Obesity Revisited

November and the holidays are here. Summer is just a memory and we are almost out of hurricane season. Did you know that November is Aviation History Month, Child Safety Protection Month, National Adoption Awareness Month, and Peanut Butter Lovers Month. Is also contains one of the most important holidays to Americans, Thanksgiving. The focus of this holiday seems to be getting lost in the hype of Black Friday sales. Yet let us take this time to count our blessing and give thanks for living in a country of freedom, earned by the bloodshed of those who gave their lives to preserve our way of life. Let us also give thanks for our health, our families, our lifestyle, and for the opportunities presented to us because we live in America. Give thanks by giving to and helping those who are less fortunate.

In this November E-Letter, we present information about Obesity, our Ask the Doc question relates to lying about college applications, and our email of the month is about how we treat people. We hope you find the enclosed information helpful. As always, we appreciate your questions and feedback.

Qualified Supervisor. Dr. Joel Kimmel has recently been certified by the State of Florida to supervise mental health counselors seeking supervision to meet the licensing requirements in Florida. If you or anyone you know needs a qualified supervisor to meet these requirements, contact Dr. Kimmel for further information.

Hoarding: We invite you to visit Denise Champagne’s blog about her experiences working with JZ, a hoarder. Her thoughts and pictures of JZ’s home are posted on the following site: http://a-hoarders-journey.blogspot.com. We think you will find it very interesting and you can post your thoughts and comments directly to Denise.

Low cost counseling: Denise Champagne has attained her Master’s degree in counseling and will be obtaining her hours towards licensure under the supervision of Dr. Kimmel. Because of this, we are able to offer low cost counseling. She is seeing some patients and is available for new patients. If you or someone you know is in need of counseling but just cannot afford it, please call the office and ask for Denise. All treatment provided by Denise will be reviewed and supervised by Dr. Kimmel.

Parent Education and Family Stabilization Course. We have been certified by the Department of Children and Families, State of Florida, to offer the Parent Education and Family Stabilization Course. Sometimes referred to as the Divorce Class, this 4 hour class is state mandated for divorcing parents of involved children. This course is intended to teach parents about the effects divorce has on children, to lessen the impact of difficult transitions, and to improve the ways they communicate with each other and their children. Our course is provided live and in small groups. Please contact our office at 954 755-2885 for further information.

Our E-Letter this month revisits the topic of obesity which was the focus of our E-Letter in August 2009. We felt it important to return to this huge problem as it is getting worse in our society. Whether it’s due to the stress of our economy, the fear generated by our media, the supersized portions of served food, or our society getting lazier and more sedentary, obesity is on the rise.

Obesity is much more than just being overweight. However, both result from an energy imbalance, clearly defined as eating too many calories and not getting enough exercise to burn off those calories. The excess calories get stored as fat which accumulates over time. A person’s body weight is the result of their genetic makeup, their metabolic rate, their lifestyle behaviors, their environment, and their culture. Obesity is defined as having a BMI greater than 30.

Research indicates that about 1/3 of American adults are obese. In 2000, no state had an obesity prevalence of 30% or more while in 2010, 12 states had obesity rates greater than 30%. In 2008, medical costs associated with obesity were $147 billion. Obesity related health conditions include high blood pressure, heart disease, stroke, Type 2 diabetes, cancer, depression, isolation, and low self esteem. Daily problems of obesity include breathlessness, increased sweating, difficulty sleeping, feeling very tired, back and joint pains, and decreased personal mobility.

Obesity usually develops over time from poor diet, poor lifestyle choices and to some extent, genetics. This includes eating too much fast food, not eating enough fruits and vegetables, drinking too much alcohol, eating out a lot, eating large portions, and eating for comfort to numb painful feelings. Lack of physical exercise is another extremely important factor. Many people live a sedentary lifestyle where they work at a desk and come home to watch television or be on their computer. Rarely do people get much exercise unless they commit to working out or playing a sport. The Department of Health recommends that adults engage in at least 150 minutes of moderate aerobic activity every week.

If you want to lose weight and you are not a candidate for or do not want gastric bypass surgery, you need to make an open and honest commitment to yourself that you will change your eating and activity patterns. The aim is to lose weight to improve your health and mental state. The best way to treat obesity is to reduce the amount of calories you eat and exercise more. A healthy diet should include at least five portions of fruit and vegetables every day and foods that are low in fats, calories, and added sugars. Build physical activity onto everyday routines. Walk steps, park further away so you have to walk more, and join and go to a gym and follow a workout schedule. Consider taking up a sport and try bicycling, running, swimming, or just walking several times a week.

We offer the following information on Obesity:

• Obesity has been defined as a medical condition where excess body fat has an adverse effect on health and leads to death or increased health problems
• BMI or Body Mass Index is a metric that compares weight and height; a BMI >30 is obese, a BMI between 25 and 29.9 is overweight
• About 1/3 of U.S. adults are obese and no state has met the nation’s goal to lower obesity by 15% by 2010; 12 states have an obesity percentage greater than 30%
• Obesity is commonly caused by too much intake of food, not enough physical activity, genetics, endocrine disorders, medications, and behavioral health disorders
• Age is also a factor in obesity since as you get older, the body’s ability to metabolize food slows down and you require less calories to maintain your weight
• Women tend to be more overweight than men as they burn less energy at rest and require less calories to maintain their weight
• Emotionally, many people overeat in response to anxiety, depression, anger, frustration, boredom, loneliness, and stress overload
• Lifestyle causes of obesity include eating too much processed and fast foods, drinking too much alcohol, eating too large portions, and not getting enough physical exercise
• Being obese increases a person’s chance of having heart disease, Type 2 diabetes, sleep apnea, cancer, and osteoarthritis
• Medical costs in 2008 associated with obesity were estimated to be $147 billion
• Obesity tends to run in families (genetics) although environmental factors such as lifestyle activities and what foods are eaten are important factors
• The Caloric Balance Equation describes obesity and overweight as a result of energy imbalance; Eating too many calories and not getting enough physical activity
• You will gain weight, that is, be in Caloric Excess if you eat more calories than your body is using and you will store those extra calories as fat leading to weight gain
• People who are obese often face prejudice/discrimination in social situations, at work, and at school, and commonly feel rejected, depressed, and ashamed
• In children, obesity can lead to high blood pressure and cardiovascular disease, breathing problems, joint problems, fatty liver disease, and emotional problems including low self esteem, isolation, and depression
• Environment and behavior are the greatest areas for prevention/treatment of obesity
• Successful and permanent weight loss comes from increasing physical activity, changing how and when you eat, and changing your behavior

• Make a commitment to losing weight, stay motivated, and consider each and every pound lost a success
• Reduce sedentary time spent watching television and being on the computer
• Build physical activity into everyday routines such as walking stairways, parking further away from your destination, and standing rather than sitting
• Eat foods that are low in fats, calories, and added sugars
• Eat at least 5 servings of fruits and vegetables daily in reasonable portion sizes
• Exercise regularly and take up any sport, including bowling
• Seek professional help if you have difficulty committing to and losing weight

LW writes: I recently found out that my 18 year old daughter lied to me. She said she had submitted 4 college applications and we have been checking each day to see if she has been accepted into one of the schools. Our hopes have been high and we have been joking about where she would live at each of the schools. Yesterday, I found out that she had lied and had not completed even one application. I feel so betrayed and hurt and am so angry. How should I deal with this so that my anger doesn’t stop her from filling out the applications and submitting them?

Dr. Joel Kimmel replies: There are several issues here that have gotten entangled. Your anger at her for feeling hurt is justified and you would probably like to punish her to teach her a lesson. In fact, she does deserve some consequence. However, one needs to be aware of the possibility that punishment and your anger may adversely affect her leading to not completing the applications at all. Another issue is the importance of submitting the applications before their deadlines and why she did not do them but told you she had.

The issues involved here are honesty, trust, procrastination, parent-child relationships, and whether she really wants to go to college. What is needed is open and honest communication in a safe environment so that your daughter can let you know why she did not do her applications and why she told you she had. Is she being passive-aggressive? Is she afraid to disappoint you? Is she rebelling in some way? Is she afraid to leave home, friends, and familiar surroundings? Or are there other reasons? Taking out your anger on her will probably cause her to close up and not talk with you. Restraining your anger may be quite difficult to do. Yet if you are able to have this conversation, the two of you may learn a lot about each other. If this conversation is successful, you and she will learn why she did not do the applications and lied to you. Once known, this obstacle can be removed and the applications completed. A consequence should still be given but not out of anger. You might consider including a mental health professional in this conversation so that the environment remains safe for communication. Good luck.

If you would like to discuss this further, you are welcome to call me at (954) 755-2885.

We would like to thank Al H.for sending us the following email:

Five lessons about the way we treat people

1 – First Important Lesson: Cleaning Lady
During my second month of college, our professor gave us a pop quiz. I was a conscientious student and had breezed through the questions until I read the last one: “What is the first name of the woman who cleans the school?” Surely this was some kind of joke. I had seen the cleaning woman several times. She was tall, dark-haired and in her 50’s, but how would I know her name? I handed in my paper, leaving the last question blank. Just before class ended, one student asked if the last question would count toward our quiz grade. “Absolutely,” said the professor. “In your careers, you will meet many people. All are significant. They deserve your attention and care, even if all you do is smile and say “hello.” I’ve never forgotten that lesson. I also learned her name was Dorothy.

2 – Second Important Lesson: Pickup in the Rain
One night, at 11:30 p.m., an older African American woman was standing on the side of an Alabama highway trying to endure a lashing rain storm. Her car had broken down and she desperately needed a ride. Soaking wet, she decided to flag down the next car. A young white man stopped to help her, generally unheard of in those conflict-filled 1960’s. The man took her to safety, helped her get assistance and put her into a taxicab. She seemed to be in a big hurry, but wrote down his address and thanked him. Seven days went by and a knock came on the man’s door. To his surprise, a giant console color TV was delivered to his home. A special note was attached. It read: “Thank you so much for assisting me on the highway The other night. The rain drenched not only my clothes, but also my spirits. Then you came along. Because of you, I was able to make it to my dying husband’s’ bedside just before he passed away… God bless you for helping me and unselfishly serving others. “Sincerely, Mrs. Nat King Cole.

3 – Third Important Lesson: Always remember those who serve
In the days when an ice cream sundae cost much less, a 10-year-old boy entered a hotel coffee shop and sat at a table. A waitress put a glass of water in front of him. “How much is an ice cream sundae?” he asked. “Fifty cents,” replied the waitress. The little boy pulled his hand out of his pocket and studied the coins in it. “Well, how much is a plain dish of ice cream?” he inquired. By now more people were waiting for a table and the waitress was growing impatient. “Thirty-five cents,” she brusquely replied. The little boy again counted his coins. “I’ll have the plain ice cream,” he said. The waitress brought the ice cream, put the bill on the table and walked away The boy finished the ice cream, paid the cashier and left. When the waitress came back, she began to cry as she wiped down the table. There, placed neatly beside the empty dish, were two nickels and five pennies. You see, he couldn’t have the sundae, because he had to have enough left to leave her a tip.

4 – Fourth Important Lesson: The obstacle in our path
In ancient times, a King had a boulder placed on a roadway. Then he hid himself and watched to see if anyone would remove the huge rock. Some of the King’s’ wealthiest merchants and courtiers came by and simply walked around it. Many loudly blamed the king for not keeping the roads clear, but none did anything about getting the stone out of the way. Then a peasant came along carrying a load of vegetables. Upon approaching the boulder, the peasant laid down his burden and tried to move the stone to the side of the road. After much pushing and straining, he finally succeeded. After the peasant picked up his load of vegetables, he noticed a purse lying in the road where the boulder had been. The purse contained many gold coins and a note from the King indicating that the gold was for the person who removed the boulder from the roadway. The peasant learned what many of us never understand: Every obstacle presents an opportunity to improve our condition.

5 – Fifth Important Lesson: Giving When it Counts
Many years ago, when I worked as a volunteer at a hospital, I got to know a little girl named Liz who was suffering from a rare & serious disease. Her only chance of recovery appeared to be a blood transfusion from her 5-year old brother, who had miraculously survived the same disease and had developed the antibodies needed to combat the illness. The doctor explained the situation to her little brother, and asked the little boy if he would be willing to give his blood to his sister. I saw him hesitate for only a moment before taking a deep breath and saying, “Yes I’ll do it if it will save her.” As the transfusion progressed, he lay in bed next to his sister and smiled, as we all did, seeing the color returning to her cheek. Then his face grew pale and his smile faded. He looked up at the doctor and asked with a trembling voice, “Will I start to die right away”. Being young, the little boy had misunderstood the doctor; he thought he was going to have to give his sister all of his blood in order to save her.