Thursday, September 27, 2007

P.H.A.T or Fat?

“Doc, I just don’t understand”, said Patient X, one of my long-time patients. “My blood pressure is okay, I’m taking my medicine as prescribed and my blood work is normal. Look at my weight. It’s almost the same as last visit. Did you check my thyroid? I think my hormones are all out of order. I need that weight loss pill. Those television potions that I spent hundreds of dollars on aren’t working to rid me of my cellulite and baby fat. My knees are aching, I get short of breath walking up and down the stairs. I snore all the time, and I’m always tired. I’m going to start exercising this week, I promise. Doc, can you help a sister out with some of those weight loss pills? I need to lose 30 pounds this month for my daughters wedding, class reunion, cruise… These guy where looking at me and said I was P.H.A.T.” Or did they mean fat?

“Patient X” has the same story each visit and despite being a regular and loyal client, taking charge of her life has taken a back burner to quick fixes for weight loss. She’s probably one of the nicest people I have ever met; however she seems to be in denial when it comes to her health and the hard cold facts. Her blood pressure was elevated at 130/85 (normal is 120/80 or less), her cholesterol and fasting blood sugar was also mildly elevated, and wrapped around her waist was an excess of fat that had increased by several inches over the last year creating a cute, but deadly “jiggle” as she walked. My patient, Patient X, has what we call the metabolic syndrome, which is a group of risk factors found in one person. The risk factors for the metabolic syndrome include an increased waist circumference, elevated cholesterol (specifically the triglycerides), a low HDL (the good cholesterol), elevated blood pressure (130/85 or greater), and an elevated fasting blood sugar (greater than 100 mg/dl). It is estimated that over 50 million Americans have the metabolic syndrome and one of the dominant underlying factors is abdominal obesity (excess fat around the stomach).

The disease obesity, which can be simply defined as excess in body fat, is not the same as being overweight. “A person who is overweight is running a definite health risk, but an obese person is loudly and insistently asking for trouble”, says Stacy Mitchell, M.D. co-author of Livin’ Large: African American Sisters Confront Obesity. Overweight and obesity are labels for ranges of weight that are greater that what is considered healthy for a given height. When discussing adults, the Body Mass Index or BMI determines overweight/obesity. In my practice, I consider the BMI a vital sign as it helps me to assess my patient’s risk for obesity and the diseases that come along with it. So by simply taking one’s height, weight, and waist circumference, not only can your doctor determine your BMI and risk for obesity, he/she can also gain some insight on your risk for heart disease, the number one killer of all Americans.

In the past 20 years there has been a significant increase in obesity in the United States and African American’s are under attack. Obesity does not discriminate as the Food and Drug Administration (FDA) estimates that almost two-thirds of (64%) of all Americans are overweight; almost one-third are obese. Conservative estimates by the Centers for Disease Control (CDC) show that 65% of African American women and 33% of African American men are overweight. Childhood obesity is on the rise and we are now seeing shocking increases in diabetes, heart disease, and hypertension in this previously active and healthy population. Overweight/obese individuals are at risk for developing many conditions including diabetes, heart disease, strokes, high blood pressure, arthritis, hypothyroidism, high cholesterol, sleep apnea, gall bladder problems, gout, cancer of the kidney, endometrium (lining of the uterus), breast, colon and rectum, esophagus, prostate and gall bladder; depression, anxiety, etc… Obesity is now considered the second most preventable cause of death in the United States, preceded only by smoking. Four hundred thousand deaths a year are estimated to be associated with obesity.

There are treatment options for this disease; however, we must first accept that there is a problem, especially in the African-American community. While some medications have been approved for treatment (orlistat and sirbutamine) and there are surgical options, which are reserved for extreme cases, proper diet and nutrition coupled with regular and consistent exercise and modification of behaviors associated with overeating is the mainstay of treatment.

She’s P.H.A.T (pretty, hot, and tempting), “big boned”, full figured, pleasing plump, or thick! That can be a compliment to some ladies, but it could also mean she’s fat, obese, or overweight depending on the messenger. Remember, being overweight/obese is not an issue of aesthetics. “You can be overweight and still stop traffic”, says Teri Mitchell who also co-authored Livin’ Large. The reality is it’s still unhealthy. For more information on obesity visit, pick up the book Livin’ Large by Teri and Stacy Mitchell.

(c) 2007 Rani Whitfield. This article was published September 2007 at www/

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