be used as a last resort

1) Appetite suppressors or anorectics, ephedrine-like and sympathetic stimulant based drugs are not recommended. Most of them give serious side effects and may lead to addiction. Some popular drugs: Adipex, Didrex . Ionamin. Recently, one appetite suppressor drug, fenfluramine + phentermine or fen-phen caused valvular complications in the heart. It has been removed from the market. Recently an anti-epileptic drug called topiramate (Topamax) has been found to induce weight loss, but may induce cognitive impairment (confusion).

Another drug, silbutramine (Meridia) has been approved by the FDA but it is under scrutiny . This drug works through the brain chemistry decreasing appetite. Long-term experience with Meridia is limited.

The best hope, for now, is the natural hormones produced by the small bowel, such as PYY3-36.. It has been found that obese people have low levels of PYY3-36 and if this peptide is infused prior to meals, it curtail the calorie intake with significant weight loss. The peptides are normally released during meals, signaling a "satiety level to the brain".

A hormone secreted by adipocytes (fat cells) is leptin. Leptin works in similar fashion as PY3-36, but obese people have been found to be resistant to it.  Another substance called adiponectin, also secreted by adipocytes decreases insulin resistance in the tissues, has been found to be low in the obese (New England Journal of Medicine. Rachel Betterham and Mark A.Cohen 349;10 www.NEJM.org, September 2003) 2).

 A newly discovered substance called rimonobant, promises good results by curving not only the appetite, but decreasing the urge to smoke cigarettes and marijuana; it blocks the endocannabinoid or CB-1. Thesew receptors are in the brain, mainly in the basal ganglia, hippocampus, cerebellum, also en the nerve terminals of the GI tract . This latest drug also lessens insulin resistance, promotes significant weigh loss and waist line reduction: about 20 lbs/3.1 inches in one year on 20 mg. daily according to the RIO-NA study in the USA and Canada, involving over 6600 subjects. Rimonobant seems the ideal drug for the treatment of obesity as well as the metabolic syndrome. Two main studies so far corroborated these findings, the RIO-Europe and the RIO-Lipid trials. A word of caution: It has been reported that rimonobant may increase suicide rates among individuals with mental depression. At present this drug is being sold only in Europe and Canada.

(2) Fat absorption blockers. Orlistat (Xenical) is one of  the newest drug. It interferes with the lipases, enzymes that allow absorption of fat in the bowel, causing undigested fat to be eliminated in the stools.  It is not an appetite suppressor nor is it addictive.  It has some adverse reactions, such as flatulence, diarrhea and "fatty stools". It is being sold over the counter under the name of  "Alli".

3) Surgical procedures are recommended only in extreme cases with BMI's over 40. There are several of these procedures:

Liposuction, primarily accomplishes temporary cosmetic results. It may be complicated by pulmonary embolism. In fact, 20 deaths in 100,000 have been reported after liposuction, vs. 1 death in 100,000 in other surgical procedures.

Bariatric Surgery or Gastroplasty shrinks the stomach by partial resection or stapling. Normally the stomach holds one litter of food. Obese people may hold over 5 liters and its capacity is reduced surgically. Over 100,000 of Bariatric surgeries were done in the USA in 2003. Gastro-intestinal bypass eliminates part of the stomach and small bowel. It gives spectacular results, but 10% of cases are complicated by "ventral hernia" due to weakness of the abdominal wall". The incidence of infections in the surgical wound is high in all these procedures. A new less invasive and reversible laparoscopic method is being used successfully, it is called the LAP-BAND technique; its complications and discomfort are minimal.

Note: Several cases of severe vitamin B1 deficiency may follow these procedures, therefore,  the use of supplemental vitamin B1 is indicated.

Electrical pacemaker  implants, similar to the cardiac pacemakers, with the electrodes placed in the gastric wall; this device gives electrical stimulation which causes a  sensation of a fullness in the stomach.

Diets:

Throughout the years, many diets have been formulated in order to reduce the risk factors for arteriosclerosis, therefore decreasing the incidence of heart attacks and strokes. The same risk factors are also involved in arterial hypertension, overweight or obesity and diabetes.  It is very unfortunate, that, until the year 2003, most of the popular diets have been conceived around the famous “Old Food Pyramid” developed by the USDA in 1992.

The old pyramid has the following flaws:  

• Minimizes the consumption of fats in general. No distinction is made between saturated animal fats and unsaturated fats contained in fish oil and vegetable oils. 

• Encourages the use of carbohydrates by suggesting six to eleven servings a day of bread, pasta and rice. No emphasis on the benefit of fiber containing carbohydrates.

• Recommends generous portions of diary products and proteins from meats without distinction of white vs. red meats, poultry, chicken or turkey or fish.

The USDA has published a new Pyramid in 2005. See comments below.

The medical group of Harvard University  proposed in January 2003 issue of The  Scientific American, a pyramid that makes the best sense of all. See it below.

The Paredes Diet

This diet is based on the Pyramid designed by the Harvard Medical group in 2003 and the old Mediterranean diet. It advices at the first level, whole grain foods at most meals, vegetable oils: olive, canola, soy, peanut etc. at most meals. On the second level it recommends green and colorful vegetables in abundance: carrots, broccoli, asparagus, eggplant and fruits: bananas, grapes, pears, strawberries, tomatoes. On the third level it recommends legumes and nuts. On the fourth level broiled or baked fish, poultry (preferably chicken without the skin and some turkey) none of them fried; dairy products (fresh cheese or cottage cheese, 1% milk) and voilá: eggs, which are not forbidden food as it was thought before. A large class A egg contains 240 mgs.of cholesterol. The daily allowance of cholesterol is 250 mgs. Therefore, It is O.K. to eat 3-5 eggs a week. Goodbye eggbeaters! Notice that alcohol is mentioned. One or two glasses of wine with supper is acceptable, preferably red wine, for its high content of poliphenols. At the top of the pyramid are the least recommendable foods: red meat (one steak a week, cooked after the fat has been trimmed off will not hurt), rice, white bread, potatoes (especially fried or chips), pasta, and sweets should be kept to a minimum. Place lean pork next to chicken because of its low content of fat. Processed turkey is not recommended, since it contains the skin which is very rich in cholesterol and saturated fat.

Anyone can plan their own sensible diet keeping in mind that both quantity and quality are important. Very few people that lead a sedentary life require more than 1500 calories per day. Observing the different ethnic diets, we noticed that the Mediterranean countries: Greece, Italy, France and Spain follow the new pyramid pretty well. In addition, all of them consume red wine with their meals. In Japan, the consumption of fish is very significant. All these countries have an average life for their population which is 3-4 years higher than in the United States. It is important to note that people from these countries walk a lot and enjoy long, leisurely dinners which are relaxing and socially pleasant. In the US, meals are rushed and un-relaxed.

This Food Pyramid should be followed closely. It emphasizes the intake of unsaturated fats, oils, and fiber containing carbohydrates. It also encourages moderate alcoholic consumption.

Comments on the last Food Pyramid released by the USDA in 2005:

Two and half million dollars and thirteen years later, the newly designed Food Pyramid by the USDA is well presented and recommends specifically the proper type of food stuffs to be consumed in the amounts required by each individual according to age, sex and degree of physical activity performed daily. It emphasizes physical exercise regularly. One important drawback, however, is the lack of access to the common public; Adobe Acrobat is necessary to read this pyramid.

The New Pyramid can be seen by visiting http://www.mypyramid.gov

Assumptions and myths regarding diets and food:

There are no magic diets or pills that will promote weigh loss and maintain the loss. The greatest incentive is to look in the mirror and decide if you like what you see. Decide to loose weight using common sense and knowledge. The assumption that only a specific diet works is false.  Reduce the quantity of food to half if your Body Mass Index is over 26, then select the quality of food that you should eat reading the labels of food stuffs that you purchase. Begin a progressive form of exercise even if it is only walking for half an hour 5 days a week. You will look and feel better and your self-esteem will improve.

Review of the most popular diets: 

Dr. Dean Ornish's Reversal Diet: The diet recommended by Dr. Ornish is a low-fat, plant-based diet that uses fruits, vegetables, whole grains, beans, and soy products in their natural forms. It incorporates moderate quantities of egg whites, nonfat dairy or soy products, and small amounts of sugar and white flour. These foods are beneficial because they are low in harmful substances and are rich nutrients that may be protective against heart disease and many other illnesses.

The Atkins Diet: Dr. Atkins' weight loss diet is based on four stages of carbohydrate restriction. Breads, pastas, fruits, and milk should be avoided, but consumption of meat, poultry, fish, eggs, fatty cheeses, and heavy cream is unrestricted. The diet claims to work because it reduces glycogen storage which forces the body to utilize fat stored fat for energy, inducing a state of ketosis. It also claims to reduce insulin levels, which is the culprit of fat storage in adipose cells. In actuality, the Atkins' Diet effectively creates weight loss because the high fat and protein content promotes a sense of satiety after eating. Triglycerides and other lipid levels are also reduced. Weight reduction on this diet is partially due to water loss. Studies published in the New England Journal of Medicine (May 2003) by Samaha, Foster, and others demonstrated that the initial benefits, weight loss and reduction in lipids levels are significant during the first six months but less significant during the rest of the first year. Most often the benefits are lost after the first year due to lack of compliance. It has also been reported damage to the kidneys may occur during the ketosis state induced by this diet.

The American Heart Association (AHA) Diet: Healthy food habits can help you reduce the three main risk factors, high blood cholesterol, high blood pressure, and excess body weight which lead to heart attack or stroke. The American Heart Association Eating Plan for Healthy Americans is based on dietary guidelines, released in October 2000 which recommend; limit saturated fat intake to less than 30% of calories, limit cholesterol intake to 300 milligrams per day, strive to reach and maintain your ideal body weight, limit sodium and sweets, consume 30-40 grams of fiber daily.

The Mediterranean Diet: The Mediterranean Diet consists primarily of vegetable oils, fresh vegetables, abundant fish, fiber containing carbohydrates and moderate amounts of red wine (red wine contains antioxidant polyphenols and posibly,  resveratrol which has multiple beneficial metabolic effects). In the Mediterranean countries, meals are pleasurable episodes in daily life. Meals involve good social interchange, last a minimum of two hours,  require attention to refined flavors. All of this is conducive to a great degree of satisfaction resulting in the healthy physiological phenomenon of endorphin release. A possible benefit occurs with release of intestinal hormones which signal the brain that a level of satiety has been reached. It is fair to say that Mediterranean diets are by far healthier than the current American diet.  According to the 2000 WHO (World Health Organization) report on longevity, we rank 24th in the world, in spite of the fact, that we have advanced medical care and facilities. The Mediterranean countries, France, Spain, Italy and Greece are on top in longevity. 

The Pritikin Diet: Developed in the late 1950’s, the Pritikin Diet recommends high consumption of generous portions of vegetables, excludes animal products, and requires a detailed calorie count. It emphasizes a 45 minute walk per day. A draw back may be a reduction in calcium balance and a low level of compliance.
The Zone Diet: This diet developed by Barry Sears M.D. recommends 40% protein, 30% carbohydrate and 30% fat intake. This 40-30-30 plan is strict and difficult to follow. All foods with a "high glycemic index" are avoided; however, many of these are fiber containing vegetables such as carrots that have high nutrient value as well. Total calorie intake is between800-1200 per day which does result in weight loss, but is very difficult to follow.

The South Beach Diet: Recommended by Dr. Agatston in 1999, this diet has become very popular. Carbohydrates are classified as good or bad. Good carbohydrates are high fiber cereals and whole wheat breads. Bad carbohydrates are white flour bread, pastas, biscuits, and sweets. Fats are classified as good or monounsaturated and bad or saturated. It’s three, two week phases make the diet complicated to follow. Calcium supplements are needed because there is a reduction in animal product intake. This diet recommends the consumption of at least 8 glasses of water daily which is wise.

Weight Watchers Diet: “Weight Watchers” which requires weekly meetings started in the early 1960’s. It uses group support for encouragement and compliance. Over 20 million people in the world attempt to follow it. No foods are eliminated, but caloric intake is. Weigh loss is very slow.

Slim Fast Diet: It uses meal replacement by pre-prepared packages that become costly. It does not teach healthy eating habits and it induces quick weight lose that is difficult to sustain.

Revised July 20th, 2007