Programme of Weight Loss Treatment and Obesity Management in Adults Offered by Freedomhealth
Anybody who is obese or overweight, will always have a higher risk of developing many health problems, such as diabetes, heart disease, cancer, etc. Also if one is able to achieve his/her ideal weight, apart from looking and feeling better, it will help your mental and physical health, as part of one’s general well-being.
How do I know if I am overweight or even obese? To find that out, we need to calculate our BMI.
BMI stands for body mass index and this would be a good estimate to determine how much of your body is made up of fat. It is the relationship between your weight and your height. You can calculate your BMI by dividing your weight (in kilograms) by the square of your height (in metres).
For example, if your weight is 70 kg and your height is 1.75 metres, your BMI is 70 / 1.75 x 1.75, which is 22.9. The objective is to have a BMI between 18.5 to 24.9. Anybody with a BMI above 25 should aim to lose some weight, and the higher this figure, the higher the risk to one’s health.
Less than 18.5: Underweight – involving some health risk.
18.5 to 24.9: Ideal weight – Normal, no risk.
25 to 29.9: Overweight – involving moderate health risk.
30 to 39.9: Obese – involving high health risk.
40 and over: Very obese – involving very high health risk.
Once you have calculated your BMI and the actual figure is within the overweight or obese category, you need to develop a plan to try to lose weight. Here, at Freedomhealth, we can help you to achieve your goals. A realistic aim would be to lose 5-10% of your weight over a period of three months. This would be usually an amount between 5 to 10 kg (about one to one and a half stone.) This loss, even though quite modest, will greatly reduce your increased health risks. The best chance of losing weight, and keeping the weight off, is to be committed to a change in lifestyle. This includes eating a healthy diet and doing some regular physical activity.
In addition to this, health risks are much greater when the extra fat is mainly around your waist rather than mainly on your hips and thighs. This is a very common problem among men, even with a normal BMI. A waist measurement of 102 cm or above for men (92 cm for Asian men) and 88 cm or above for women (78 cm for Asian women) would involve a significant health risk.
Our Basic Principles
- It is a well-known fact that if energy intake is greater than energy expenditure then weight will be gained. If the two are the same, weight will not change and the only way we can lose weight is for the calory intake to be less than the expenditure. A small but consistent excess of intake over the expenditure will cause a large increase in weight over the years.
- Intake is not the only aspect to take into account, because it is possible to modify the expenditure too, by introducing regular exercise to our daily routine.
- Unfortunately, there is no quick fix to losing weight. It is a long and arduous task. Obesity is considered as a chronic disease by The World Health Organization. The correct management is not just helping to get rid of some unwanted pounds but rather more a long-term approach to change attitudes, habits and values for the rest of that person’s life.
Initially we would recommend the following tests: urine is routinely tested for glucose, in order to exclude diabetes. Fasting blood lipids (cholesterol), glucose, thyroid function and other relevant hormonal tests are also performed. It is important to exclude any organic cause for the weight gain. If we identify a specific reason, we would of course treat that first.
The following patients are specially in need of help and advice:
- Patients with a BMI >30
- Patients with a BMI >28 and concomitant illnesses such as chronic obstructive pulmonary disease, ischaemic heart disease and diabetes.
- Patients who are overweight and have diabetes, other risk factors or serious diseases.
- Advice to prevent gaining weight is offered also to high risk individuals such those with a family history of obesity, smokers, etc.
We have many years of experience helping patients in these situations.
Aims of Our Management
We would develop a personalised plan of action including the following aspects:
- Identify the possible causes that have made the person obese or overweight. There are probably several contributory factors: psychological, physical, social, habits, etc.
- Focus on why we want to lose weight concentrating on all the benefits and incentives, with a positive attitude, assessing at the same time the degree of motivation.
- Design a personalised exercise programme and a specific diet.
- Set a realistic target for weightloss rate and desired final objective. For someone with a BMI above 35, aiming to achieve a BMI of less than 25 is at first unrealistic.
In addition to this, we will also consider cognitive and behavioural therapy to help in changing certain behaviours – to identify the wrong attitudes and actions in their lives, understand them and try to rectify them, identify correct responses and to implement them. I refer here to possible “comfort eating” or even depression and anxiety that will need to be treated.
Dietary modification and advice on exercise will be our first aim. Trying to lose weight without exercise is extremely hard.
It is very helpful to keep a food diary, including all snacks taken during the day. The food diary will be over a period of at least a week and will show a typical day’s intake, without forgeting snacks, sweets and treats. Also drinks, whether tea or coffee which may contain sugar or alcoholic drinks. Avoid sugar and use skimmed milk. Alcohol should be reduced rather than banned as it can be an important quality of life issue for many people. Alcohol contains many calories and suppresses blood glucose levels, increasing the appetite.
Diet and Exercise
Many overweight people may have done no exercise at all for many years. It is very important to discuss the options and find a type of exercise that is fun and enjoyable. Age and level of fitness must be taken into account. This is very important as we should consider that the exercise is not just for the time whilst we are losing the weight, but for life. However the physical activity must be of a certain minimal duration, intensity and frequency in order to help suppress insulin levels and burn fat. This exercise routine should take 30 to 40 minutes of sustained exercise at least 5 times per week combining cardiovascular actitivy with weights. The first aim should at least be a daily 500 Kcal deficit of energy requirements by modification in dietary habits and exercise.
Exercise will increase basal metabolic rate and after vigorous exercise, including weights and resistance exercises, metabolism will continue being stimulated for the following 36 hours. And it helps us feel good about ourselves. At the beginning, weight often drops quite fast but the rate of loss then slows down, causing sometimes some disappointment. However this often reflects that the lost weight was in fat and is being gradually replaced by muscle because of the exercise. Muscle is much more aesthetically satisfying than excess fat, but it is also healthier and it has a much higher basal metabolic rate. In order to get the best out of regular exercise, we can also refer our patients to an excellent highly-qualified personal trainer.
As with all chronic diseases, follow up will be arranged with the same doctor, in order to assess the patient’s progress. Monthly appointments will be arranged at first, with intervals getting longer with time, monitoring the weight and the total well-being of the patient. The achievement of a target weight is not the end of the process. Excess weight can be a chronic problem and needs to be managed throughout the person’s life as it is very common to relapse and pile up the pounds again and again. Weight going up and down is not desirable and is very unhealthy.
We consider that the management of obesity and excess weight is a life long process. The attitudes towards a healthy diet and regular exercise must change for life.
Here at Freedomhealth, we offer a holistic approach to help and support our patients to lose weight and change their lifestyle.