Fifteen years ago, Marissa Epstein, director of the University of Texas Nutrition Institute and a member of HealthyWomen’s Women’s Health Advisory Board, was nearly obese. Her weight loss journey that started her career path in nutrition was largely inspired by success stories from other women.
“I used to cut pages out of everyday women’s magazines … It wasn’t pictures of their bodies that inspired me, but the life hacks they figured out,” said Epstein, the vice director of Let’s Move !, Michelle Obama’s White House Initiative Combating Childhood Obesity.
Epstein suggests that inspiration from others with similar goals can help people with obesity looking to lose weight. With the third wave of COVID-19 looming, there has never been a better time to start.
Dr. Sarah Finn, Medical Director of the Dartmouth-Hitchcock Weight and Wellness Center, defined obesity as a communication disease in the body – a communication problem between the gut and hormones that talk to the brain and fat cells.
Since 2013, the medical community has recognized obesity – a body mass index (BMI) of 30 or more, as measured by weight and height – as a disease.
Obesity is on the rise across the county. According to the Centers for Disease Control and Prevention (CDC) 2019 Adult Obesity Prevalence Maps, more than 20% of adults in the United States lived with obesity
The maps show higher obesity rates among black and Hispanic adults across the country. According to CDC data from 2017-2018, blacks (49.6%) had the highest prevalence of obesity, followed by Hispanics (44.8%), whites (42.2%), and Asians (17.4%).
Obese patients rarely see a doctor without increasing their weight. Finn called this the obesity tendency: blaming the patient and falsely assuming that obesity is a will sickness.
“Many obese patients don’t trust healthcare providers,” said Finn. This can lead to disease severity due to a lack of preventive care: Obese patients are less likely to receive annual physical interventions, checkups and vaccines, Finn explained.
For people with obesity, this stigma is twofold: they face systemic racism and the obesity tendency in healthcare. A 2017 CDC article questioned the use of BMI to measure the health of African American women. It found that “differences in body composition, fitness level and dietary deviations that can predict health and longevity are not taken into account”.
Money also plays a role. For years, obesity treatment was not reimbursable by insurance, which likely made it difficult for low-income people to afford care. 2019 data shows that blacks and Hispanics are more likely to experience poverty.
“There is an economic reality to how we talk about obesity and how we look at it in the medical field,” said Epstein.
Obesity, Health Risks, and Covid-19
Obese people are at increased risk for other chronic diseases, including heart disease, diabetes, asthma, sleep apnea, high blood pressure, certain cancers, and mental illness. Finn explained that in obese patients, fat cells get larger and outgrow their blood supply, causing inflammation.
“We believe that inflammation attacks the nerves that try to communicate between the gut, fat cells and the brain,” said Finn.
There is still evidence, but three large studies recently done suggest that obesity increases the risk of COVID-19 infection.
One study found that obese patients had a 113% increased risk of developing COVID-19, a 74% higher risk of going to intensive care, and a 48% higher risk of dying. Another study showed that in a hospital system, 77% of Covid patients were overweight or obese.
There are many theories as to why obesity could increase the risk of COVID-19, including increased inflammation and more viscous blood that tends to clot. Finn said it could also be purely mechanical – larger visceral fat around the organs pushes the diaphragm and limits lung expansion.
“If you have a viral infection in your lungs, you can’t breathe as deeply,” said Finn.
Despite biological mechanisms that work against the obese body to help lose weight, Epstein argued that for most people, obesity can largely be managed through diet, exercise, and support. She recommends finding a registered nutritionist to address the underlying psychological issues. RDNs are trained in diet coaching and behavior therapy, which Epstein says is extremely effective in treating obesity. She also recommends building a community around your weight loss goal.
“A support system is one of the best predictors of sustained weight loss success,” said Esptein, adding, “Before you dive into your food consumption, look into your content consumption. See and read content that inspires you and up.” Encourage your trip? ”
Even a small amount of weight loss (5% -10%) can be of great benefit, Finn said, urging people to think about what they can control. Eating fewer processed foods, meditating on stress relief, and getting more exercise can aid weight loss.
Although rarely used, Finn said obesity drugs can also be useful in losing weight and keeping it off. She believes they are used so rarely because of a lack of training from providers and a misunderstanding that today’s drugs are harmful.
Epstein noted that weight loss plateaus are real and a sign of success. If and when this plateau is reached, don’t be discouraged.
“You are now venturing into a new era of lifestyle change long-term,” said Epstein. “This is really about tweaking and refining the decisions you make on a regular basis.”
Nobody says the journey is easy, but small, mindful lifestyle changes have bigger and longer lasting effects than crash dieting.
In fact, Finn said dieting on its own doesn’t work. Regarding the part of the brain that controls hunger and often interferes with weight loss attempts, Finn concluded, “Treating obesity is learning how to beat the gatekeeper.”