Weight loss and health outcomes

HEALTH, EXERCISE & WEIGHT LOSS

The United States has been criticized by doctors, researchers and government officials as being one of the fattest and unhealthy countries in the world. Our population currently faces numerous problems regarding health issues, weight loss, and now childhood obesity. Historian Harvey Levenstein (1988) contends that the most dramatic changes in the American diet occurred between 1880 and 1930. These changes were a result of many sociological factors and technological advances, including the development of the modern cooking range; the advent of new ways to preserve food; and the birth of our modern processed food industry. Levenstein (1988) also states that the greatly expanded food supply that resulted from the settling of the American West to be another factor, as well as Prohibition. This paper will examine the problems in the way Americans eat with a brief historical background of food consumption in the United States. It will also address various sub-topics of health and weight loss, including exercise, diets, diet pills, nutrition and food, surgical options and attributable health issues.

Brief Overview of the American Diet

Americans living in the thirty-four years between 1880 and World War I experienced radical changes in the food industry. The Midwest began producing great quantities of wheat and dairy that were shipped via railroad to the East.

A greater amount of food production meant the need for new technology to enhance preservation. Giant food corporations emerged and manufactured processed foods that were accepted by all classes. Around 1900 a giant sugar corporation mounted a successful campaign to denigrate brown sugar. Consumers were already convinced that white products were superior to brown ones. Even the poorest farmers gave up their consumption of molasses and homemade sorghum, while workers abandoned their intake of molasses and brown sugar. In the thirty-five years between 1880 and 1915, the per capita consumption of white refined sugar doubled. Historically speaking, these events were the beginning of a sugar-consuming, unhealthy population.

By 1930, Prohibition had been in effect for ten years. Prohibition caused many fine restaurants whose liquor sales provided the majority of their revenue to close down. The French chefs hired by the upper class and elegant restaurants were either living on the streets or buying their tickets to return home. In their absence, small diners catering to the lunch hour market quickly appeared. These luncheonettes and self-service cafeterias served canned foods, soft drinks, salads, cold dishes, and sandwiches on toast. Levenstein (1988) shows the great changes that took place in American restaurants since Prohibition, with the disappearance of the menu with unpronounceable French names giving way to the Americanized menu. Trained chefs were replaced by unskilled laborers could easily open a can and heat its contents. This was literally the beginning of the fast food industry, and changes in the diet were largely due to the economic differences in the upper and lower classes. As a result of the costly refining process, white flour and white sugar were more expensive. Molasses and brown sugar were more common in the middle and lower income families. The upper classes consumed more red meat and other more expensive items than the poorer classes who could not afford the variety of fine meats.

The American Diet Shift

Thus, the shift in the American diet can be attributed to the changes that took place in the various decades. In 1880, people were eating authentic food that was prepared from scratch. In 1930, people were eating more processed food, including canned and fresh vegetables that were unavailable or cost prohibitive in 1880. To be "pleasingly plump" was in style, and it was not until decades later that the super slim models took over the runway, and being thinner was "better." In the 2000's the goal of being thinner became of widespread importance in the U.S., and thin role models and celebrities are plastered all over the television, movies and magazines. Childhood obesity has been raised as a significant problem in the past few years for the first time. Fast food giants such as McDonald's have been blamed as the cause of this epidemic. Miracle diets, diet pills and surgical options to weight loss have appeared out of nowhere and have become a fad. People have followed the footsteps of celebrities, and have turned to fast-remedies such as stomach stapling and liposuction. The United States has turned into an obese country where ironically, everyone is on a diet or trying to lose weight as soon as possible.

Dieting

Recent media reports have publicized the short-term weight loss that sometimes occurs through the use of low carbohydrate weight-loss diets (Physicians Committee for Responsible Medicine, 2006). The theory behind low-carbohydrate diets is that if dieters avoid foods containing carbohydrates, or starch and sugars, they will lose pounds. An example of one such diet is the Atkins diet. This diet drastically restrict the intake of fruit, fruit juice, starchy vegetables, beans, bread, rice, cereals, pasta and other grain products, and all other foods containing carbohydrate, leaving a limited diet of foods that contain primarily fat and protein: meat, cheese, and vegetables. As the diet proceeds, the carbohydrate restriction relaxes somewhat, but fatty, high-protein foods continue to dominate the dieter's plate. For example, one would begin with a breakfast of 4 slices of bacon, coffee, and 2 scrambled eggs. Lunch would consist of 1 bacon cheeseburger, with no bun, 2 slices of bacon, 1 ounce of American cheese, a small tossed salad with no dressing, and seltzer water. Dinner would consist of 3 ounces of shrimp cocktail with mustard and mayonnaise, 1 cup of soup, a 6-ounce T-bone steak, a tossed salad, 1 cup of Jell-O, 1 cup of whipped cream, and a beverage of choice. The maintenance diet would consist of a more relaxed restriction, but still include fatty, high-protein foods.

The Atkins Diet

The Atkins diet has received criticisms over the years, and a review of 107 research studies on various low-carbohydrate, high-protein weight-loss diets concluded that weight loss on these diets is not due to any special effect of restricting carbohydrate; rather, weight loss depended on the extent to which the dieters' caloric intake fell and how long they continued with their regimens (Physicians Committee for Responsible Medicine, 2006). Other reports have also found calorie reduction to be the most important factor in weight loss, with no special weight-loss advantage from the restriction of carbohydrates. A review on the safety of low-carbohydrate diets notes that Atkins-type diets are at a greater risk for being nutritionally inadequate and raise the issue of potential long-term health effects (Physicians Committee for Responsible Medicine, 2006). Long-term studies of the general population following a variety of diets and short-term studies of individuals on low-carbohydrate diets raise important concerns, such as colon cancer, which is one of the most common forms of cancer in North America and Europe and is among the leading causes of cancer-related mortality. Other concerns include heart disease, since weight loss tends to reduce cholesterol levels, while saturated fat and cholesterol tend to raise them. Studies of the Atkins diet and other low-carbohydrate, high-protein diets have not been of sufficient duration to evaluate their potential to affect kidney function (Physicians Committee for Responsible Medicine, 2006).

The South Beach Diet

The South Beach Diet is another extremely fashionable nutrition plan based on many of the same low-carbohydrate principles first popularized by the Atkins diet, and named after one of the most-beautifully populated beaches. However, the diet's main selling point is it's comparative flexibility; followers are allowed to eat some grains and fruit, which are strongly discouraged in Atkins (the South Beach Diet Review, 2006). The South Beach Diet still contains numerous restrictions that leave many dieters feeling deprived and depressed a result of carbohydrate restriction. While "good carbs" are allowed with South Beach, dieters must forgo to potatoes, fruit, bread, cereal, rice, pasta, beets, carrots, and corn for the first two weeks, and after that, most of these foods remain strongly discouraged (the South Beach Diet Review, 2006). After a severe 14-day induction phase, banned foods are slowly reintroduced, until the person reaches their target weight, after which a few basic guidelines apply. The diet is based on the observation that Americans are addicted to their carbs. By breaking this cycle, the South Beach diet promises not only to make you want to eat less food, but better food. According to the South Beach Diet Review (2006), not only is it risky to lose so much weight in such a short amount of time, many dieters are likely to go right back to their old favorites once they return to less restricted eating habits.

Diet Pills

Prescription Diet Pills

Diet pills have recently become a new craze for those trying to lose weight, because they are very tempting to those that have tried several other diets without success. However, many diet pills are fraudulent, and even the most natural-sounding diet pills or weight loss supplements can be attributable to dangerous weight loss. There are typically two types of weight-loss pills: over the counter and prescription pills. Prescription weight loss pills are diet drugs, regulated by the Food and Drug Administration. If certain side effects exist, then they are advertised and prescribed for weight loss only under certain criteria and in certain pill-dosages. Examples of prescription diet pills include Merida and Phentermine, and these types of diet pills are principally designed for those suffering from serious obesity. Diet and weight loss prescription drugs are not a cosmetic solution for weight loss, and neither are they intended to replace convention diet and weight loss programs.

Over-the-counter Diet Pills

Over the counter diet and weight loss pills is a rapidly growing market in the weight loss sector. These pills are classified as food supplements rather than diet drugs, and are fairly unregulated. These diet pills are not tested by the Federal authorities, not subject to the same advertising, dosage or labeling requirements, even though some experts consider that over-the-counter pills are in reality diet drugs. Although many over-the-counter diet pills and weight loss supplements contain ingredients with powerful amphetamine-like properties and have been associated with serious side effects including death, there is no compulsory reporting procedures for these diet products (Collins, 2006). Most of the over-the-counter diet pills function to suppress the appetite or burn caloric intake, but the dangers and side effects of these pills can vary enormously because many pills contain a variety of ingredients and dosage instructions may be inaccurate. Possible side effects include nervousness, tremor, diarrhea, bulging eyes, racing heartbeat, elevated blood pressure and maybe even heart failure (Collins, 2006).

Nutrition and Food

Recent research indicates that the growing awareness of the relationship between diet and health has led to an increasing demand for food products that support health above and beyond providing basic nutrition. According to the International Food and Information Council (2006), probiotics and prebiotics are components present in foods, or that can be incorporated into foods, which yield health benefits related to their interactions with the gastrointestinal tract. A probiotic has been defined as "a live microbial food ingredient that, when ingested in sufficient quantities, exerts health benefits." Prebiotics are defined as "nondigestible food ingredients that beneficially affect the host by selectively stimulating the growth of one or a limited number of bacterial species in the colon, which have the potential to improve host health." Today, probiotic-containing foods are commonly found and consumed in Japan and Europe (International Food and Information Council, 2006). In the United States, several probiotic- and prebiotic-containing foods have recently been introduced into the marketplace.

Probiotic microorganisms can be found in both supplement form and as components of foods and beverages, and certain yogurts and other cultured dairy products contain such helpful bacteria. Prebiotics are found naturally in many foods, and can also be isolated from plants; in order for a food ingredient to be classified as a prebiotic, it has to be demonstrated, that it: (a) is not broken down in the stomach or absorbed in the gastro-intestinal tract, (b) is fermented by the gastrointestinal microflora; and - most importantly, selectively stimulates the growth and/or activity of intestinal bacteria associated with health and well-being (International Food and Information Council, 2006). The human gastrointestinal environment, including the microflora, has a significant role in the health of its host. The normal gut microflora activity is complex and can be impacted by a number of factors: the gut microflora, which includes both potentially beneficial and potentially harmful bacteria, is important in maintaining a healthy intestinal tract and helps the intestine act as an effective barrier; allowing nutrients to be absorbed, and keeping out toxins and pathogens (International Food and Information Council, 2006). The gut microflora breaks down vitamins and also ferments fibers and carbohydrates that are not digested in the upper gastro-intestinal tract. This breakdown produces fatty acids that are important for supporting a healthy intestinal barrier and also inhibits the growth of harmful bacteria (International Food and Information Council, 2006).

Exercise

An essential part of maintaining good nutrition and the desire to exercise is a decision including a commitment of time and effort. Research indicates that unless you are convinced of the benefits of fitness and the risks of unfitness, you will not succeed. Regardless of your age, gender or role in life, you can benefit from regular physical activity, and exercise in combination with a sensible diet can help provide an overall sense of well-being and can even help prevent chronic illness, disability and premature death (President's Council on Physical Fitness and Sports, 2006). Benefits of exercise and increased activity are improved health, increased efficiency of heart and lungs, reduced cholesterol levels, increased muscle strength, reduced blood pressure, and reduced risk of major illnesses such as diabetes and heart disease, weight loss, and an overall improved sense of well-being.

Health experts recommend that individuals should get at least 30 minutes of moderately intense physical activity on all or most days of the week. Examples of moderate activity include brisk walking, cycling, swimming or doing home repairs or yard work. The President's Council on Physical Fitness and Sports (2006), recommends a little work toward permanently changing your lifestyle to incorporate more activity. Some of their suggestions are to: take the stairs instead of the elevator, park at the far end of a parking lot and walk to the office or store, get off public transportation a few blocks before your stop, get up from your desk during the day to stretch and walk around, take a brisk walk when you get the urge to snack, increase your pace when working in the house or yard, mow your own lawn and rake your own leaves, and carry your own groceries. It is also recommended that for persons with cardiovascular disease, an appointment with a physician should be made before undertaking more vigorous activity.

Other suggestions include: tailoring your program to your own fitness level, setting realistic goals, choosing an exercise that fits your lifestyle, giving your body a chance to adjust to your new routine, not getting discouraged if you don't see immediate results, not giving up if you miss a day; just get back on track the next day, and finding a partner for a little motivation and socialization. Finally, it is important to build some rest days into your exercise schedule, and to listen to your body if you have difficulty breathing or experience faintness or prolonged weakness during or after exercise.

Surgical Options

The decades of the 2000's have seen the rapid growth of surgical options for weight loss; however, such options are intended for the morbidly obese and not for purely cosmetic reasons. Many people seek surgical options for cosmetic reasons, and there are doctors that perform such surgeries, contributing to the dangers associated with these measures. For weight loss surgery for the obese, treatment is a two-step process: assessment and management. Assessment requires determination of the degree of obesity and absolute risk status by a practitioner; whereas management includes weight control or reducing excess body weight and maintaining that weight loss as well as instituting other measures to control associated risk factors. Understanding what the procedure exactly entails is necessary for an individual to give what is called "informed consent" for the procedure.

Informed consent is a legal term meaning that you agree that you have received and understood enough information about a weight loss surgery's benefits and risks to allow yourself to make a decision that is right for you (Obesitycare.com, 2006).

Gastric Bypass Surgery

One way of treating your biological or genetic obesity factors is through the use of weight loss surgery to promote weight loss by restricting food intake or interrupting the digestive process. Gastric bypass surgery, more commonly known as stomach stapling typically involves stapling off a large portion of the stomach so that the stomach size is greatly reduced (Obesitycare.com, 2006). Weight loss surgery is recognized by the American College of Surgeons and the American Heart Association, and it is endorsed by the National Institutes of Health and many other prominent medical institutions. Weight loss surgery is a good solution for those that are more than 100 pounds overweight or 100% above their recommended weight.

Weight loss surgery also may be an option for people with a BMI between 35 and 40 who suffer from life-threatening problems such as severe sleep apnea or obesity-related heart disease or diabetes (Obesitycare.com, 2006). It is also a good solution for those that suffer from serious associated health-risk factors such as: high blood pressure (hypertension), heart problems (cardiovascular disease), diabetes, shortness of breath, swelling of the legs, joint and back pain, depression, infertility other weight-related conditions.

According to the American Society for Bariatric Surgery (ASBS) and the National Institutes of Health, Roux-en-Y gastric bypass is the current gold standard procedure for weight loss surgery. It is the most frequently performed operation for weight loss in the United States, accounting for more than 90% of all weight loss surgeries (Obesitycare.com, 2006). In the Roux-en-Y gastric bypass procedures, a surgeon makes a direct connection from the stomach to a lower segment of the small intestine, bypassing the duodenum, and some of the jejunum. A 15-60 cc proximal gastric pouch is created using several staple lines. The proximal gastric pouch is drained into a segment of the jejunum and "bypasses" the distal stomach and duodenum (Obesitycare.com, 2006). The proximal part of the divided intestine is then connected to the side of the intestine that was previously attached to the pouch. The difference between short limb (or proximal) and long limb (or distal) gastric bypass is the length of the roux limb. Long limb gastric bypass results in more malabsorption than short limb gastric bypass (Obesitycare.com, 2006). The result is sustained weight loss of >50% excess body weight in over 80% of patients, and after 10 years, 50-60% of excess body weight loss has been maintained by some patients (Obseitycare.com, 2006).

Gastric Band (Lap Band) Surgery

Another surgical option is called Gastric Band (lap band), a surgical procedure that is a purely restrictive approach to reducing the capacity of the stomach by which a band is placed around the upper most part of the stomach giving it the shape of an hour glass. This band divides the stomach into two portions, one small and one larger portion, and no stomach stapling is required. The Lap Band induces an early feeling of stomach fullness, thereby decreasing food intake, and weight reduction is achieved because an individual will feel the need to eat less. This is because it only takes a small amount of food for the Lap Band to give a true feeling of appetite satisfaction (Obesitycare.com, 2006). The Lap Band is designed so that it can be inflated or deflated at any time after the operation to meet weight loss requirements, without any further surgery (Obesitycare.com, 2006). This is achieved by injecting a fluid solution into a port placed under the skin, and may be an option for people with a BMI between 35 and 40 who suffer from life-threatening problems for example, severe sleep apnea or obesity-related heart disease or diabetes (Obesitycare.com, 2006).

Gastroplasty (Stomach Stapling)

Gastroplasty, also known as stomach stapling, is a purely restrictive procedure with no malabsorptive effect. The goal of this procedure is to severely restrict the patient's capacity to eat certain foods by creating small stomach within the regular stomach. In this stomach stapling procedure, a vertically oriented staple line is placed high on the right side of the stomach, and the outlet is measured and its size controlled (Obesitycare.com, 2006). A mesh band or a silastic ring (flexible, but inelastic) is placed around the outlet of the pouch to keep the pouch outlet from stretching (Obesitycare.com, 2006). Aside from the creation of the small pouch there is no significant change in the gastrointestinal tract, and this procedure may be an option for people with a BMI between 35 and 40 who suffer from life-threatening problems for example, severe sleep apnea or obesity-related heart disease or diabetes (Obesitycare.com, 2006).

Health Issues Related to being Overweight

In recent years, many medical studies have shown a relation between obesity and high blood pressure, heart disease and stroke and cancer. Research indicates that obese individuals have a higher blood pressure than individuals with a normal blood pressure. Government and private sector health experts now estimate that 65% of America's adults are overweight and 31% of adults are obese and at risk for chronic diseases such as diabetes and hypertension (American Heart Association, 2004). This cardiovascular risk is increased with obesity. Many research studies have focused on answering the question of what causes the relation between obesity and high blood pressure. Many medical studies have shown that obesity presented an increase in the cardiac output and the blood volume, and in the arterial resistance.