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Obesity — A Term that Carries a Lot of Weight. Should We Change It?



The idea of obesity is a difficult subject to broach on many levels. The term itself is loaded with stigma, and people who suffer from this condition can become resistant to even hearing the word, let alone talk about it. The shame and anticipation of judgement can be disabling, and yet the language we use when discussing weight is so limited. What can health practitioners do to break down the wall?

In a study published in a 2012 issue of the journal Obesity, researchers asked 390 obese adults in primary care settings in the Philadelphia area to complete a questionnaire about the terms that are most and least acceptable to describe excess body weight. Out of the 11 terms that were offered, “fatness” was rated as the most undesirable, followed by “excess fat,” “large size,” “obesity” and “heaviness.” (The most preferred terms were simply “weight,” “BMI,” “weight problem” or “excess weight.”)

These words encompass the majority of terminology currently used in health care to describe excess weight. But in an effort to change how physicians and patients engage with the topic of obesity, the American Association of Clinical Endocrinologists, or AACE, and the American College of Endocrinology, or ACE, have proposed a new diagnostic term to describe obesity: Adiposity-Based Chronic Disease, also known as ABCD.

“Right now, obesity is relegated to a simple construct of having a [body mass index] over 30,” says co-author Dr. Jeffrey Mechanick, a professor of medicine and medical director of the Kravis Center for Cardiovascular Health at the Icahn School of Medicine at Mount Sinai in New York City and past president of AACE. “But the word obesity doesn’t confer sufficient information about the disease risks.” ABCD on the other hand, focuses on a complications-centric approach to diagnosing, categorizing, and treating overweight.

The categorization takes into account a number of measures. In addition to BMI, this new system also takes into account the person’s waist circumference, waist-to-hip ratio, fat identified on advanced body imaging techniques such as ultrasound and MRI, and perhaps inflammatory markers on blood tests. The proposed model also includes three distinct stages:

Stage 0: The person is carrying excess weight but doesn’t have health complications from it.

Stage 1: The person is experiencing mild to moderate complications — such as prediabetes or slightly elevated blood pressure — due to excess body weight.

Stage 2: The person has more severe complications – such as type 2 diabetes or significantly high blood pressure – that are related to carrying excess weight.

What category a patient falls into would inform treatment, and would also increase the likelihood that a physician would focus on treating not just weight related complications, but also the excess body weight itself.

This new model will hopefully not only create a less biased way for physicians to engage with patients about their weight; it will also hopefully be a way for weight loss treatments to be more readily covered through insurance by having this new diagnostic term being incorporated into the medical coding structure — such as the ICD-10, or the International Classification of Diseases.

How we talk about obesity matters. And perhaps a better way to talk about obesity is to not talk about “obesity.” Not in the way people are used to hearing anyway. What are your thoughts?

Source: U.S. News


Blog written by Vanessa Ramalho/Robard Corporation


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How You Discuss Weight with Patients is Just as Important as Treatment: Free Webcast



Good news: Medical providers are finally starting to address obesity and its impact on their patients’ overall health. Bad news: Without a standard to look to for how to discuss weight with their patients and what the best treatment options may be, providers run the risk of fat shaming their patients, leading to unintended negative effects.

A review of recent research presented at the 125th Annual Convention of the American Psychological Association looked at how unconscious bias against overweight patients can impact how physicians interact with them about their weight, leading to increased stress for the patient. This stress, combined with feelings of shame, can cause patients to delay treatment and even avoid interacting with health care providers altogether. While providers always mean well, the way in which patients are approached about their weight can make all the difference when it comes to discussing medical concerns with sensitivity.

With obesity only recently being identified as a disease — with links to more than 20 chronic conditions (and growing) that are still being researched — it’s hard to know the best way to proceed with overweight patients without a standard and clear medical protocols to refer to as guidance. You’ve taken the step in acknowledging the importance of addressing obesity with your patients, but where do you go from here?

First off, it is important to acknowledge that no one is the expert at everything. If obesity treatment is not something you have focused on in the past, there can naturally be a learning curve as far as how to discuss it with your patients, and how to move forward with treatment. Working with an experienced partner in weight loss can not only save you time, but it can also help you provide the highest quality care.

We invite you to begin learning about how to speak with your patients about their weight with our complimentary webcast, How to Speak to Patients About Obesity. Learn directly from other doctors and peers in the field about what works, so that you can continue to elevate your standard of care while saving yourself and your patients both time and money.

Good news: If you’ve committed to providing the best care to your patients by choosing to treat obesity, you’re not alone. And we’re here to help.


Source: Science Daily


Blog written by Vanessa Ramalho/Robard Corporation


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How Hormone Havoc Prevents Weight Loss



Have you ever thought there must be more to losing weight than just dieting and exercise? Well, it turns it you are right! Gaining and losing weight can be due to many things, for example:  Sleep deprivation, nutritional imbalances, genetics, environmental toxins, gut flora imbalances, food addictions, allergies, and inflammation.1 Frequently ignored is the impact of hormones on weight and metabolism. Hormones determine what your body does with food; therefore, balanced hormones are crucial to controlling weight

In men and women, hormone production declines with age which can trigger a sluggish metabolism and weight gain. Body shape changes (almost always an indicator of hormonal imbalance) with fat appearing around your middle, belly, breast, and arms.
2 Hormones affecting weight in both men and women are cortisol, insulin, thyroid, estrogen, progesterone, and testosterone. When any of these are imbalanced, hormonal disorders ensue causing weight gain and or difficulty losing weight.

Cortisol
Stress — real or imagined — throws the body into panic mode and cortisol is released into the bloodstream. Cortisol raises blood sugar and breaks down fat for energy. This response is lifesaving when faced with life threatening situations. When the immediate stress ends, cortisol rises, leading to craving for fatty, salty, sugary foods to replenish the source of energy that was just depleted. Then cortisol falls to normal levels. Prolonged stress leads to continuously high levels of cortisol which causes continual excess calorie intake. Since these calories aren’t needed immediately, they get deposited as abdominal fat.
3 Chronically elevated cortisol keeps blood sugar elevated which can lead to insulin resistance.

Insulin
Sugar (glucose) stimulates the release of insulin which carries glucose into cells to be used as fuel. When cells have received enough glucose, excess gets stored as fat, especially in the belly and buttocks. Insulin resistance is when the body produces insulin but cells are less sensitive to it. As a result, the pancreas will pump out increasingly more insulin, but the insulin is unable to push glucose into cells. This excess circulating insulin causes sugar cravings, increased appetite, and weight gain.

Thyroid
This hormone regulates the metabolism of every cell in the body. When the thyroid gland is not making enough of this hormone, it’s called hypothyroidism. Hypothyroidism causes a slowing of most bodily functions. Sometimes, people have symptoms of low thyroid including fatigue, hair loss, sluggishness, weight gain and or difficulty losing weight. However, their lab tests are normal.
4 This is a source of great stress for individuals who know something is wrong but the cause is not obvious. Thyroid hormone needs to be suspected and tested properly. 

Testosterone, Estrogen, and Progesterone
As men and women age, testosterone levels decrease, leading to a loss of muscle and bone, accumulation of belly fat, and decreased metabolism. The effect is more severe in men because their testosterone levels are much greater to begin with. Ovaries produce less estrogen and progesterone in women starting as early as age 35.  When estrogen is not in correct balance with other hormones (primarily progesterone), weight gain can occur. Signs of estrogen excess are weight gain around the abdomen, hips, and thigh, water retention and abdominal bloating. Estrone, the main estrogen in menopause, shifts fat from hips to abdomen. Progesterone helps the body utilize and eliminate fat and increases metabolism. Excess progesterone production relative to estrogen leads to an increased appetite and fat storage. 
5,6

To prevent weight gain from hormonal imbalance:
1. Limit carbohydrate intake
2. Reduce stress 
3. Have hormones levels checked and balanced 
4. Take a probiotic
5. Exercise 45 min., 5 days/week

To learn more about medical weight loss and how it might be able to help your patients control the effect of hormones on weight and metabolism, click here.

References
1. Smith, P., “Why you can't lose weight: why it's so hard to shed pounds and what you can do about it.” Garden City Park, NY: Square One Publishers, 2011
2. Smith, P., “What You Must Know about Women’s Hormones,” Garden City Park, NY: Square One Publishers, 2010
3. Epel, E, et al., “Can stress reshape your body? Consistently grater stress-induced cortisol secretion among women with abdominal fat” Psychosomatic Med 2000; (62):623-632
4. Brownstein, D., “Overcoming Thyroid Disorders.” West Bloomfield, MI: Medical Alternatives Press, 2002
5. Kalkoff, R, et al., “Metabolic Effects of Progesterone “Journal Obstetrics Gynecology, 1982: 142-146
6. Vliet, E., “Women, Weight and Hormones.” New York: M. Evans & Company, 2001

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