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insulin resistance. Individuals who suffer
from metabolic syndrome are twice at risk
of cardiovascular diseases compared to
healthy individuals. As the global obesity
epidemic continues, metabolic syndrome
and its cardiovascular effects are expected
to continue to rise. With this in mind, it
is pertinent that prevention and treatment
strategies are emphasized to the public.
in energy density than higher
energy density. This, in turn,
allows a lower calorie intake
while still providing the feeling
of satiety. A diet that revolves
around lower energy density
foods would greatly assist in
the prevention of obesity.
Additional dietary changes
that can help include eating
a high protein diet, avoiding
sugary soft drinks and fruit
juices, drinking more water, and
reducing refined carbohydrate intake. Table
1 displays the average amount of calories
needed by gender. However, caloric needs
depend on the amount of physical activity
and age. This data is for moderately active
individuals and how they can lose weight.
Energy Expenditure
In addition to caloric intake, energy
expenditure is equally essential. An
inactive lifestyle promotes weight gain.
Getting exercise in everyday activities such
as brisk walks holds a high preventative
effect. Standard guidelines dictate that
an endurance-oriented exercise of at least
Prevention & Treatment
Prevention
Given its high prevalence and difficulty
in treatment, obesity prevention holds
primary importance.
Caloric Intake
Good nutrition means eating an
appropriate amount of calories and the
right kind of food to be healthy and
perform at their best in both sports and
life. A calorie is a unit that measures energy
in our food. Too many calories can result
in weight gain. In addition, standard
obesity prevention guidelines emphasize
low energy density foods and avoidance of
high energy density foods. Energy density
refers to the number of calories per gram
of food. Lower density foods (such as fruits
and vegetables) hold more volume for the
same amount of calories when compared
to higher energy density foods (such as
many processed food products.) Thus, for
an equivalent amount of calories, a person
can consume a larger volume of food lower
2 hours per week is crucial in obesity
prevention. On a biochemistry level,
activity holds scientific backing. AMP
protein kinase (AMPK) is a fuel-sensing
enzyme that is activated by muscle usage in
humans. Upon exercise activation, AMPK
stimulates energy usage mechanisms such
as fatty acid expenditure and decreases
energy storage mechanisms such as
fatty acid uptake. Regular exercise that
incorporates weightlifting is critical in
preventing the excessive fatty acid storage
that leads to obesity.
Table 1
Age Range
19-25
26-45
46-65
65 and older
19-25
26-45
46-65
65 and older
Maintain
Weight
(Calories)
2,800
2,600
2,400
2,200
2,200
2,000
1,800
1,600
Lose 1
Pound
Per Week
(Calories)
2,300-2,500
2,100
2,200
2,000
1,700
1,500
1,300
1,150
Summary
In summary, your caloric needs depend
on whether you want to maintain, lose,
or gain weight. The many factors involved
include gender, age, weight, height,
physical activity level, and other factors
such as endocrine disorders. Humans
are not cars on an assembly line. We at
West Chester Cardiology personalize each
individual, considering all their factors
before making our recommendations.
Treatment
Treatment methods heavily depend on
the patient's characteristics, such as their
BMI level and their available resources. A
BMI between 25 and 35 should have the
long-term goal of 5% or more significant
weight reduction. A BMI greater than
35 should have a long-term goal of 10%
or greater weight reduction. Although
seemingly small, many studies have
indicated that a 5-10% weight reduction
in obese individuals substantially lowers
symptoms of metabolic syndrome and the
risk of cardiovascular disease.
Nonsurgical Treatment
Similar to the aforementioned
preventative measures, calorie intake and
energy expenditure should be closely
monitored. In addition, weight-reducing
drugs, such as Orlistat, have been found
effective when combined with a healthy
lifestyle implementation.
Surgical Treatment
In highly obese patients (>35 BMI)
in which all other methods have been
unsuccessful, obesity surgery may be
considered. Examples of bariatric surgeries
include adjustable gastric band, gastric
bypass, and sleeve gastrectomy, all depicted
in Figure 3.
This article was written in collaboration by Mian A. Jan, M.D., Chairman of
Department of Medicine, Penn Medicine Chester County Hospital. He was assisted by
Danyal A. Quraishi, a neuroscience graduate interning with West Chester Cardiology.
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