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Why are women losing the battle of the bulge?

BY ALLIE SHAH
Star Tribune (Minneapolis)

Frances Traphagan has been battling weight issues her whole life.

For years, the south Minneapolis mom struggled to balance work demands and motherhood. After every pregnancy, her weight problem grew. Her habit of eating on the run also tipped the scales in the wrong direction.

Finally, at 240 pounds, the 5-foot-3 Traphagan chose to have bariatric surgery at the Hennepin Bariatric Center and Obesity Program at Hennepin County Medical Center in downtown Minneapolis.

“It was my very last effort to try to lose weight,” she said.

She’d tried everything before that – from Weight Watchers to the Atkins diet to the grapefruit diet.

“I did have some success, but nothing was ever permanent,” she said.

After a national report this summer showed that women have surpassed men in obesity rates, doctors and obesity researchers are searching for answers to why women are struggling more than men.

For the first time, more than 40 percent of U.S. women are obese, according to the latest numbers from the Centers for Disease Control and Prevention.

The nation as a whole continues to struggle with obesity, with 35 percent of men considered obese. But while men’s obesity rates appear to have stabilized, women’s are still rising, the CDC report shows.

Dr. Maria Collazo-Clavell, an endocrinologist at the Mayo Clinic who works with overweight and obese patients, has been working in the obesity research field for 20 years. She said the recent findings give her pause about whether public health officials are taking the right approach to tackling obesity.

“All of that makes you question: Are you on the right track?” she said. “The data would say no.”

That so many women are obese is cause for alarm not only because of the increased health risks for them but also for those around them, Collazo-Clavell said.

“That’s kind of the tip of the iceberg,” she said. Women are often the primary caregivers in a family, and their eating and activity habits can influence their children and others in their family.

An example of that ripple effect: Collazo-Clavell is starting to see some of her previous patients’ children and is working with them to help manage their obesity.

It’s difficult to pinpoint what is causing women to struggle more with obesity than men, but doctors say there likely are many factors at play.

Women typically have two times in their lives when they are at risk of gaining significant amounts of weight: childbearing (during pregnancy and after giving birth) and menopause.

Collazo-Clavell hears from many new mothers that they find meal planning and preparation tough after giving birth. Also of concern, she notes that women as a group are going into pregnancy heavier than they were 20 years ago.

It makes it harder to manage a healthy pregnancy weight if they’re already overweight, she said.

An epidemic

One of the country’s leading health problems, obesity can lead to serious diseases, including diabetes and heart disease.

Body mass index (BMI) is calculated by dividing weight (in kilograms) by height squared (in centimeters). Anyone with a BMI of 25 or more is considered overweight, while those with a BMI of 30 or more are obese.

For example, a woman of average height in the U.S. (5 feet 4) would be classified as obese if she weighs at least 175 pounds. An average height American man (5 feet 9) who weighs 203 pounds or more would be considered obese.

Dr. Guilford Hartley is medical director of the Hennepin Bariatric Center and Obesity Program, where 100 surgeries for weight management are performed each year.

He sees many more female patients than men. Part of the reason, he said, is that women are more likely to seek medical treatment for a weight issue than men.

“In our culture, when a man’s overweight, nobody pays too much attention,” he said. “But we have such an emphasis on being thin for women that we’re culturally forcing women to be more concerned about their weight than men. The social pressure if you’re overweight and a woman is higher.”

Those seeking surgery often have struggled with a weight problem for a long time.

“Usually by the time I see them, most of them get here saying, ‘I’ve done this all my life. This is my sixth yo-yo,’” he said.

He found the recent CDC report on obesity rates concerning. “Up until these reports, it was looking as if the so-called obesity epidemic was kind of plateauing.”

In analyzing the new data, Hartley and Collazo-Clavell point to societal changes that have led people to become more sedentary.

“If you were a clerical person, 20 years ago you’d have to get up and put the piece of paper in the file cabinet. Now you never have to get up off your chair,” Hartley said. “We have engineered … physical activity out of our workplace and out of our home place.”

The prescription of “eat less and exercise more” does not address the kind of vigorous activity needed to tip the scales.

“When we tell them to exercise more, we mean get on a treadmill for an hour, three days a week,” he said. “And the kind of exercise that it takes to have a significant impact on weight is more like if you’re a hardscrabble farmer and you’re working up a sweat for eight hours a day just to put food on the table.”

Constant fight

It’s been 10 years since Traphagan had a surgical band wrapped around her stomach to make it smaller. The band makes it possible to consume only 1.5 cups of food at a time. But it’s still possible to overeat, she said, which is why she had to learn how to eat healthfully to control her weight.

Today, she has poached eggs instead of doughnuts for breakfast and drinks plenty of ice water throughout the day. She has maintained a healthy weight.

“It’s been real hard, though. It’s not easy,” she said.

“I got down to 155 pounds. My goal weight is 124. I’m still working on that, and I hope to achieve that this year.”

(This article first appeared in: http://www.bradenton.com/news/local/health-care/article95803902.html)

Can a Drug or Surgery Solve Your Weight Problem?

Successful Weight Loss
(Published first in The Huffington Post)

In a word, no. Can they help? Perhaps.

Last month I wrote an article that spoke somewhat favorably of the new weight loss drug, Saxenda. I said it was perhaps the most important weight loss medication ever developed.

Wow! Did I get lambasted! I got all sorts of email blasting me for going over to the dark side and becoming a drug pusher and lackey of Big Pharma. I even got an email from my favorite professor of counseling at the University of Massachusetts, now friend, Allen Ivey, Ph.D. Besides being a friend, he is a big shot in the counseling field, the father of Microcounseling and developer of “active listening”. He said he was “sad” to see that I seemed to be pushing drugs. He is the last person on earth that I would want to be mistaken about my views on the solution to obesity. We’ve since gotten that misunderstanding corrected, but I want to make sure it is clear with everyone who reads my blogs.

I am still the world’s staunchest advocate of the behavioral therapy I teach to reverse the condition of obesity. It works -like a miracle, some say. But not 100% of the time. For some, it is not enough.

After 30 years successfully helping people to lose weight permanently, I am convinced that a percentage of the population is dealing with a physiological condition that creates more persistent and intense degrees of craving and compulsion than the rest of us have to deal with. My approach teaches people how to overcome the habits and feelings that make them overweight but sometimes those cravings and compulsions are so strong that nothing on God’s natural earth will quiet them.

If you’ve ever had a blister on your foot or a pebble in your shoe, you’ll remember that your brain is getting the message loud and clear that you need to relieve that pressure and you need to relieve it right now. You will feel the drive to relieve it until you do. It won’t go away until you do whatever it takes. There is no “will-powering” it away. Something is going on in the body, physiologically and chemically, that is triggering a response in your brain that will bother you until you satisfy it. It isn’t exactly the same with the food cravings that some have, but it gives you an idea of what some people are dealing with. Hold your breath for as long as you can and see how powerful the urge to breathe becomes. This is the kind of relentless drive that a small percentage of the population is fighting in their attempts to stop eating too much.

For them, some sort of intervention or tool that would make it easier for them to eat less would be a Godsend. Then, perhaps what they learn in a good behavioral approach would be enough. Self-programming and cognitive techniques like I teach work like magic for many people, but they would be so much more productive for these folks with eating hyperdrive if we could reduce that drive, which the pharmaceuticals can do. Or in the case of surgery, an additional tool to use behaviorally.

Make no mistake about it, drugs or surgery will not by themselves solve your weight problem. To solve your weight problem, you need to make a permanent change in your behavior, made possible with behavioral therapy, taught in my book and by my therapists. Success comes with learning how to eat what you like in ways that keep you at your desired weight and it becoming habitual and a new “normal” for you. Now, with these new medical interventions, success may be possible even for those who have suffered from an abnormally intensive eating drive. Weight loss drugs or surgery may now enable them to overcome the obstacles that prevented them from being able to make those behavioral changes.