How to Lose Weight During the Pandemic

Golden Gate Bridge in San Francisco. (Dr. Noorali Bharwani)
Golden Gate Bridge in San Francisco. (Dr. Noorali Bharwani)

Are you overweight or obese? Easy way to find out is by measuring your height and girth. Your girth should be half the size of your height.

Studies have shown obesity is a significant factor for critical illness during COVID-19. Obesity was also an important factor for mortality in patients with COVID-19. This is most likely due to obese patients were known to have a defective immune system that makes them vulnerable to a type of infection that specifically require a prompt cellular immune response (Obes Res Clin Pract. 2020 July-August).

The current pandemic has changed people’s social life limiting outdoor activities. They gain weight. It is known as “Quarantine 15”. Many people have put on 15 or more pounds in weight during the last six months or so.

The weight gain is not a surprise if you have a sedentary lifestyle. With gyms closed and groceries delivered, it was easy to lounge around and eat. People working from home have additional stress of managing family and keeping up with work schedule. Binge eating, snacking and comfort eating was a psychologically verified response to stress.

Stress and depression are going to affect your weight. When you are under stress your body tries to protect you by not giving up any calories. Plus, you tend to eat more when you are depressed.

According to the Centers for Disease Control and Prevention (CDC), severe obesity increases the risk of a dangerous breathing problem called acute respiratory distress syndrome (ARDS), which is a serious complication of COVID-19.

Also, people with severe obesity are more likely to have other chronic diseases and health conditions that can increase the severity of COVID-19.

The immune response to infection is altered in overweight patients. We do not know how effective a COVID-19 vaccine will be for these individuals.

Losing five or 10 pounds during the pandemic is entirely possible. Weigh yourself at least once a week. People who weigh themselves are more likely to keep their weight down.

Dr. John Morton, MD, medical director of bariatric surgery at Yale New Haven Health System, says he has seen patients in telehealth appointments who have gained five, 10, and even 30 pounds during the pandemic (Yale Medicine, July 1, 2020). They are looking for ways to lose weight.

How to lose weight during the pandemic?

The first step is to come up with a plan, says Dr. Morton. He recommends building new routines around what he calls the four pillars for weight loss: diet, exercise, sleep, and stress management. You have to have a disciplined routine otherwise it does not work.

“That means getting up in the morning, taking a shower, getting breakfast, and having a plan for the day. Purpose gives direction, and it helps when it comes to weight,” says Dr. Martin.

One or two pounds a week is a reasonable weight loss pace, Dr. Morton says. “If you want to cut back by 500 calories a day, that might mean you are exercising the equivalent of 200 calories and cutting out 300 calories in your diet.” It can be done.

Where there is a will there is a way. Be safe and stay healthy.

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Obesity projections for 2020 are grim.

The Colosseum amphitheater located in the centre of Rome, Italy. (Dr. Noorali Bharwani)
The Colosseum amphitheater located in the centre of Rome, Italy. (Dr. Noorali Bharwani)

Obesity is generally caused by eating too much and moving too little. Fat and sugar are high in calories. They are your big enemies. Add to that lack of exercise and physical activity. All that leads to surplus energy that will be stored by the body as fat.

Here are the facts.

In 2020, 83 per cent of men and 72 per cent of women will be overweight or obese.

Currently, 72 per cent of men and 63 per cent of women are overweight or obese (people who are overweight have a BMI of 25 to 29, people who are obese have a BMI of 30 or greater).

More than 50 per cent of these individuals will suffer from diabetes. or pre-diabetic conditions. These projections were presented by Northwestern Medicine researchers at the American Heart Association (AHA) Scientific Sessions recently in Orlando.

The AHA has set a target to help North Americans improve their overall heart health by 20 per cent in 2020. To achieve this target, we have to make a drastic change in out eating habits and increase our physical activities.

More people would need to improve health behaviors related to diet, physical activity, body weight and smoking, and health factors, related to glucose, cholesterol and blood pressure.

Believe it or not, less than five per cent of Americans currently are considered to have ideal cardiovascular health. Can you believe that – only five per cent!

The modest six percent improvement in cardiovascular health that is projected for 2020 means better cholesterol and blood pressure numbers for Americans and fewer smokers.

Achieving a healthy weight through diet and physical activity is the best way most Americans can improve their cardiovascular health. Add to that not smoking is the number one preventable cause of preventable death.

Obesity is a chronic and often progressive disease, similar to diabetes or high blood pressure. Many organizations including Obesity Canada, the Canadian Medical Association, the American Medical Association, and the World Health Organization now consider obesity to be a chronic disease.

It is estimated that one in 10 premature deaths among Canadian adults age 20 to 64 is directly attributable to obesity.

It is no secret that most methods of treating obesity have failed. Some are good for a short duration but most people revert to their old habits. Habits are hard to get rid off. Habits that have been ingrained in your system since childhood.

Experts agree there is no single solution to the problem of obesity. We should help people make better choices. People are addicted to sweet and high-fat foods that are inexpensive and easily available.

Can you think of a law that will make us exercise more, eat less and eat healthy?

Finally, a question to think about. Is BMI the best way to measure ideal weight?

A study published in the Frontiers in Public Health (July 24, 2017) by Philip B. Maffetone and colleagues say using BMI to measure obesity likely underestimates the problem. They propose measuring a person’s waist instead of their weight to assess health risks. Abdominal fat or obesity has more severe health effects than fat in other parts of the body.

Ideally, all should aim to keep their waist measurement less than half that of their height.

If you want to lose weight then 75 per cent of your effort should be spent on eating less and eating right. Twenty-five per cent of your effort should be spent on physical exercise. Have a wonderful healthy and happy 2020.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Statistics Show Majority of Canadians Overweight and Overfat

Photograph by Dr. Noorali Bharwani.
Photograph by Dr. Noorali Bharwani.

According to Statistics Canada, 61.3 per cent of adult Canadians were overweight or obese in 2015, says an article in the Canadian Medical Association Journal (CMAJ August 31, 2017). That means three in five Canadians are overweight or obese.

In 2015, the percentage of those who were obese rose to 26.7 per cent, up from 23.1 per cent in 2004. Obesity has continued to increase in adult men and women who are age 60 years and older.

Researchers warn us focusing on body mass index (BMI) misses the risks of high body fat in people of normal weight.

BMI is a person’s weight in kilograms divided by the square of height in meters. BMI does not measure body fat directly. But BMI is an inexpensive and easy-to-perform method of screening for weight category.

Your BMI may be normal for your height and weight but you may still have more fat than is good for you. It may misclassify someone who is short and muscular.
On the other hand a high BMI can be an indicator of high body fatness.

BMI can be used for population assessment of overweight and obesity. Because calculation requires only height and weight, it is inexpensive and easy to use for clinicians and for the general public. BMI can be used as a screening tool for body fatness but is not diagnostic.

How is BMI interpreted for adults (over age 20)?

  1. BMI below 18.5 – underweight
  2. BMI 18.5 to 24.9 – normal or healthy weight
  3. BMI 25.0 to 29.9 – overweight
  4. BMI 30.0 and above – obese

The question is – Is BMI the best way to measure obesity?

The CMAJ article says, “A provincial spokesperson for Manitoba (where child obesity is climbing) questioned the value of the measurement because BMI does not consider lifestyle behaviours like dietary quality, physical activity, which are, in fact, stronger determinants of death and disease.”

The CMAJ article goes on to give many examples where BMI may not accurately reflect a person’s risk of serious obesity related illnesses. Incidence of coronary heart disease, stroke, cancer and type 2 diabetes is higher in overweight and obese person.

A recent study in Frontiers in Public Health (July 24, 2017) by Philip B. Maffetone and colleagues say using BMI to measure obesity likely underestimates the problem. They propose measuring a person’s waist instead of their weight to assess health risks. Abdominal fat or obesity has more severe health effects than fat in other parts of the body.

A person has to reduce abdominal girth to reduce adverse health risks. A person’s waist should be less than half their height. This waist-to-height ratio may be the single best clinical indicator of health risk as it can be used throughout childhood, into adult life, as well as throughout the world.

Most clinicians usually know if the patient in front of them has too much body fat. They should not have to wait for the latest consensus to encourage lifestyle changes: lose weight, make dietary quality changes and increase physical activity. Simply put… eat less and exercise more.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

The Secret to Losing Weight – Eat Right and Eat Less

Sunset at Shirley Heights Lookout in English Harbour, Antigua. (Dr. Noorali Bharwani)
Sunset at Shirley Heights Lookout in English Harbour, Antigua. (Dr. Noorali Bharwani)

If you want to lose weight then 75 per cent of your effort should be spent on eating less and eating right. Twenty five per cent of your effort should be spent on physical exercise. If you made a New Year’s resolution on losing weight then this is a good time to take stock of your achievement. We are into April. Have you lost at least four pounds?

If yes, then keep it up. Slow and steady wins the race. If you haven’t then you should know that there are 37,000 books in the market on how to eat right and lose weight. According to the Canadian Medical Association Journal (CMAJ March 17, 2015), dieting programs and books are a $66-billion industry. Now you know where all your money goes.

We all have different ideas on what is right and what is wrong. When it comes to eating, it will be hard to find two people following the same dietary regimen to lose weight. If you want to be a permanent loser (I mean losing weight) then eat less.

Obesity has been officially recognized as a disease by the American Medical Association. Obesity gives you grief with multiple medical problems. In Western countries, people are considered obese when their body mass index (BMI) exceeds 30 kg/m2. They are considered overweight if the BMI is 25-30 kg/m2. In simple terms you are either of normal weight, overweight (25-30 kg/m2) or obese (over 30 kg/m2).

It is no secret that most methods of treating obesity have failed. Some are good for a short duration but most people revert to their old habits. Habits are hard to get rid off.

There are many nutritional guidelines, official and unofficial, and yet, despite all of this evidence, we have failed to make a real impact on the problem at the population level. There is no simple solution. It is determination and hard work.

So the secret is out – to lose weight you have to eat smart and eat less for life.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!