What is a Obesity

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese.

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Dr. Dina Prus

Dr. Dina Prus

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Dr. Roshney Jacob-Issac

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Dr. Swaminathan Giridharan

Dr. Swaminathan Giridharan

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Obesity and Dieting - Lifestyle Change Verses Crash Diets

Obesity is a long-term issue for most patients, and so it needs a long-term solution.

While crash diets are attractive in so far as they make the scale look better, they’re not the solution. Medically, you want to keep your weight down over many, many years, and thereby, hopefully, decrease your risk of heart disease, and cancer, and the other risks that are associated with obesity.

Losing weight for six months, 12 months, two years, again, is not undesirable, but medically we want you to keep the weight off over a longer period of time. People tend to gravitate back to their usual diets and lifestyle, and so the effect is lost and after three, four, five years, they’re back to their weight they were before.

Another medical concern about crash diets or fad diets where you rapidly lose weight is that while you’re losing fat you’re also losing muscle. That’s actually disastrous. It’s a general rule as we age as human beings never to do something that will jeopardize your body’s muscle.

The muscle determines your metabolic rate, so if you undergo a crash diet and you lose muscle, after you come off the diet and your muscle mass is lower, your metabolism is lower. If you then eat the same food that you had before, with a lower metabolic rate you’re gonna gain weight, and that is a simplistic explanation for yo-yo dieting where you lose the weight, you rebound, and you end up weighing more two years later than you did when you started.

So, it is important, therefore, that exercise and thereby maintenance of your muscle mass is an integral part of any weight reduction strategy for sustainability of that strategy. So, it’s important to discuss this with your healthcare providers, your exercise specialist, and address the obesity issue over the long term. Diabetes Treatment Obesity Patient Communication System

Presenter: Dr. Richard Bebb, Endocrinologist, Victoria, BC

Local Practitioners: Endocrinologist

Quiz: Do You Understand Obesity?

Test your knowledge by answering the following questions:

Questions
True
False
1

Diabetes is associated with obesity.

Explanation:
Many medical problems such as diabetes, stroke and heart attacks are associated with being overweight or obese.
2

A BMI over 25 is considered obese.

Explanation:
A Body Mass Index (BMI) between 25 and 29.9 is considered overweight. BMI is a statistical measurement of your height and weight. A BMI of 30 or more is considered obese.
3

Going on a crash diet can lower the metabolism.

Explanation:
Muscle mass effects the metabolic rate. Crash diets can cause muscle loss which can slow the metabolism.
4

There are medication options for people with obesity.

Explanation:
Yes, commonly prescribed weight loss medications include orlistat, phentermine, buproprion and naltrexone. These medications may be prescribed when other lifestyle changes have not proven effective.
5

Sleep habits are not associated with obesity.

Explanation:
Sleep habits are associated with obesity. Other common reasons include consuming too many calories, leading a sedentary lifestyle, and certain medications.
(Answer all questions to activate)

Understanding Why Obesity is a Chronic Disease

Obesity is a chronic disease. 2015 was the year where the Canadian Medical Association recognized obesity as a chronic disease. For decades, obesity was recognized as a risk factor to develop other complications such as diabetes and hypertension.

It is an entity on its own, and it’s a chronic disease, because we all know—and everybody that’s tried dieting or losing weight does know that the battle is lifelong. Once we suffer from obesity, we have dis-regulation of several hormones, or even the neurobiology is modified.

For a long time obesity was regarded as being a lack of motivation. We now know that there are genetic factors involved, there is neurobiology involved, and there are hormonal factors that are implicated in weight management. Let me explain. Our adipose tissue actually secretes a hormone called lectin. Lectin goes to our brain to tell our brain we have enough storage.

Well, when we suffer from obesity, and we live with obesity, that signaling is lost. There’s a hormone secreted by our gut called the GLP-1, secreted after we eat, to tell our brain we just ate, we just had a caloric intake, so you can stop eating. It’s called satiety, satiety signaling. Well when we suffer from obesity, that signaling is also dampened. So now imagine: you’re trying to lose weight. You’re trying to control your caloric intake. And the two main signaling are dampened in your brain.

This being said, there is a concept of setpoint that I wanted to bring up. The concept of setpoint is important because it finally explains the weight rebound. Everybody that loses weight on a diet re-gains their weight. Sometimes very quickly, sometimes over years. But the reason is the setpoint theory.

Let me explain. When we lose weight, we also lose muscle mass. And muscle mass is very important for our basal metabolic rate. If we lose muscle mass, we lose basal metabolic rate, which kind of limits our calorie burn at rest. So we tend to re-gain weight.

Not only that, there’s also hormonal adaptation. I told you about a hormone secreted by the gut that is used for signaling in our brain to tell us we just had a caloric intake. Well, when we lose our weight, we lose that signaling. Imagine that? Even less. We’re already resistant to that satiety signaling, okay, that fullness feeling. And now we have less signalization to our brain.

Not only that, there’s a hormone called ghrelin secreted at the level of the stomach, that actually increases appetite. Well, guess what? When we lose weight it increases. So we have our defense mechanism is to make sure that we don’t die from starvation. So if we lose weight, as soon as there’s going to be food around we’re going to be able to re-gain our weight.

If you’re looking for more information on obesity and how to help with weight management, ask your family doctor, ask a specialist. You need a multidisciplinary approach: dietitian, kinesiologist, personal trainer even, to make sure that there are agents, medication to help you also if you suffer and you live with obesity. Diabetes Treatment Obesity Patient Communication System

Presenter: Dr. Alexandro Zarruk, Family Doctor, Pierrefonds, QC

Local Practitioners: Family Doctor

Local Registered Dietitian

Victoria Middleton

Victoria Middleton

RD
Registered Dietitian
New York City, NY
Yumna Khan

Yumna Khan

RD
Registered Dietitian
Burlington, ON

Sarah Blunden, PDt CDE CPT, Dietitian, discusses the importance of making good lifestyle choices when managing diabetes.

Dr. Alexandro Zarruk, MD, MSc., FACP, FRCPC, Internal Medicine, talks about medications that can help patients lose weight.

Dr. Richard Bebb, MD, ABIM, FRCPC, Endocrinologist, discusses causes of obesity.

Muscle Mass & Weight Control in Regards to Diabetes and Obesity

The preservation of muscle mass is critical to control your weight.

One pound of muscle consumes roughly 50 calories per day, and that’s without exerting yourself. That’s sitting on the couch watching the football game. So, six pounds of muscle would be 300 calories a day so that’s roughly a light breakfast.

So, if you undergo and crash diet and you lose six pounds of muscle, you’ve just lost – you have to diet 300 calories a day to break even afterwards. So again, it’s critical not to jeopardize your muscle mass.

So it is important, therefore, that exercise, and thereby maintenance of your muscle mass, is an integral part of any weight reduction strategy for sustainability of that strategy.

It’s important to discuss this with your healthcare providers, your exercise specialist, and address the obesity issue over the long term. Diabetes Treatment Obesity Patient Communication System

Presenter: Dr. Richard Bebb, Endocrinologist, Victoria, BC

Local Practitioners: Endocrinologist

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