Afsoun Khalili, ND
Obesity Statistics
As stated by the World Health Organization (WHO) in 2006, globally there are more than 1 billion overweight adults, at least 300 million of them obese.
The consequences of obesity on health are now well known. In fact, not only does the condition increase the risk for chronic diseases, including Type II diabetes, cardiovascular disease, hypertension and stroke, but it also is responsible for the development of certain forms of cancer as well as premature death.
According to the WHO (2006), the key causes of obesity are increased consumption of energy-dense foods high in saturated fats and sugars, and reduced physical activity. Moreover, what is interesting is that being overweight and/or obese often co-exist with under-nutrition in developing countries. The WHO recognizes that obesity is a complex condition, with serious social and psychological dimensions, affecting virtually all ages and socioeconomic groups.
Increased consumption of more energy-dense, nutrient-poor foods with high levels of sugar and saturated fats combined with reduced physical activity have led to obesity rates that have risen three-fold or more since 1980 in some areas of North America, the United Kingdom, Eastern Europe, the Middle East, the Pacific Islands, Australasia and China.
In addition, childhood obesity is becoming an epidemic in some areas around the world, including North America. An estimated 22 million children younger than age five are estimated to be overweight worldwide.
According to the U.S. Surgeon General, in the U.S. the number of overweight children has doubled and the number of overweight adolescents has tripled since 1980. The prevalence of obese children aged 6 to 11 years has more than doubled since the 1960s. Obesity prevalence in youth aged 12-17 has increased dramatically from 5% to 13% in boys and from 5% to 9% in girls between 1966-’70 and 1988-’91 in the U.S. It is important to recognize that this is a global problem and increasingly extends into the developing world; for example, in Thailand the prevalence of obesity in 5- to 12-year-old children rose from 12.2% to 15.6% in just two years.
Obesity accounts for 2%-6% of total healthcare costs in several developed countries; some estimates put the figure as high as 7% (WHO, 2006). The true costs are undoubtedly much greater, as not all obesity-related conditions are included in the calculations.
Canada is not immune from this global epidemic, either. The prevalence of obesity in Canada has progressed rapidly over the years. The proportion of Canadian adults who are obese almost tripled in the last 15 years, from 5.6% in 1985 to 14.9% by 2000-’01 (Statistics Canada, 2001).
Obesity is a worldwide epidemic, and a complex issue with multifaceted causes. Though lack of knowledge about healthy eating plays a crucial role, both getting support as well as providing continuous support and encouragement seem to play an important role in weight loss and maintenance (Blackburn, 2005).
Currently, the WHO defines overweight as a Body Mass Index (BMI) of 25 or more, and obesity as a BMI of 30 or more. These cut-off points can provide a reference for individual assessment.
The Be Your Best Self Program
At the Robert Schad Naturopathic Clinic (RSNC), the teaching clinic at the Canadian College of Naturopathic Medicine (CCNM), many patients who approached us for weight loss and weight management found it difficult to make changes without continuous support and encouragement, and they found it even harder to relate to their intern or ND who did not seem to have any weight issues. So because of this and because we felt that we could make a difference at least locally with regards to obesity, we created Be Your Best Self (BYBS), a program where individuals feel supported by their peers as they learn about healthy eating and are given practical information on how to change not only their lifestyle, but also the way they think about food and health.
The BYBS program includes regular visits with a fourth-year intern or ND and eleven weeks of support group meetings. The support group meetings are an important and integral component of the program. In fact, research conducted on weight loss and weight maintenance shows that success in weight loss and maintenance is strongly influenced by positive feedback, encouragement and group support.
Group meetings provide the know-how, motivation and peer support that is much needed while making lifestyle changes and losing weight. During the eleven weeks that an individual attends the group meetings, they not only learn about healthy eating and the importance of an active lifestyle, but they acquire an understanding of how various conditions can be exacerbated or caused by having an unhealthy lifestyle and eating habits. The first 40 minutes to one hour of the two-hour meetings are comprised of a presentation based on one of the following topics:
- Stress and relaxation-meditation and breathing exercises
- Exercise and healthy eating
- Eating disorders and various diets
- Labels and ingredients; how to cook healthy; healthy recipes
- Depression, anxiety and other mood disorders
- Cardiovascular disease
- Exercise and active lifestyle
- Menopause and its effect on weight gain
- Fatigue and thyroid issues
Since many participants claim to not know how to shop healthy, we organize a shopping trip to a local grocery store to demonstrate how healthy shopping can be easy and affordable. In the second half of our two-hour session, we encourage discussions, questions, concerns and dialog regarding the presentations and personal challenges that may have arisen for the attendees during the week, or even in the past. We also introduce a number of behavior-altering exercises that help identify the reasons behind why an individual might choose to emotionally eat and ways to overcome them (Beck, 2006).
Group meetings are held every Monday for the simple reasons that most people – when making a commitment to changing a behavior – always promise to start on a Monday, and it is a great way for people to start their week: with a reminder of their goal.
When a patient joins the program, a thorough assessment is made prior to commencing treatment. This is to ensure that there are no underlying causes for the weight problem and to assess the patient for eating disorders, yo-yo dieting patterns and so on. Like most weight loss programs, aside from taking a detailed history, a full physical examination as well as BMI, hip-to-waist ratio, and any appropriate lab work or tests based on the symptoms of the patient, are performed. Patients are requested to bring in a detailed and truthful diet diary, and are encouraged to continue recording what they eat daily thereafter for themselves. According to Dr. Judith Beck (2006) at the Beck Institute and many other experts in this area, keeping a record of what one eats is crucial, since it allows for the individual to see on paper what he or she is eating, take responsibility for it and, as a result, become more aware of his or her own eating patterns.
Our philosophy with BYBS is that although good nutrition is crucial to good health, diet is not the only aspect of effective weight loss. Physical activity, as well as the psychological relationship that individuals develop with food, are highly important and must be addressed in a successful weight loss program. Weight loss is not just about physical change. Overeating is triggered by emotional stress, not necessarily physical hunger.
In our program, the majority of people who join are women of various age groups, socio-economic backgrounds and ethnicities with diverse past histories. Most of those women tend to be peri- or post-menopausal. This comes as no surprise, since as we get older weight becomes more of an issue, and as estrogen decreases the battle with weight is even more pronounced.
BYBS tries to help women in the program feel in control by taking responsibility for their health, and also provides an environment where their perception of food and eating can become a healthier and more realistic one. As William James once said, “The greatest revolution in our generation is the discovery that human beings, by changing the inner attitudes of their minds, can change the outer aspects of their lives.” What I have found to be the biggest challenge for the majority of our participants is overcoming the mind.
Rate of Weight Loss
With Marketdata forecasting that by 2010, the total U.S. weight loss market will increase to $68.7 billion, it is difficult to compete with promises for fast and easy weight loss when making healthy lifestyle changes can not only be challenging for many, but the weight loss can also be much more slow and not as drastic as some of the meal replacement or very low-calorie-intake programs that are available.
With the BYBS program, weight loss can occur as rapidly as 2-3lbs/week and as a slowly as 1lb/week or sometimes 2-3lbs every four weeks, which can be frustrating for someone who has 100lbs to lose. Nevertheless, with continuous support and encouragement, and by changing their attitude towards weight loss, most women who join the program develop better self-esteem, feel more in control and thus become empowered. Then they realize that weight lost quickly can be regained quickly, and that weight lost slowly is more easily maintained.
As with any other weight management program, BYBS is not for everyone. It is certainly not for those who want to lose a lot of weight very quickly, nor for those who are not ready to make changes, step out of their comfort zone or admit that they may have a dysfunctional relationship with food.
This program at the RSNC, though based on several healthy approaches to weight loss – including the Blackburn model (which emphasizes eating moderate food portions, exercising regularly and getting support; see Blackburn and Waltman, 2005) as well simple naturopathic principles – is mainly focused on healthy eating and living a balanced life. And, the uniqueness of every individual is taken into account so that each patient develops the tools with which she can make appropriate changes based on her individual lifestyle and needs.
For some people, weight gain is simply a question of unhealthy habits and lack of knowledge with regards to eating and exercising, but based on my experience, for many it is more about having an unhealthy and at times addictive relationship with food. As one woman said at a group meeting, “I eat when I’m sad, I eat when I’m upset, I eat when I feel lonely, I eat when I’m bored, I eat when I’m happy and I even eat more when I realize that I’ve just overeaten!”
Finally, it is important to recognize that not one diet or approach fits all, and something that can work effectively for one person does not necessarily work as well for another. Nevertheless, if the calories in and out do not balance at the end of the day, weight loss will not occur.
In my opinion, self-knowledge and insight are probably the best qualities to develop and possess in the path to a healthier lifestyle, as Theodore Rozak said: “Nothing we ever imagined is beyond our power, only beyond our present self-knowledge.” And as people get to know themselves and their own habits better with the right state of mind and guidance, they can overcome anything … even excess weight.
Afsoun Khalili, ND is a graduate of CCNM, with a background in biochemistry. She is currently an assistant professor and clinic faculty member at the Robert Schad Naturopathic Clinic (RSNC) and treats HIV positive individuals at the Naturopathic Clinic at Sherbourne Health Centre. Over the last four years, Dr. Khalili has been involved with the Corporate Wellness Program (CWP) at CCNM, and she is a frequent lecturer for CWP presentations. She has also inaugurated the Be Your Best Self healthy lifestyle change and weight management program at the RSNC, which has now been going on for more than four years. Dr. Khalili maintains a private practice in Toronto and has over the last few years given lectures on a variety of health issues.
References
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