Looking To Lose The Spare Tire?

63% of Americans are overweight with a Body Mass Index (BMI) of 25 or greater. How do you know if you are overweight? You can calculate your BMI, which is based on your height and weight (divide your weight in kilograms by your height in meters, squared); or you can go to one of many websites with BMI calculators and simply input your weight and height (pounds and feet and inches) and it will do the math for you (Google "BMI calculator"). A BMI under 18.5 is considered underweight (most models), a BMI of 18.5 to 25 is considered normal or healthy, a BMI above 25 is considered overweight, and a BMI over 30 is considered obese. BMI is not accurate in very muscular individuals who are heavy for their height but do not have much fat. A DEXA scan is a much more accurate way to determine BMI or percentage of fat in body composition.

Overweight people are more likely to have diabetes, heart disease and hypertension, stroke, dyslipidemia (elevated levels of cholesterol and/or triglycerides), liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, gynecological problems and certain types of cancer (endometrial, breast, colon). North Carolina, where I live, was number 8 on the nation's top 10 most obese list with 29% of its citizens being obese in 2008. Estimated direct and indirect health costs for North Carolina's obesity epidemic in 2006 were $57.37 billion for adults and projected costs for 2011 are $75.64 billion.

What are some of the reasons for being overweight? Bottom line, the calories taken in exceed the calories expended; and, no matter how much we would like there to be a magic way to avoid calorie restriction and exercise, they always come into play when we are talking about weight issues. But other factors can also be a part of the picture. Hormonal imbalance can cause weight gain. For example, polycystic ovary disease, menopause and hypothyroidism (low thyroid hormone) can all be associated with weight gain. Stress, with its elevated levels of cortisol, can be associated with weight gain. Lack of sleep can cause weight gain--people who sleep less the 7-8 hours per night have an elevated BMI compared to those who sleep 8 hours or more regardless of their caloric intake! Common medications associated with weight gain are antidepressants, anti-diabetes drugs, oral contraceptives and steroids.

Sometimes we are doing everything right, but we have that one problem area that just won't seem to cooperate with our workout. We have the love handles, the muffin top, the spare tire or the saddlebags that don't respond to diet and lifestyle changes. Some of the latest technology is geared toward losing the problem area or sculpting, losing some inches and gaining some encouragement and enthusiasm for continuing on the path of the virtuous. There is a bewildering array of procedures and techniques available, so here is a brief summary of what is new and not so new.

Oldest among the body sculpting techniques is liposuction. Liposuction has progressed over the years from a procedure requiring anesthesia and often blood transfusions to the current state-of-art liposuction with tumescent anesthesia using microcannulas, which allows the procedure to be done with the patient awake and with little scarring. Newer additional modifications include various assist technologies such as ultrasound, laser or water jets to make the liposuction easier for the surgeon and more efficacious for the patient (allows suctioning of more fat, faster.) One of the problems with liposuction is that along with the fat there are blood vessels, lymphatic vessels, connective tissue, fibroblasts, etc. that are disrupted by the procedure and can take 6 months or more to fully heal. The tissue located just under the skin neither looks nor feels normal for 6 months or more.

An even more invasive procedure for body sculpting is abdominoplasty or "tummy tuck" which is fairly major surgery, requires general anesthesia, and, again, will take 6 months or longer to fully heal.

Non-invasive (non-surgical) methods have been added to the list of available techniques, and one that has been around a long time is mesotherapy, also called lipodissolve, lipostabil, lipolysis or injection lipolysis. With this technique multiple injections are given in multiple sessions to "melt away" unwanted small areas of fat. Some of the problems with this technology include the lack of a standard ingredient list for the material injected, and the FDA currently views this procedure as "unapproved drugs for unapproved uses." Lipodissolve was banned in Kansas in 2007 by the Kansas State Board of Healing Arts, in part due to complaints about the procedure; and three medical associations have issued health warnings cautioning against the use of injection lypolysis, including the American Society of Plastic Surgeons (ASPS), the American Society for Aesthetic Plastic Surgery (ASAPS), and the American Society of Dermatologic Surgery (ASDS). If that's not enough to dissuade you, I don't know what is.

Other non-invasive devices include one that utilizes mild electrical frequencies in conjunction with heat and vibration to "minimize fat", but is supposed to work by reducing cellulite and toning muscles. The manufacturer is vague about its mechanism of action and does not present any clinical studies. It is non-invasive, requires 6 initial treatments, as well as regular maintenance treatments and is basically a non-medical device that is marketed to salons and spas (read ineffective.)

Yet another non-invasive device combines massage and laser to activate fibroblasts in the skin in order to temporarily reduce the appearance of cellulite. Results are not sustained, and treatments must be repeated on a regular basis to maintain the look.

A very popular non-invasive device for cellulite reduction and body shaping uses radio frequency (RF) and infrared light with suction and tissue manipulation (rollers that spread out the skin as the energy is being delivered.) What, no kitchen sink? The theory here is that the combination of infrared and RF energies increase the oxygen delivery to the cells by heating the skin, which increases the metabolism of stored energy, i.e. fat, thereby reducing the size of the fat chamber or cell. The recommended number of treatments is 8-16 (!) with supporting treatments every month thereafter as results are not sustained. There are no studies to support this theory of the mechanism of action, and the manufacturer does not have studies to indicate expected and measurable results.

The latest technology uses a cold laser or low level laser therapy (LLLT) to emulsify fat within the fat cells and create a small pore in the fat cells, allowing fat to flow out of the cells to be taken up and eliminated by the body's lymphatics. Initially used to facilitate healing and decrease pain, this laser was discovered to liquefy and release fat and was used to assist liposuction. It was then realized that it works to reduce inches even without liposuction as once the fat is released from the fat cells it is accessible to the body's systems for elimination. This technology has been well studied and has been shown to result in a sustained loss of fat. This translates to an average loss of 5-6 inches or a drop in 2-7 dress sizes. It involves no discomfort, no surgery and no down time. Additional benefits include a reduction in cholesterol, LDL cholesterol and triglycerides for most people. Studies are currently underway to see how long this effect lasts. There is also a decrease in the hormone, leptin, which results in a decrease in appetite.

The best course of action is to follow a low glycemic diet and to get moving. Get active! Sleep 8 hours a night and destress through meditation or one of the biofeedback or holosync devices available (the subject of another blog.) Make sure you do not have a hormonal imbalance and review your medications with your doctor. Lastly, if you just need a little sculpting, there are many techniques available.

For more information contact Dr. Lisa Hogan at Youthology, Aesthetic & Anti-Aging Medicine, 919-847-1495 or lisa@youthology.md or visit http://www.youthology.md/.