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Patient Case of the Week Archive |
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Recently I saw a female patient who was 5'2" tall and weighed 250 pounds. I calculated her BMI (body mass index) at 46 and it should be 25! The reason that this is important that this index is a guage of how much weight there is per height and this correlates in all studies with earlier chances of death! (For a good discussion about BMI, click here.) Obesity is probably our greatest modifiable disease that kills us in this country. This patient came to me to help her with her weight and we used diet, and exercise. She has done well so far but she has not done as well as she would have liked. There are some things that many people can do that are not risky and are in fact healthy. A low fat diet has been shown to be beneficial for the heart as well as even minimal exercise has been shown to reduce cardiac problems dramatically. Everyone should attempt to be at a BMI of 25 or less. To check out your BMI click here. If you would like to see it on a graph, click here. Many people in this area are using the Sugarbuster's Diet or the Dr. Atkin's Diet which are both low carbohydrate/high protein diets. These are controvercial. in the literature but they can produce dramatic effects. The trick is to stay on them for a long time to maintain the weight loss. Diabetics should not be on these diets as they could cause kidney damage with the high protein content. A medline search of the Dr. Atkin's diet produced the following article discussion which is a critique of the diet:
Very fat people die earlier than people of normal weight because hypertension, diabetes and coronary disease are more frequent among the markedly obese. Most obese subjects, however, are only slightly overweight and their mortality is not elevated. Reasons for dieting are more often psychological than somatic. 2. Reducing diets are ineffective because the obese rarely follow them. Total fasting and intestinal bypass may provide better results, but are more dangerous. 3. Atkins' diet eliminates carbohydrates from food without restricting protein and fat intake. Deprived of carbohydrates, the body uses fat for fuel. A small part of metabolized fat is eliminated in the urine as ketone bodies, and this is why such diets are called "ketogenic". They have been known at least since 1863. 4. Caloric loss due to ketonuria does not exceed 100 Cal/day in the non-diabetic. It is maximal during total fasting and cannot be increased by a ketogenic diet. 5. In the short run, such diets produce rapid weight loss due to polyuria. On the other hand, refeeding carbohydrates causes water retention and weight gain. 6. The diet decreases appetite: patients eat less without feeling severe hunger and without measuring their food intake. 7. Orthostatic hypotension, fatigue, and nausea are frequent, despite what Dr. ATKINS claims. 8. The diet increases plasma cholesterol and uric acid. It may be dangerous in diabetes (anorexia, acidosis) and in heart or kidney failure (hypokalemia). 9. The diet, though far from good, is better than the book. ATKINS' theories are at best half-truths, and the results he claims lack credibility. The obese subject's disappointment with traditional reducing diets and the book's hard-sell style account for ATKINS' success. |
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