Can you be fat and skinny at the same time?

In clinical medical practice, obesity assessments are typically based upon the Body Mass Index (BMI) a measure of weight for height. Similarly, most obesity related population statistics are reported based upon the BMI. The BMI is commonly utilized because of its ease of use but fails to capture the spectrum of obesity related cardiometabolic risks. Studies have indicated that a high body-fat percentage, even with a normal body weight, results in an elevated cardiometabolic risk.

An article published in the August, 2013, issue of Obesity, studied the effect of a high body-fat percentage in 12,386 middle aged adults (30 to 49 years) with a normal BMI (18.5 to25). Subjects were excluded if they had been treated for hypertension, diabetes, or hyperlipidemia, or diagnosed with a chronic disease or pregnant. They were also excluded if any of the blood tests were grossly abnormal (greater than three standard deviations from the norm) or failed to respond to all questions on a lifestyle questionnaire.

Based upon the questionnaire, subjects were stratified as to smoking history (nonsmoker, smoker, exsmoker), alcohol consumption (nondrinker, moderate drinker, heavy drinker), and exercise (nonexercise, irregular exercise, regular exercise). Coincidental with measuring height, weight and waist circumference, the body fat and body muscle percentages (BF% and BM%) were measured using a bioelectric impedance device. The device was calibrated to a DEXA scan. Blood tests included total cholesterol and triglycerides, HDL and LDL cholesterol fractions, fasting glucose and insulin. Insulin resistance was calculated from this data.

Within the normal weight range (BMI: 18.5 to 25), obesity was defined as BF% greater than 25% in men and 30% in women. Cardiovascular disease risk factors were defined as: (1) high blood pressure greater than 130/85 independently, (2) hyperglycemia with fasting glucose greater than 100, and (3) dyslipidemia with triglycerides above 150, or HDL cholesterol less than 40 for men and 50 for women, or LDL cholesterol more than 160.

Based on BF% and BMI, as defined above, 4.5% of men and 21.9% of women were classified as normal weight obese (NWO). Those classified as NWO exercised less frequently and had a higher abdominal fat distribution. Those with NWO had higher blood pressure, total cholesterol, LDL cholesterol, triglycerides and insulin resistance than the normal BF% group. Adjusted for age, all of these cardiometabolic risk parameters were elevated in the NWO compared to those with normal BF%. After adjusting for age, fasting glucose and HDL cholesterol were not significantly different between groups. After adjusting for the lifestyle factors, fasting glucose and blood pressure did not significantly differ in the male subjects.

This study supports the concept that the BMI is a crude indicator of the relationship between weight and health. This also reveals why basing an insurance surcharge based upon BMI is inappropriate.

Practical Health Strategies ( www.practicalhealthstrategies.com ), offers wellness programs in the Pensacola and Mobile area, and throughout north Florida, and south Alabama, Georgia, and Mississippi. Wellness Plans you can Live With!

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“Biological Clock” Affects Hunger and Appetite

Epidemiology studies have consistently found a correlation between obesity and short sleep time while other studies have correlated both short and long sleep time with obesity. These studies have been widely reported in the popular press. Unfortunately, these studies are in conflict with most animal studies which have shown weight loss associated with total or partial sleep deprivation.

A recently published article in the journal Obesity gave insight into this discrepancy. The results were also consistent with the hypothesis proposed in Practical Health Strategies’ ebook: “Lose Weight for your Sleep Apnea” available on Amazon.com.

This article reports the effect of thirteen days of forced desynchrony on twelve, non-obese adults. Forced desynchrony is an experimental tool in which the sleep/wake cycle is forced out of phase with the internal biological clock located in the hypothalamus of the brain. The forced desynchrony in this protocol consisted of the subjects living on a 20 hour “day” schedule rather than a true 24 hour day. The subjects followed a normal (24 hour day) fixed sleep/wake schedule for two to three weeks prior to the desynchrony protocol and were maintained in constant but low level light throughout the desynchrony to assure a stable internal clock. The cycling of the internal biological clock was tracked by monitoring the core body temperature. Thus, the sleep/wake cycle in the 20 hour behavioral day was out of phase with the internal biological clock and the phase shift increased over the duration of the study.

Meals were designed to maintain energy balance and for constant macronutrient distribution: 60% carbohydrate, 24% fat, and 16% protein. At regular times the subjects rated their hunger, appetite, and food preferences.

The results revealed a strong circadian, biological clock, rhythm in hunger, appetite, and preference for sweet, starchy and salty foods peaking in the biological evening time and minimal in the biological morning. This was independent of the time since last meal, time since awakening, and calories consumed. By contrast there was no circadian linked preference in vegetables.

The authors compared the results to the two-process model of sleep regulation as covered in the “Lose Weight for your Sleep Apnea” ebook. This study may help explain the inconsistency in animal sleep deprivation studies, which show weight loss, and epidemiology studies, which show weight gain.

Practical Health Strategies (www.practicalhealthstrategies.com), offers wellness programs in the Pensacola and Mobile area, and throughout north Florida, and south Alabama, Georgia, and Mississippi. Practical Health Strategies offers Wellness Plans you can Live With!

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The Role of Low Dietary Protein

Some weight loss diets have emphasized protein intake to help reduce hunger between meals. Research has suggested, however, that the role of protein is more basic than just “hunger” and that protein balance, at least sometimes, may be dominant over carbohydrate balance.

An article in the January, 2013, issue of the journal Obesity investigated this effect, referred to as protein leverage. Fifty inbred mice were fed, ad libitum, five custom diets with equivalent appearance, palatability, and caloric density varying only in the ratio of protein to carbohydrate composition. Thus, the diets with lower protein content also had higher carbohydrate content. The experiment spanned sixteen weeks, from the age of nine weeks to the age of twenty-five weeks for the mice. The mice were followed for weight gain, length growth and body fat. The researchers also evaluated the diet effects on thermogenesis.

The mice on the lowest protein diet consumed excess energy compared to the mice on medium or high protein diets and the mice on the highest protein diet had the least weight gain. The mice on the lowest protein diet had nearly twice the mass of fat depots, indicating higher adiposity, compared to the mice on the highest protein diet. Energy expenditure increased on the lowest protein diet but not enough to compensate for the increased energy intake and prevent the increased fat deposit. This suggests that control of protein consumption to sufficiently meet protein balance is dominant over control of total energy consumption, at least in mice in this age range.

The mice on the diet with the most properly balanced ratio of protein to carbohydrate, 23:57, actually grew the largest overall. This reflects the need for both protein and carbohydrates for normal growth, (Remember, the mice were young and in the growth age period.) but a low protein diet resulted in increased adiposity.

Practical Health Strategies (www.practicalhealthstrategies.com), offers wellness programs in the Pensacola, Panama City, and Mobile area, and throughout north Florida, and south Alabama, Georgia, and Mississippi. Practical Health Strategies offers Wellness Plans you can Live With!

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