Battling Obesity on Birmingham Medical News

Battling Obesity

By: LAURA FREEMAN

Dr. Jamy Ard is Assistant Professor of Nutrition Science and medical director

If Oprah with all her millions can't hang on, and Carnie Wilson, the poster girl of weight loss surgery, is struggling with her weight again, what hope is there for average people? Although the track records for long-term success have been less than encouraging for most approaches, as science learns more about the complex causes contributing to obesity, the odds may be getting better.

One local program whose maintenance success attracted national media attention is the EatRight program at UAB.

"Bottom line, a weight loss plan must be individualized and it requires different strategies depending on where a patient is starting from," said Jamy Ard, M.D., Assistant Professor of Nutrition Science and medical director of UAB's Eat Right Weight Management Program.

A New Weapon In The Weight-Loss War

When patients are frustrated by slower than expected weight loss or a scale that refuses to budge, there is a new tool that may be able to help them understand exactly what is going on.
The SenseWear® Metabolic Tracker, developed in collaboration with UAB research and made by Body Media, is an arm band device that measures calories burned, steps taken, intensity of exercise, hours of sleep and the quality of that sleep.
Data is visible in an up-to-the minute display on a digital wristwatch, and it can be reviewed by health professionals to design or adjust a weight loss program for optimal results. It may also help identify problems that can be addressed medically.
The device can be leased through the UAB Eat Right Weight Management Program, and is also available for purchase.

"If a patient only needs to lose a few pounds, we may start with small steps like writing down what they are eating so they become more aware and better at self monitoring."

For those who have a significant amount of weight to lose, or urgent medical issues, the program offers Optifast nutrition replacement with close medical monitoring.

"It allows patients to take a vacation from food and use the time to relearn healthier ways of relating to it and to activity. The positive reinforcement of seeing rapid success keeps them going," Ard said.

Patients are transitioned to real food, and then to the EatRight For Life maintenance program, which offers group support and classes to help them learn to make time for their priorities in life and set goals.

"Most diets can work. The challenge is keeping weight off. Obesity is a long- term medical issue, and diets shouldn't be thought of as a short-term fix," Ard said. "It's also important to recognize and treat contributing factors such as sleep deprivation. Lack of sleep affects appetite and leads to more unplanned eating. It also lowers energy levels, so people move less. The resulting weight gain leads to a circular problem of sleep apnea, poor sleep quality, more weight and consequences for the heart and overall health."

To lose weight, Ard recommends combing both diet and exercise. For patients who have problems with weight bearing exercise, the program works with the Lakeshore Foundation. "They can choose aquatics, exercise bands, stationary bikes—the important thing is to start somewhere," Ard said.

Most hospitals in Birmingham offer similar programs based on nutrition and exercise, and there are several surgical weight loss programs with excellent reputations.

Patients considering bariatric surgery should be carefully selected. Surgery is a tool for weight loss, but not a magic bullet. With a stomach that will only hold a couple of tablespoons of food, people who are genetically inclined to prefer sweet and high fat foods or who depend on food for emotional support will need new skills to help them choose nutrition over taste and deal with feelings in new ways.

"Science is learning a lot about obesity that is likely to change how we'll be treating it in the future," Ard said. "We don't yet have much in medication to help. Ten years from now, we'll probably have a combination of medications, perhaps one to target the brain to control appetite, and another to alter metabolism. We're moving toward combining medicines that create a synergy at lower doses."

Looking at the big picture, Ard says what is most needed now is for medical science to demonstrate the effectiveness of treating obesity as a long-term medical condition.

"We wouldn't give diabetics a diet and a one-time prescription and expect them to stay healthy without follow-up," he said. "If the nation is serious about turning the tide on obesity and the health problems associated with it, we have to see insurance reimbursement for consistent, long-term treatment as with any other chronic disease."