SIU School of Medicine

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Division of General Internal Medicine

Weight Control

Obesity is a major international problem - and Americans are among the heaviest people in the world. Over 60% of people in the US are either overweight or obese.

What causes obesity?
There are a number of factors contributing to obesity. Although your genetic makeup does play a role, environmental factors play a huge part in contributing to obesity.

By simple definition obesity is a disease of energy imbalance, where “energy in” exceeds “energy out”. The lifestyle of high-calorie, high-fat convenience foods along with sedentary behaviors has led to a rise in prevalence of obesity.

Why lose weight? — Obesity is associated with many medical problems, most of which improve with weight loss:
Diabetes mellitus
Hypertension (high blood pressure)
High cholesterol
Coronary heart disease
Stroke
Sleep apnea
Gallstones
Osteoarthritis
Cancer (colon and prostate cancer in men; uterine and gallbladder cancer in women)
Shorter life expectancy

How severe is your weight problem?
Know your Body Mass Index: For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the “body mass index” (BMI). BMI is used because, for most people, it correlates with their amount of body fat.

BMI = body weight (in kilograms) / height (in meters) squared. Click here for our online BMI calculator.

A person with a BMI between 25 and 30 kg/m2 is considered overweight. Overweight refers to a weight above the "normal" range.

Anyone with a BMI greater than 30 kg/m2 is obese. Obesity is defined by the presence of excess body fat.

See the following table for example:

Height Weight range BMI Considered
5 feet 9 inches 124 lbs or less Below 18.5 Underweight
125 to 168 lbs 18.5 to 24.9 Healthy weight
169 to 202 lbs 25 to 29.9 Overweight
203 lbs or more 30 or higher Obese

Know your waist Circumference:
Body fat that accumulates in the stomach area (described as "abdominal obesity") is more of a health risk than body fat that builds up in the buttocks and thigh areas. For this reason, your waistline provides valuable information about your risk for heart disease, high blood pressure, high cholesterol, and type 2 diabetes. Normal waist circumference is less than 40 inches in men and 35 inches in women.

Losing weight vs. not gaining weight?
All persons who are obese or overweight should try not to gain additional weight. In addition, those who are obese or who are overweight with other risk factors should consider losing weight. A complete health assessment by a physician is the best way to decide the right steps for you.

Steps to lose weight:
Your doctor can help you determine what measures are practical and achievable based on your needs, interests, and willingness to embrace change. Here are a few general points to keep in mind:

Identify a realistic weight-loss goal. Small changes can make a surprising difference in your health.

Don't try to make major, dramatic changes overnight. If you are expecting to achieve too much, too quickly, you may be setting yourself up for disappointment.

Set your sights on modest changes in your food choices or activity level. This can produce a feeling of accomplishment, which can help motivate you over time. For example, aim for eating more vegetables next week, rather than for losing 50 pounds next year.

Weight loss is not the only measure of success. By increasing your activity and eating healthier foods, you can improve your health even if your weight stays the same.

Dietary change
Controlling calories is the bottom line to a weight loss diet.

  • Eat at least 5-7 servings of fruits and vegetables daily.
  • Eat 25-30 grams of fiber daily from fruits and vegetables, whole grain breads, cereals etc.
  • Choose whole grains over refined processed carbohydrates.
  • Drink at least 64 ounces of water daily.
  • Choose more calorie free, caffeine free, sodium free beverages (water, diet soda, or unsweetened iced decaf tea).
  • Eat at least 2 servings of low-fat dairy per day.
  • Choose more low fat proteins like skinless chicken, turkey, soy products and leaner cuts of beef and pork. Eat fish at least two times a week.
  • Pre plan healthy snacks like yogurt, high fiber cereal or crackers, low-fat cheese and fruit throughout the day.
  • Limit sodium intake to 2,400 mg a day.
  • Read the labels on snack foods, and choose the ones with less fat and fewer calories.
  • Low-carbohydrate diets have become extremely popular (e.g. Atkins diet, South Beach Diet). Although they may help you lose weight slightly faster than a low-fat diet in the first few months, they are no more effective in the long run.

Behavior change
Maintain a food journal. Write down the kinds of food you eat, the places where you eat, how often you eat and the emotions you feel when you eat. Using these records, you can identify triggers that cause you to eat.

Take steps to break the chain of events between the triggers for eating and eating itself.

  1. Consciously avoid situations and places that trigger binge behavior.
  2. Keep trigger foods out of sight.
  3. Become aware of when emotional eating occurs and try to substitute other activities like deep breathing, going for a walk, and talking to a friend.
  4. Eat only at the kitchen table. Don't drive, watch television, or read when you eat. Distractions cause “mindless” eating.
  5. Push the plate away when you are no longer hungry. Don't feel compelled to finish what is on the plate.
  6. Eat only because you are hungry, not because you are bored, stressed, or tired.
  7. Use smaller plates. Pre-portion foods on plate and do not opt for second servings. Pick up a glass of water between each bite. Chew the food a defined number of times.
  8. Establish regular meal times. Meal skipping fuels binge eating and overeating.
  9. Go grocery shopping on a full stomach.
  10. When eating out pre-plan ordering strategies before arrival, make healthy choices like salad dressing on the side, split entrees, substitute steamed vegetables for french fries.
  11. Establish a "buddy" system. Having a friend or family member available to provide support and reinforce good behavioral changes is very helpful.
  12. Learn to be assertive. Learn how to refuse food offered at parties and social gatherings.
  13. Develop an internal support system. If you eat a piece of cake that is not on the weight loss program, there are at least two ways that you can respond. A negative response would be: "Oh, you stupid idiot, you've blown your diet!" and, as a result, you may eat more cake. A positive internal conversation for the same event could be, "Well, I have eaten cake when it wasn't in my plan and now I should do something to get back on track." This positive approach is much more likely to be successful than negative, self-deprecatory comments.

Being more active
Regular physical activity has been shown to help prevent heart disease, type 2 diabetes and osteoporosis, as well as other chronic conditions. It is important for maintaining good health, regardless of whether weight is a problem or not. Simple measures applied every day can make a significant difference over time.

The minimum public health recommendation for physical activity is 30-60 minutes of moderate intensity exercise on most, preferably all days, of the week.

  • Increase whatever physical activity you are currently doing by adding 10 minutes a day, or increase the intensity from low to moderate.
  • Don't use a remote control when watching TV. Simply getting up to change the channel can make a difference in your activity level.
  • Limit time spent online, watching TV, and playing video games to less than two hours per day.
  • Take the stairs instead of the elevator or, get off one floor earlier and take the stairs to the last floor.
  • Park at the far end of the parking lot and walk to your destination, rather than parking as close as possible. Get off the bus one stop earlier and walk the rest of the way.
  • Do more household chores (e.g., dusting, vacuuming, weeding).
  • Walk/run with the dog and/or the kids.
  • Use an exercise machine (e.g., treadmill, bike) while watching TV.
  • Take "active" vacations—go hiking or ride bicycles.
  • Walk to do errands (e.g., grocery store, post office, etc.) instead of driving.
  • Consider buying a pedometer, which measures how many steps you take a day, and gradually increase the number of steps you take every day. (Pedometers can be purchased at sporting good stores.)
  • Don't be embarrassed about exercising!

Weight-loss programs
Some commercial weight-loss programs, such as Weight Watchers, TOPS, Jennie Craig, and Overeaters anonymous, Nutrisystem combine good advice with support about nutrition and physical activity. This type of support from an organized group may help you achieve and maintain weight loss.

Tell your physician if you are participating in a weight-loss program. If you have one or more serious conditions (in addition to being overweight or obese), or if you're taking multiple medications, you need to work with your doctor to choose a program that is safe and appropriate for you.

Review the Voluntary Guidelines for Providers of Weight Loss Products developed in 1998 by the Partnership for Healthy Weight Management. The guidelines can be found at:
http:// www.consumer.gov/weightloss/brochures.htm.

Weight-loss medications
Some medicines are effective in helping obese patients lose weight in combination with diet, exercise and behavior change. The guidelines for people who are candidates for medical therapy for weight loss are those with a:

  • BMI of 30 or more and no risk factors for additional conditions
  • BMI of 27 or more (but less than 30) with one or more obesity-related condition(s) or other disease(s)

If you feel that medical therapy might be helpful in your efforts to control your weight, speak with your doctor about the risks and benefits of these medicines.

Over-the-counter dietary supplements
Some people choose to take over-the-counter dietary supplements in an effort to lose weight. Tell your doctor if you are using supplements for weight loss. While some supplements can enhance short-term weight loss, their safety is questionable. It is wise to be cautious and to seek a doctor's opinion before using these types of products.

Surgery
Surgery is ONLY recommended for severely obese patients who have not been successful with diet, exercise, and medication. The National Institutes of Health recommend that surgery be considered for those at the following weight levels:

  • Patients with a body mass index >40 or more.
  • Patients with a body mass index >35 or more who also have serious medical problems that would improve with weight loss.
    For those with less severe obesity, the risks of the surgical procedure outweigh any potential benefits.

Where to get more information?
Your doctor is the best resource for finding out important information related to weight management. Not all obese patients are alike, and it is important that your situation is evaluated by someone who knows your medical history.

National Library of Medicine

The Hormone Foundation

American Obesity Association

National Institute for Diabetes, Digestive and Kidney Diseases

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