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Troy Smurawa, MD
Approximately 97 million people in the United States are overweight or obese and the World Health Organization has
declared obesity a “global epidemic.” The increased consumption of energy in the diet has made a major contribution to
this epidemic. Physical inactivity also has made a significant contribution to the obesity epidemic.
The American Heart Association classifies obesity as a major cardiovascular disease risk factor. Other adverse health
conditions associated with obesity include: hypertension, hyperlipidemia, diabetes, osteoarthritis, colon and breast
cancer and gall bladder disease.
Body Mass Index (BMI) is a practical and reliable tool for evaluating health risk in people who are overweight or obese.
BMI is highly correlated with body fat. BMI is calculated as weight in Kg divided by height in meters squared times
10,000.
BMI = (weight (kg) / height (m)2) x 10,000
Classifications of BMI:
Weight Classification BMI
Underweight < 18.5
Normal 18.5 – 24.9
Overweight 25.0 – 29.0
Obese 30.0 – 39.9
Morbidly Obese > 40
Both decreasing dietary energy intake and increasing physical activity is essential for the long-term maintenance of a
healthy body weight. Individual will lose weight when they reduce dietary energy and fat intake and engage in greater
amounts of lifestyle physical activity.
Benefits of weight loss and exercise include:
1. Lower blood pressure
2. Lower risk of developing Diabetes
3. Lower cholesterol and triglycerides
4. Raise cardioprotective HDL cholesterol
5. Reduce risks of cardiovascular disease
6. Reduce symptoms of osteoarthritis
Data from several studies have shown that even a 10% weight loss ob body weight can provide health benefits in
overweight and obese individuals. A weight loss of 10% is an appropriate and attainable initial goal.
The key to successful weight loss is to begin by setting clear and realistic goals. Start by making small steps to reach
these goals. The best goals are attainable, measurable, and flexible. One should develop weekly, monthly, yearly and
lifelong goals. It is important to set realistic attainable goals and to make a firm commitment to work towards these goals
everyday. Make gradual changes and build upon successes. Add a little distance when walking or running or add a few
more steps when walking up flights of stairs. Make intentional efforts to include increased physical activity in activities of
daily living; such as parking in the far end of the store parking lot or taking the stairs instead of the elevator. Lifestyle
changes become more manageable by using small goals as building blocks to larger goals. Weight loss isn’t the only
marker of success, but consistently weighing oneself weekly helps one to know if you are making enough changes to meet
your goals. You can expect to lose about 10% of your initial body weight in the first 6 months.
Chose appropriate awards and make a firm commitment to yourself that you will do what it takes to achieve the reward.
Avoid rewards that sabotage your progress, such as eating dinner out or having a dessert. You will naturally feel more
motivated on some days and less on other days. Do not let a minor setback stop you. Begin again the next day and focus
on the long term goals. Avoiding temptations to give in to excesses will make you successful in the long run.
Here are some ideas to give you extra motivation:
1. Picture yourself enjoying the reward
2. Keep a simple record of progress and setbacks
3. Plan alternatives ahead of time
4. Use post-it notes to post inspirational messages
5. Do Not let minor setbacks stop you cold
6. Have a friend, spouse, child or co-worker join you
Keys to successful weight loss management:
1. Identify a reasonable weight goal.
2. Prevent additional weight gain.
3. A combination of healthy eating and exercise is the key to weight loss and the prevention of weight gain.
4. Reduce body weight by 5-10% of initial body weight with a sustained weight loss of more than 10% of initial
body weight to maximize long term health benefits.
5. Progressively increase physical activity levels to at least 150 minutes (2.5 hrs) of moderate intensity physical
activity per week. Progress to200 – 300 minutes (3.3 – 5 hrs) per week or more than 2000 Kcal of energy
expenditure.
6. Reduce energy intake by 500 – 1000 Kcal per day combined with a decrease in dietary fat of less than 30%
of total energy intake.
7. Incorporate resistance training exercises into a weight loss program to improve strength and function and
minimize loss of lean body mass.
Physical Activity Tips:
1. Low to moderate intensity exercise (50 – 70% MHR-maximum heart rate) for a duration of 30 minutes or
longer.
2. Choose modes of exercise on the basis of individual preference and availability of resources.
3. A wide variety of exercise choices should be offered: upper body, lower body, weight bearing, non-weight
bearing, resistance, anaerobic and aerobic exercises.
4. Use an exercise diary to record the days, minutes and types of exercise.
5. Include resistance exercises at a moderate intensity 2-3 times per week. Start with 1-2 sets of 8-15 repetitions
for each major muscle group.
6. Increase daily physical activity through “nonstructured” exercise participation. Taking the stairs or parking at
the far end of the parking lot.
