Obesity is one of the most common chronic diseases in this country. Currently greater than 50% of Americans are considered to be overweight or obese. The prevalence steadily increases with age going, for example, from 11.4% of women aged 20-24 years to 38.5% for women aged 65-74 years. Obesity is substantially more frequent in Black women (43.3%) than in either Black men (25.7%) or white women (25.1%) The direct and indirect costs attributable to obesity are estimated at $140 billion a year.

Serious health hazards associated with obesity include:
•   Coronary heart disease
•   Stroke
•   Hypertension
•   Type II diabetes
•   Hypercholesterolemia
•   Hypertriglyceridemia
•   Gall bladder disease
•   Obstructive sleep apnea
•   Degenerative joint disease
•   Certain cancers (females: breast, endometrial cancers; males: prostate and colon)

What is a desirable weight?
Desirable body weight can be quickly estimated as follows:

•	For men, allow 115 pounds for 60 inches and 5 pounds for every inch above 60 inches
•	For women, allow 100 pounds for 60 inches and 5 pounds for every inch above 60 inches
•	Frame size can be adjusted for by adding 10% to the desirable weight for large frame and subtracting 10% for small frame.

Calculating the body mass index (BMI). Recently scientists have used the BMI to determine relative weight. The BMI represents weight in kg divided by height in meters squared or:

Obesity is defined as a BMI > 30 kg/m2; while someone is considered to be overweight with a BMI >25 kg/m2 .

Treatment approaches.
All weight loss programs should include these three fundamentals:
1. a nutritionally-sound hypocaloric diet
2. an exercise plan
3. careful record keeping of all food intake and exercise

This approach has served us well for over 20 years. Most overweight and obese individuals with BMIs of 26-35 kg/m2 should be treated with this approach initially.
Characteristics of high-fiber hypocaloric diets:
  • 800-1500 kcal per day
  • 60 grams protein (high quality choices)
  • 55-60% of energy as carbohydrate
  • 15-25% of energy as fat
  • 25-50 grams of fiber/day (30-35 grams/ 1000 kcal)

VLCD are good choices for most individuals with BMIs of 35-40 kg/m2 and for persons with BMIs of 30-35 kg/m2 who have not responded adequately to less intensive programs. These are medically-supervised programs.

Elements of a VLCD program.
  • Supplement: 500-800 kcal/day
  • HMR* 500 supplement provides:
  • Protein 50 g
  • Carbohydrate 79 g
  • Fat 1 g
  • Energy 520 kcal/day
  • Medical monitoring weekly or as required
  • Behavioral education classes weekly
  • Exercise: goal of 2000 kcal/week
  • Maintenance program: 18 months
  • *HMR, Health Management Resources, Boston, MA.