What is Health and What Does it Look Like? Discussion on Obesity!

I start the new year with a challenge to myself and to my readers to make this a year to strive towards optimal health. This article is for me, to remind me what I know and what I need to do! Enjoy!

The current obsession with woke eagerness to avoid fat-shaming is, I believe, a grave disservice to the population, preventing people from addressing the very serious health issue that is obesity.

Prior to the 1970s obesity was rare, and extreme obesity was seldom seen. Today obesity seems to the the norm. Just because something is normal, doesn’t mean that it is healthy or ok!

Weight and height are concrete parameters; overweight is not a perception, a bias, or a discrimination, it is a physical state of being that has massive impacts on health, mobility, comfort and social activity. Obesity is one of the leading risk factors for all types of cancers, a recent critical concern. It is causally linked with multiple health conditions.

Obesity in the Philippines

Obesity is a grave concern in the Philippines and a drain on the limited health care system, and a cost that most Filipinos cannot afford. This 2022 figure shows nearly 4/10 of Filipinos aged 20 to 59 and more than 1/10 children aged from 5 to 19 were obese.

I am sure that these figures are already far worse following the pandemic lockdowns. A pediatric endocrinologist friend has lost several patients to morbid obesity (these children get so fat that they cannot breathe properly, and then they die if they cannot be helped in time) during the pandemic years. He told me he had only ever seen 1 prior case in his long career, but now he is routinely treating young children for severe obesity and type 2 diabetes.

I also theorize that the poor metabolic health of many Filipinos has contributed to the Philippines huge excess deaths starting in 2021 and still continuing. Could poor metabolic health, marginal nutrition status, and vaccine AEFI have combined to become synergistically fatal?

Generally Filipinos eat massive amounts of rice, with small amounts of ulam (meat and/or vegetable sides). Fast food is available everywhere and is often cheaper than other meal options.

A typical office party includes sweet spaghetti or fried noodles (pancit), battered chicken, pizza, buko salad (a very sweet fruit salad), soft drink, and cake!

People who have no money will sometimes eat boiled rice with simply salt or soy sauce for flavor, which fills their stomach and provides energy, but provides next to no nutrition.

BUKO SALAD

Tools to identify optimal weight

Height weight charts are one tool to determine optimal weight. Note that these may not be accurate for heavily muscled people, very small people, children and the very elderly.

European and Asian targets are different as Asians have elevated risk factors at relatively lower weights.

ASIAN HEIGHT WEIGHT CHART

The BMI ranges for Caucasians have slightly higher cutoffs for the normal and overweight categories: healthy weight range is 18.5 - 24.9, overweight is 25 - 29.9, and obese is 30 and above.

BMI alone is not a stand-alone indicator for obesity. Waist size can also give an indication. Essentially, the belly should be smaller than the hips. A waist:hip ratio of < 0.95 in men and < 0.80 in women is considered optimal and indicative of low risk for conditions linked with overweight.

Of course, there is the mirror test. Stand naked in front of a mirror. There should not be tires of fat anywhere. Breasts (for women), age wrinkles, and scars aside, there should not be squishy bumps or lumps anywhere. Ribs should be slightly apparent, collarbones and some muscle definition should be visible.

One of my favorite on-line calculators is the ketogains body composition calculator. They also provide recommendations for macronutrient composition and calories. They also offer high quality on-line coaching, keto diet and weight training, and community support (which I have used in the past with great results).

Obesity as Malnutrition

I subscribe to the belief that obesity is driven by malnutrition. This has been very much driven by my following the works of Marty Kendall who is one of the founders of Optimizing Nutrition, and has done extensive research on nutrient density and satiety.

The human body has an inherent drive to get adequate protein (essential amino acids must come from diet), and adequate fat (essential fatty acids must come from diet), and key micronutrients. Failure to meet the body’s nutrition needs will drive hunger, even if it means consuming far more energy (typically carbohydrates, often accompanied by processed fats) than the body needs. Malnutrition with obesity is often seen accompanying poverty and low income, but affects all socioeconomic groups. The cheapest foods are often high in carbohydrates but low in nutrition.

A minimum requirement for protein for adults is typically in the range of 1 to 1.5g per kg of body weight. Requirements are higher in growing children, during pregnancy, during old age (when absorption can be an issue), during intense exercise and body-building, and during illness and recovery from illness. Typically fat comes with protein foods (particularly animal based protein foods), and getting sufficient amounts is not a problem. Protein is very satiating. It is difficult to overeat protein simply because the body detects that sufficient protein has been eaten and hunger will cease.

Sugar was rare in the human diet before the 19th century. It’s consumption rose slowly over time, but only exploded in the 1970s with the low fat fad, where the population were convinced that fat causes heart disease and poor health, and should be avoided!

But fats make food taste good and tasteless processed food will not sell. So, the fats were replaced with sugars, and the biggest new sugar added to the human diet was processed high fructose corn syrup.

In terms of fats, there was also a change in the type of fats eaten by the population. Seed oils were cheap to mass produce and replaced more traditional mostly animal sourced fats. In the public’s mind vegetable fats were healthier than animal fats. They could also be hydrogenated to give them long shelf life without spoiling.

In parallel with the consumption of seed oils and sugars, obesity has also burgeoned.

The impacts of increasing sugar consumption may be delayed and generational, indicating an urgent need to cut sugar consumption of not just obese (and all) adults but also our children.

Ultra-processed foods are also a concern. They are chemically concocted to be irresistible; the crunch, the sweet and salty combinations. They are often high in sugar, salt, seed oils and chemical flavor additives. They provide calories but little to no nutrition.

Management of Obesity / How to Lose Weight

While obesity absolutely can be caused by medical issues such as hypothyroid, which needs separate treatment, and while the medical establishment has labelled obesity as a disease to be medically treated with drugs and surgery (at great cost and with often irreversible side effects), lifestyle measures, knowledge, and a good serve of self-discipline (ie. decision to make a change and follow through on that decision) do not cost anything and can be very effective.

Remember also that weight loss may not be fast (after an initial water loss). The weight took years to gain, it may take months or even years to lose. This is ultimately not about losing weight, it is about getting and staying healthy. Weight loss should be the byproduct of long-term health improvements.

Tips for eating to improve health and to make weight management easier, in no particular order

• Eat whole unprocessed foods focusing on meats, eggs, nuts, vegetables and fruits.

• Eat a variety of textures and colors. Brightly colored foods often contain high levels of micronutrients.

• Avoid processed and most factory made foods.

• Avoid foods with added sugars. For processed foods avoid any that have sugar in the top 3 ingredients. Be aware that different types of sugars can be added to the same food, with different names, to hide the actual sugar content. Thus, also look at actual grams of sugar in the label.

• Read labels. If the ingredients are very complicated or are not obviously food (ie. chemicals and numbers), avoid that food items. Processed foods, when occasionally taken, should have few ingredients, all of them directly recognizable as food.

• Avoid foods with high fructose corn syrup as an ingredient.

• Skip the seed oils / vegetable oils. Cold pressed oils such as avocado, olive can be good for salads. Butter / ghee, animal fats, coconut oil are stable for frying.

• Avoid deep fried foods (particularly battered and deep friend foods) if trying to lose weight; boiling (keep the vegetable water to make soup), grilling, sautee, stir-fry, or pan fry (with small amounts of fat) are all alternatives

• Limit the carbohydrate portions, even of whole foods if you need to lose weight. Ketogenic or low carb diet are a naturally low carb way of eating (I will elaborate in a different post).

• Eat your calories don’t drink them. Avoid all sweetened beverages. Plain water is a good means of hydration. Artificial sweeteners are also problematic and should be avoided (details in a different post).

• Do not snack as a habit. Snacking should only be done in response to real hunger, portions small, and choices should favor whole foods.

• Practice fasting. Two substantial meals can be adequate for many adults, and this can be the easiest way of limiting calories. Some people also take this further and eat just a single substantial meal each day. Extended fasting may be used, but do your research / do under appropriate supervision if you have medical conditions that may be affected.

• There is no need to eat breakfast if you don’t want. There is no need to eat dinner. Eating at specific times is an artificial construct. Breakfast is driven by the cereal and breakfast food producers, though dinner is often an important family bonding time. The key is to eat when hungry and to provide your body with the nutrition it needs and sufficient energy to maintain all body processes.

• Eat until no longer hungry, do not eat until full or stuffed! Portion control!

• Use a smaller sized plate.

• If you know you have no discipline about certain foods, do not buy them and take them home!

• Avoid upsizing drinks and sides. Even better, just buy the burger without soft-drink and chip sides. Buy the Jollibee Chicken without rice!

  

• Know that it can be normal to feel hungry when you eat less frequently. Hunger will not kill you, it is a good thing! It is your body giving you the signal that it is time to appropriately refuel.

• Do not mistake hunger and thirst. When feeling like a snack, try a glass of water first.

• Limit alcohol. For health! If you do drink avoid sweet mixers. Soda water can replace tonic water. Limit beer. Stick to dry wines, and straight spirits, or on the rocks.

• Get enough sleep / quality rest! Adequate sleep is an essential part of managing obesity.

• Move as much as you can in your daily activities. Exercise and/or be active every single day! You cannot exercise to compensate a poor diet away. Even weight loss is not much affected by normal levels of exercise (it takes a long time to exercise away even a single donut), but it helps tremendously with fitness and well-being.

I like the following healthy eating guide.

Or this one!

I am back at the gym, resolved to stick with low carb which I know works for me and gives me optimal diabetes management (I have been diagnosed as diabetic since 2008 very early in my first pregnancy - which birthed not only my awesome daughter, but also my interest in and detailed study of nutrition), and to cut alcohol consumption.

My 2024 health improvement commitment starts today! Please join me!

Blessings and good health!