Why We Are Fat and What We
by
Dennis B. Kottler, MD
Introduction
This
is the first part in a series looking at major health concerns that affect our society in
epidemic proportions and the likely reasons these problems have become so common. This current monograph deals with the epidemic of
obesity in adults and offers practical suggestions to combat this major health threat. Innovative self-treatment approaches are
discussed that have proven effective in large numbers of people. The author also addresses impediments to weight
loss that involve relationships with other people and personal psychological and
psychiatric “roadblocks.”
“Dimensions” of the Problem: Defining Obesity and Overweight
Recent
guidelines on obesity published by the National Heart, Lung, and Blood Institute of the
National Institutes of Health (June 1998) give an indication of the scope of the weight
problem and suggest meaningful ways in which to assess the degree of overweight.
According to these guidelines, an astounding 55% of American adults fall into the
combined categories of “obese” and “overweight.”
There
are many ways to assess degree of obesity. Two
of the ones proposed by the National Heart, Lung, and Blood Institute involve BMI or body
mass index and measurement of waist circumference.
Body Mass
Index
This
measurement is defined as follows:
The
easiest way to determine your BMI is to use the table displayed at the conclusion of this
monograph.
Note that the BMI guideline is
independent of gender. A BMI of 25 to 29.9 is
considered overweight and one 30 or above is considered obese.
Waist Circumference Measurement
The other measure of obesity
recommended by the NHLBI is a simple waist circumference measurement. This measure does vary with gender. It is best used in combination with the BMI
guideline. According to the National Heart, Lung, and Blood Institute, a waist
circumference of over 40 inches in men and over 35 inches in women signifies increased
risk in those who have a BMI of 25 to 34.9 (or greater).
Another measure of obesity is total
body fat which can be measured by means of a device which measures the body’s
resistance to an electrical current. Finally,
total body fat can also be measured by total immersion in a tank of water and calculation
of body density based on the amount of water displaced compared to the person’s
weight. However, the measures discussed
above, particularly body mass index, correlate well with this latter measurement and are
easier to obtain, since they do not require special equipment.
Dangers of Excess Weight
According to the National Heart,
Lung, and Blood Institute:
Obesity and overweight substantially
increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary
heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory
problems; and endometrial, breast, prostate, and colon cancers. Higher body weights are
also associated with increases in all-cause mortality.
We may add to this list of health
risk dangers the lifestyle impediments introduced by excess weight. Some of these include: Decreased mobility, decreased ability to
participate in many recreational activities, discomfort caused by ill-fitting clothes,
difficulty accommodating to the environment such as sitting in narrow airplane seats, and
impaired social effectiveness as a result of the social bias against obesity. This latter problem can be subtle and may take the
form of failure to make a good impression in a job interview, lack of effectiveness while
on the job, as well as the more obvious decreased odds of meeting someone for a romantic
involvement.
Finally, people who are obese are
often “food-centric” planning their activities with the focus on eating. This can limit the inclination to pursue other
means of gratification, since food becomes a very strong self-reward mechanism. Of course, this pattern only leads to
further obesity.
Technology: Outrunning the Human Genome
There
is one overwhelming reason why our Western, American society has fallen victim to a
rapidly increasing problem with overweight and obesity.
In fact, most of the “fattening” of our population has occurred in the
last 40 years and especially in this past decade. The
reason for this dangerous trend lies in the fact that our modern technology is progressing
incredibly faster than our poor poky human genome (the genetic endowment each generation
inherits from its parents). Human
evolution is indeed a very slow process, measured in millions of years. Lifestyle change brought about by technological
“evolution,” or should we say “revolution,” has been astonishing over
this last several decades.
Two
obvious inventions, which have impacted our lifestyle to an immeasurable degree, are the
automobile and the television, the latter being to some degree supplanted for many of us
by the computer. The increase in sedentary
lifestyle afforded by these two inventions alone is probably enormous. We have even created a word for the chronic
television viewer, “couch potato.”
Now
we are beginning to experience the effects of another major invention, the internet. We no longer have to leave the sedentary comfort
of our sofa to obtain anything, from information to any number of things we can shop for
on the web and have delivered to our door. We
can even order food without having to get up and use the telephone. We can cyber-travel to anywhere on the globe,
experience sexual stimulation through vivid images, and chat with a huge number of other
cyber-people. We can substitute the
“virtual” world for the “real” world and think this is a great favor
of modern technology. (Before I get too
caught up in my criticism of this lifestyle, I must remind myself that this monograph is
published courtesy of this very same world wide web technology, so I’ll stop here,
but you get the point.)
Unfortunately,
our genome is still geared to a much more active lifestyle than modern technology
supports. Think of the caveman who spent many
hours hunting and gathering food. The
energy expenditure of the food-seeking probably consumed most of the calories ingested. The challenge was to prevent starvation.
In
fact most of the million or so years humans have existed in roughly their current
anatomical form, avoiding starvation was the key to survival. This starvation threat remains a critical
challenge in much of the third world. In this
regard, it is interesting to note that the government of India has a law which prohibits
beverages being sold with a sugar content of less than 5%!
It is extremely difficult to find diet drinks in India.
To
adapt to the challenge of starvation, evolution developed a stomach which can be distended
to accommodate huge quantities of food. Anyone
can attest to this who has frequented an “all-you-can-eat” buffet. Other
adaptations include a feeding behavior which tends to be calibrated for eating calories
far in excess of that required to maintain normal weight (in modern society). In primitive times this voracious appetite
served man well, since one never new when the next meal would be hunted down. The excess energy is stored in glycogen reserves
in the liver and, of course, in the form of fat deposits.
This was not a problem for the very active primitive man, but it is a major problem
for the largely sedentary modern homo sapiens.
Another
problem that we inherited from our primitive ancestors is the overwhelming appetite many
of us have for sweet, salty and fatty food. It
is no coincidence that we crave food high in calories and salt. The idea was to prevent starvation, and the salt
helped retain fluid to avoid dehydration. In
our present society of abundant food, these propensities come back to haunt us and tempt
us into further and further weight gain.
An
obese patient of mine recently remarked regarding her food intake: “I only eat till I am full and than I
stop. Isn’t that what you are supposed
to do.” Unfortunately, her appetite is
geared to a much more active lifestyle than the one she currently lives.
Curiously,
the people who probably would have been the best survivors in primitive days or under
famine conditions in the present, are most prone to accumulate excess fat in our current
high tech society. These individuals possess
a so-called “thrift-engine” metabolism.
They store energy well and get many miles to the gallon, using their fuel at a
snail’s pace. If they were automobiles
they would meet Federal Standards for the next 100 years.
Unfortunately, they are not automobiles, they are just fat humans.
Bringing the Environment into Synch
with the Genes
We
can’t change our genes. At least not
yet. But we can create an
environment, a personal micro-environment, that more closely resembles the environment
that our genes were originally designed for. I
speak of the “primitive” environment of the hunter and gatherer. What would this
micro-environment be? For one thing we
can simulate the calorie-burning hunting and gathering by walking to the store; cavemen
did not have cars. We can spend more time
stalking the prey, more time shopping, less time consuming.
We can make more careful use of our modern technologies, such as the internet, and
not let ourselves replace “real” life with “virtual” life. We can space out our big meals, treating
ourselves to the big meal out monthly instead of weekly.
After all the caveman most likely did not have the luxury of a sumptuous repast on
a daily basis.
What We Must Do to Lose Our Excess
Weight
After
an initial physical examination by a physician to rule out undiagnosed specific medical
problems, which may contribute to the obesity or contraindicate the recommendations below,
the fundamentals of losing weight are well known.
They essentially revolve around the joint concepts of restricting calories and increasing exercise. A good approach is to plan on losing
approximately 1 to 2 pounds per week, perhaps setting an initial goal of losing 10% of
current body weight, depending on the degree of initial obesity. Even though the obesity may require further
weight reduction, it is important to set a realistic initial goal. Once this 10% reduction is attained, the
over-weight condition can be re-evaluated (using, for example the BMI) and a further goal
of another 10% or so can be planned if this
is appropriate. For those dealing with
extreme amounts of excess fat, this slow approach may seem hopeless. However with patience and persistence eventually
a goal of reasonable weight can be achieved. Furthermore,
the methods suggested can evolve into a long-term healthy lifestyle.
Don’t
Count Calories Eaten, Count Calories Not Eaten
The
traditional diet has involved “counting calories.” While this works and may not be a problem
for some, for many people it is onerous to focus on the caloric cost of each food
ingested. Rather, one should develop a
general and approximate knowledge of the relative calories of various foods one usually
encounters and substitue the less fattening options.
Much of this knowledge is common sense.
For example, one could substitute fruit for the cake or pie dessert, eat lean meats
or fish in modest portions of 4 ounces or so, and snack on carrots and celery versus
cookies, crackers, or pretzels. Just making a
series of such substitutions and keeping everything else the same will most likely result
in some weight loss over time.
Food
preferences seem to some degree to be acquired tastes.
True there is some evolutionary pre-programming to “like” high calorie
foods and salty foods, but there is still wide latitude in the ability of the individual
to modify these proclivities. In general,
avoid sweet and mushy foods and salty and oily foods.
Get accustomed to crunchy foods involving whole grains, vegetables, nuts (in
moderation), and fruits. By all means
try to avoid adding salt in food preparation and avoid foods that already have a lot of
salt, check labels. Substitute spices
for salt. Use herbs to add distinctive
flavors to food. Use skim milk and low-fat
cottage cheese as opposed to whole milk or milk fat products. If these suggestions are followed, over a
period of time food preferences will change and the old foods will start tasting too
“rich” or fatty.
A
concept that has proven useful is the “calorie deficit” model of weight loss. It is based on the fact that a pound of fat
represents approximately 4000 calories (actually kilocalories or food calories). The 4000 calorie figure is arrived at by
multiplying the caloric value of fat, 9 calories per gram, by the 454 grams equivalent to
one pound.
Armed
with this knowledge that one pound of fat equals 4000 calories, if one “cheats”
oneself of approximately this number of calories a week, on average one will lose
one pound of fat a week, keeping all other things the same.
This breaks down to approximately 500 to 600 calories per day, the approximate
caloric price of a slice of that rich pie or cake or several handfuls of the crackers, cookies, or pretzels one is snacking
on. So figure out where you can cut
that approximately 500 to 600 calories daily and you are well on the way to trimming the
fat. To many people, this approach of
eliminating calories is much easier than counting all the calories ingested. Each temptation becomes an opportunity. The pie not eaten
is a major achievement.
Of
course a more aggressive weight loss program would require trimming perhaps 1000 calories
daily to give a weight loss of approximately 2 pounds a week. The NIH (National Institutes of Health) recommends weight loss of 1 to 2 pounds per week.
Now
add to this “calorie deficit” approach
the synergistic effects of increasing activity and the weight will dissolve ( in slow
motion of course)…it does take patience. The
main object is to plan for a long, slow process of weight loss which will then seamlessly
merge into a greatly healthier lifestyle. The
rewards will accrue over the course of the rest of one’s life in greatly expanded
possibilities for a whole host of lifestyle choices which may have been relatively
unavailable as a result of the encumbrance of excess weight.
Think of
Increasing Activity Level, Not Just Doing Exercise
Exercise
to many is a bad word. To other people it is
a pure joy. Usually a person falls into one
or the other category. Those who exercise
just to control weight without any real enjoyment of the process, usually give it up after
variable periods of time, depending on the degree of masochism involved. For those who enjoy exercise it is easy to
keep it going. Sometimes
exercise can become an “addiction,” but that is another problem that will be
addressed at another time under the general category of compulsive behaviors and
lifestyles.
The
point is, if exercise is appealing by all means do it.
Even if it doesn’t come easily give it a try.
The NIH guidelines suggest 30 minutes or so of exercise (moderate exercise) daily
if possible. Of course, depending on level of
physical unfitness, one might have to work up to this goal. On the other hand, 45 minutes of daily exercise
is better yet, if that is feasible for a given individual.
Now
for those who spurn the E-word (we’re not talking e-commerce here), try to
concentrate at the very least on increasing the level of daily activity. Take the steps as opposed to the elevator when
possible, give up trying to find the closest parking space, walk on short errands rather
than driving, offer to help a friend do a chore, help the spouse with his/her chores, and
on and on. As these unplanned activities
increase, one’s energy level and motivation to be active also increase, and the
weight loss benefits continue to accrue.
Remember
inactivity begets inactivity and activity begets more activity. People who spend much of their leisure time on the
“couch” find it ever harder to get up and do something. They not only get fat they often get
less and less motivated if not outright depressed.
Reversing the process takes effort at first but soon becomes easier and easier.
Tempo –
Increase Speed Ahead
Regarding
unplanned activity it is helpful to try to increase the “tempo” of the activity. In planned exercise, one tends to walk faster and
faster on the treadmill, for example. Similarly,
try to increase the rate at which you move about your daily life. Often people with a tendency to be overweight move
slowly. Consciously try to increase
the rate of movement, whether it be walking into the kitchen to get the carrot sticks, or
doing a chore. In the latter case, it is a
pleasant surprise to end up with more leisure time to do other active, fun activities.
Remember
slowness of movement, aside from its frequent relationship to obesity, also crops up in a
number of other undesirable settings. People
with a common form of depression often are slowed up in all activities. As we age, we lapse into slower movements. People even drive slower as they get older. Some of this slowness is the result of physical
impairment or severe neurotransmitter abnormality in the case of certain depressions. However, at least some of this slowing is
reversible when one becomes conscious of it and makes an effort to move faster. The faster tempo eventually becomes the norm. And the contribution to weight loss is an
important benefit. Of course some people are
naturally “fast” and usually not obese in the first place; other people are, as
the ancient Greeks said, “phlegmatic” by nature.
Even though these may be genetic temperaments, there is some room for change, but
first one must recognize the problem.
Attitude
One
should adopt an attitude to the weight loss challenge that recognizes the strong positives
involved. Some of these positives include:
1. Weight is something potentially under one’s
control with the rare exceptions of relatively
infrequent specific medical causes of obesity. Thus
if one is to have a physical problem, obesity is certainly one of the most hopeful.
2. Weight loss is something one can usually do on
one’s own (after an initial recommended medical examination).
3. Weight loss progress is easily measured and
monitored by use of an accurate scale and calculation of BMI and Waist Circumference
Measures, as discussed above. No fancy
and expensive laboratory tests are required as is the case with many other medical
problems.
4. Weight loss is self-reinforcing as one sees
not just the results on the scale, but the benefits which start to accrue in the form of more active lifestyle, less tendency to get winded
(climbing steps or uphill walks), more comfortable fitting clothes and more clothing
choices, compliments from others, and increased likelihood of a healthier and longer life.
5. Weight loss often can be an inspiration to friends
and family to do likewise.
6. The whole process can be thought of as a challenge
that with some dedication can be won.
Ok, Big Shot, I Tried It All and I
Still Can’t Lose Weight
At
this point, when nothing is working as it should and the scale seems stuck on the same
number, look for things that might be interfering with your best attempts at weight loss. I group these interferences into four categories: Environmental, psychological, psychiatric,
and physical.
Environmental
Impediments to Weight Loss (Especially Other People)
Look
for an “enabler.” Perhaps a spouse
or roommate is unwittingly helping to maintain your overweight condition. For example, this person may be filling the house
with fattening foods for themselves and then encouraging you to join them, not wanting to
eat alone. Or the mere availability of such
foods may prove irresistible. Deal with this
“enabler” tactfully but firmly, explaining that you have a weight problem that
endangers your health and that it is very important to you to lose the weight. Most people understand this, although they may
need to be reminded periodically.
In
some cases, more subtle dynamics may be at work.
An “enabler” may have an unconscious desire to keep you overweight for
more complicated reasons. Some of these
motivations might include competitive feelings. For
example, the “enabler” may have been unsuccessful in weight loss himself and has
difficulty seeing you “win” the weight battle.
Or perhaps, the “enabler” is in denial of your obesity as a way of
denying his own obesity. In another scenario,
the prospect of weight loss poses the fear for the “enabler” that you might
leave the relationship, especially in the case of a romantic attachment. Other dynamics are also possible. Subtle reminders to the “enabler”
regarding your need to lose weight may not be all that effective, since the
“enabler” is driven by his own motivations and self interest, and thus may have
an “investment” in your being fat, for reasons of which he is not even aware. One possible solution to this weight-loss
impediment may involve seeking professional psychological help for this dysfunctional
relationship. If this is not feasible, it may
be necessary to “resist” the pressures of the “enabler” with
one’s full determination, often quite a challenge.
Finally, in very extreme cases, a separation may have to be considered.
Then
of course there is the “food equals love” phenomenon wherein a loving parent or
spouse literally feeds the other person to slow death.
This is often a learned behavior which the perpetrator has acquired from an equally
“loving” parent. Whole families of
fat people can be formed this way, in the name of love.
Some spouses, traditionally the female although this is changing, feel guilty if
they do not prepare a nutritious and often calorie-laden meal. When the person trying to lose weight insists,
“I would be happy with a vegetarian meal tonight, or even a bowl of oats and some
fruit,” the feeder announces, “I couldn’t do that to you. Horses eat better.” “But if you really cared about
me…...,” and the futile dialog continues.
One
way, perhaps, to address the above “enabler” issues would be for both the person
trying to lose weight and the significant other to read this monograph together and then
discuss it. Often having a third party point
things out is more acceptable than hearing the same things from one of the parties engaged
in the conflict. Opening up a nice,
calm dialog about these issues is a necessary first step to creating lasting change.
Psychological
Impediments to Weight Loss
Prepare
for periods of being discouraged. Weight
loss does not proceed in linear fashion. Weight
often seems to come off in a series of stages, interspersed with plateaus. Nothing seems to be happening for a while, than
for some reason, a few more pounds come off. Then
another plateau. There will also be times
that weight seems to go up a pound or two. Have
patience, this is just how it works. Daily
variations are not important. Weigh yourself
weekly or bi-weekly.
To
avoid giving up, stay motivated by keeping an “eye” on long-term goals as well
as the scale. Think of the long-term
health benefits of weight loss. Think of how
good it will feel to be lighter and more agile and quicker in movements. Think of the improvement in the tennis game or
other physical activity. Think of the clothes
not binding around the waist. Think of all
the other activities that will be possible once the hindrance of a fat, unfit body is no
longer a problem.
Other
areas of psychological impediment are more subtle. An
individual may harbor unconscious motivations to stay fat.
He may fear the possibilities that might open up once the weight is lost. For example, obesity may have been an
“excuse” to avoid seeking romantic attachments.
Also, large size may imply self-importance and power, thinness frailty. Weight loss
may also arouse the fear of looking older with more pronounced wrinkling and sagging skin. These fears, often unconscious, may require the
skills of a therapist to uncover and treat.
The
reliance on food as a primary reward activity is also a major psychological impediment to
weight loss. Some individuals rationalize,
“life sucks, I might as well enjoy my food.”
This attitude might reflect an underlying chronic depression. Eating is also an “easier” activity with
which to reward oneself as opposed to playing a sport or leaving the house to attend a
play, or to pursue some other interest. Finally,
eating can be done by oneself without having to deal with another person. These advantages are very short-lived
gratifications as opposed to the long-term gratification that can be obtained by achieving
and maintaining a normal and healthy weight. Keep
the mind focussed on the long-term goals as numerated above.
Psychiatric
Impediments to Weight Loss
Numerous
psychiatric, medical conditions can complicate weight loss.
For example, if one has some forms of clinical depression, especially the so-called
atypical depressions, it is not unusual to gain weight.
The weight gain can be related to a general loss of interest and avoidance of
activities as well as to metabolic changes, which can result from the depression. In one such form of depression, the individual
tends to crave carbohydrates, sleep excessively, and suffer from feelings of low energy. This particular depressive state is often more
common in the winter season and it has been theorized that it bears some resemblance to
the hibernation state observed in some animals.
It is obvious how this disorder can derail any attempt at weight loss and
professional help should be obtained.
Various eating disorders can also play havoc with
weight. Examples of these disorders are
“compulsive eating patterns,” bulimia (the binge-purge disorder), and anorexia
nervosa, although this latter disorder is associated with excessive weight loss, by
definition. Under no circumstances should
bingeing and purging be used as a means to control weight and laxative use or regular
diuretic use is also not recommended, unless it is prescribed by a physician for a
particular medical condition.
Physical
Impediments to Weight Loss
The
books all recommend aerobic exercise as a weight loss adjunct. However, what about the disabled individual who
cannot bear weight on his legs? There are
many physical impairments which can make traditional exercise difficult, harmful, or even
impossible. In these cases one must be
creative. Upper body aerobic exercise can be
just as effective as lower body exercise and actually can often burn more calories. Some examples of upper body aerobic exercise are
rapid twirling of the arms in large and small circles with the arms outstretched and
rowing exercises. Consult with a health
professional for medical clearance and other suggestions.
And, of course, if one has any of a number of serious medical conditions, including
such things as cardiovascular disease, diabetes, or respiratory problems, the advice of a
physician is mandatory before beginning a weight-loss program.
Finally,
obesity when severe, is itself a major impediment to weight loss since it limits physical
activity. For the very obese it might
be an effort, or even impossible, to get out of bed.
Nonetheless even these individuals can usually do something to increase their
activity, even if the activity has to progress very gradually. For example, if it is impossible to mobilize the
entire body, at least limb exercises are a possibility.
Professional counseling by a physical therapist might be very helpful to design an
incremental activity program. The main
point is to GET MOVING...even a little.
Alternative Weight Loss Strategies
For
the sake of completeness, I will touch on various weight loss approaches other than those
recommended above. In general, these
techniques are reserved for the more severe cases of obesity where the calorie-restriction
and increased-activity approach has not produced significant results over a period of say
6 months or more and there is serious danger to one’s health. These techniques include surgical intervention,
such as gastric stapling and jejunal (intestinal) bypass, and the use of medication. Various medications have been used to help
control weight. These include amphetamines,
amphetamine-like drugs, such as phentermine, thyroid, and antidepressants such as
fluoxetine/Prozac (although not approved for this usage by the FDA). These drugs have also been used in creative
combinations, such as PhenPro (phentermine and Prozac).
None of these medications produces consistent weight loss results and in the case
of amphetamines, a potentially habituating drug, the weight loss is usually transient.
Just
recently, a drug that prevents fat absorption, orlistat, has been FDA approved and is
being marketed under the brand name of Xenical. This
drug causes much of the fat ingested to pass through the body unabsorbed and thus not
contribute to weight gain. Problems with this
latter drug include abdominal pain and bloating as well as oily diarrhea, particularly
when one ingests fatty foods. This side
effect suggests that the drug may work quite successfully for some people as a kind of
Antabuse for obesity. Antabuse, when
taken before alcohol consumption, results in a very nasty physical reaction to the
alcohol, thus making a person think twice before drinking while on this drug. Likewise, Xenical may perform the same
aversion therapy for someone used to ingesting large amounts of fatty foods.
One
of the most creative weight loss approaches tried several years ago was the gastric
balloon. Much as one would put a brick
in the toilet tank to displace water and lower the water bill, the gastric balloon, would
be lowered into the stomach and then inflated to take up space. Thus, a person would feel full with only a
modest food intake. The idea sounded
like a winner until several serious complications occurred, including death, when the
balloon would dislodge and cause an intestinal obstruction, a medical emergency.
Various
health store remedies involving herbs have been tried with limited success. And of course many people have placed
themselves on pre-formulated diets, sold under various proprietary names. The problem with these methods is that they are
not conducive to maintaining weight loss, since one usually gets bored with the limited
“foods” supplied. On the
other hand, sensible calorie restriction and increased physical activity can become part
of a normal lifestyle.
Finally,
hope may yet be on the horizon. Various
biotech companies are working on understanding the various mechanisms the body uses to
regulate weight. One interesting theory
involves a peptide (a series of amino acids) called leptin.
The theory states that fat cells normally trigger leptin release into the
bloodstream. Theoretically, when there
is more fat cell mass, more leptin is released. The
leptin then interacts in the brain with receptors in the hypothalamus to turn off eating
behavior. Obese people are thought by some to
produce either insufficient leptin, defective leptin, or to possess defective leptin
receptors in the hypothalamus, all of which would interfere with regulation of feeding
behavior and weight regulation. Thus it would
seem that the ability to supply exogenous leptin, in the form of a drug, would also turn
off eating behavior and could be given to obese individuals to help them lose weight.
Two
features have complicated the leptin picture. First,
leptin has to be injected, since the drug is broken down in the stomach and thus cannot
ever get to the hypothalamus intact when taken by mouth.
And second, there are apparently various troublemaker mice which are both obese and
have excessive leptin all in the same mouse! So
for now it is back to the drawing board for leptin.
Conclusion
I
have attempted to provide an overview of the obesity problem as we experience it in our
modern technological society. In addition, I
have offered what I believe to be practical suggestions that can be applied to the
individual who wishes to combat the forces which strive to make us fat. It is my hope that the reader of this monograph
will look back in 6 months or so and feel that the time and expense involved was well
worth it…and a total loss…of pounds that is.
Dennis
B. Kottler, MD
Please e-mail the author with your
feedback at: sinnedx1@aol.com
To use the BMI table below, first find
height in inches in the column on the left and then go across the table to locate weight
in pounds. Finally locate the BMI by
going up to the top of the column.
This table has been created using the
following formula (converts kilograms to pounds and meters to inches):
BMI = Weight in pounds divided by 2.2/
(Height in inches divided by 39.37) squared.
Please e-mail feedback to: doc@psychiatrix.com