WHAT IS OBESITY?

by Steven Mandel MD, VP of Outreach and Engagement, NY Metro FJMC

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WHAT IS OBESITY?
Obesity is defined as an excess in adiposity, resulting in adverse metabolic, biomechanical, and psychosocial consequences, driven by biological, environmental and behavioral factors. It is also defined as the amount of body fat, that is considered higher for that individual’s weight. A Body Mass Index greater than 30 kg/m2 is present in 35% of males and 40% of females.

Hippocrates noted that obesity is not merely a disease but a precursor to other medical conditions.

Maimonides: The great rabbi physician noted that illness results from overeating and that a sound body is necessary for a sound mind.

Obesity is a chronic relapsing disease, and supports a multi disciplining Approach to management.

Obesity is associated with an increase in cardiovascular disease, type diabetes, nonalcoholic fatty liver, and certain cancers, and other complications. Obesity caries a physical and psychological burden, leading to premature disability, and an increase in mortality. In the workplace, there is an increase in absenteeism, reduced productivity and an increase in health and employer costs. In the workplace there are social stressors and an increase in conflicts between workers and supervisors. With night shift there is altered sleep patterns, and circadian rhythms, with an increase in obesity. The term “ the 4 th industrial revolution “ is where more labor is shifting to sedentary work.

Obesity affects families through intergenerational transmission, with shared environmental and behavioral risk factors, psychosocial impacts and socio-economical consequences. Obesity is closely intertwined with codependence and enabling behaviors , where the dysfunctional behavioral relationship contributes both to the development of excesses weight and unhealthy eating. Parental obesity is a strong predictor of childhood and adolescence obesity, with even a higher risk when both parents are effective. Family based prevention and intervention strategies are required. Having an environment at home that models’ good nutrition and fitness practices, can aid some of the genetic predisposition to obesity.

There are many reasons for sex differences including the distribution and mobilization of adipose tissue storage, insulin sensitivity, lipoprotein profiles and gonadal hormones. MEN HAVE A CENTRAL ADIPOSE AND TISSUE DISTRIBUTION AROUND THE ABDOMEN-N APPLE SHAPE, (ANDROID), AND WOMAN ADIPOSE DISTRIBUTION IS IN THE LIMBS AND HIPS, PEAR SHAPE (DYNOID) . The main cause of obesity in men is eating high fat and high sugar foods.

People with obesity who do not accept the diagnosis or acknowledge the diagnosis is a common and challenging problem. Half the people with obesity, do not self-identify as having obesity, often due to stigma, perceptions about the etiology, or internal blame. This leads to avoidance of weight related discussions and a delay in seeking appropriate care. There are gender related behaviors towards obesity. Men will exercise and eat less fat. Woman will enter weight loss programs, follow a special diet, and eat more vegetables and fruit. Men downplay obesity as a health risk They underestimate overeating with muscle and underestimate fat. Masculinity norms place less attention to thinness. Men have a fear of judgement and an avoidance of change. GENDER IS AN IMPRTANT VARIABLE IN THE ANALYSIS OF OBESITY.

JEWISH MEN have a significant and rising prevalence of obesity. The causes include frequent consumption of calorie dense foods, Shabbat meals, minimal physical activity (especially in the ultra-orthodox communities, and socially disadvantage groups) , and lower literacy regarding nutrition and excess. Jewish values of the body include moderation and dietary practices, community, stigma, and inclusion. Health is imperative, as our ethical dimension. It is a form of neglect That goes against the principals of moderation and health. The term “intimate saboteurs” describes a person’s social dynamics of overwhelming expectations. Jewish tradition provides no excuse for being unhealthy.

Jewish stigmas include negative stereotypes, prejudice, labeling, discriminatory behavior including name calling, teasing, reduced status, In accessory to health care, and employment discrimination. The media perpetrates negative stereotypes, and enforces stigma.

Sh’mirat-Haguf : preservation of the body
Shivil Hazahov: moderation
Achilah gasah: overeating
Acilah Gasah; prohibition against overeating

Deuteronomy 4:9 Guard yourself and guard your soul very carefully

More:
Hormonal – Men have higher testosterone- more muscle mass that declines with age.
Woman – estrogen, fat storage in the lower back, and after menopause in the abdomen.

Health risks: Men – cardiovascular; Women – osteoporosis, gall stones, cancer 9 breast, endometrial

Behavior- men eat more meat, and exercise. Woman- join programs, social and support groups

Psychological – men underestimate. woman -society pressure

Treatment responses: men lose weight quicker with diet. woman have hormonal fluctuations.

Management :
People need to acknowledge the reality and learn the consequences. They need to reframe their mindset with long term goals, building strength and discipline. Start with small sustainable habits and practice portion control. Prioritize strength training and activities with goal-oriented hobbies. You should reduce liquid calories such as soda and alcohol. Monitor your progress objectively Address your emotional and behavioral triggers. Build accountability and support. Take your medical factors seriously. Focus on sleep and stress. Celebrate wins and not perfection.

The 5 As of obesity management, to facilitate engagement and shared decision making :
Ask about weight.
Assess readiness of change.
Advise and personalized goals.
Agree on a realistic plan.
Assist with resources and follow up.

Workplace: Have a healthy cafeteria, serve healthy food at meetings, encourage walking and use of the stairway, wellness classes, nutrition, training, exercise and weight management, discount health clubs, and employee screening. Include insurance plans, with employers provide incentives based upon weight and BMI.

Families are the main support for healthy choices. They can provide nutritional food options, promote physical activity, and model positions of health behaviors .Avoid ultra processed foods where the density and marking of unhealthy foods vs availability of fresh produce, impacts dietary choosing leading to obesity.

Pharmacological and surgical options can be considered, which can be at times, cost effective and as an adjunct to a comprehensive program of weight management. People need to be committed to realistic short- and long-range goals. Many people look towards alternative treatments such as mind body techniques (hypnotherapy, mindful eating, somatic exercises, and meditation), and acupuncture and acupressure.

Medications can be considered when the BMI is greater than 30km2, or greater then 27k/m2, with comorbidities such as hypertension , type 2 diabetes, dyslipidemia, sleep apnea, and when lifestyle interventions such as, diet, exercise, and behavioral modification, have not resulted in significant weight loss. Medications have a mean weight reduction of 15-21%.

Surgical interventions should be considered for adults with a BMI greater than 40 k/m2, or a BMI greater than 35 k/m2, with obesity related comorbidities who are motivated to lose weight, but who have not achieved sufficient weight loss or health improvement, despite behavioral and/or medications.

In summary, be aware of the challenges, think of personal well-being, that it takes time to achieve one’s goals, and incorporate healthy practices in your lives. Concentrate on wellness and be aware of all the resources available for support.

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Steven Mandel MD
VP of Outreach and Engagement
NY Metro FJMC