Drilling Down on Why the Journey to Achieving Ideal Body Mass Index is Not One Size Fits All
Kim Gafford became an emotional eater after her father died when she was just eight years old. Her weight was a problem by age 12— and it continued to climb— until she reached 325 pounds. When she injured her ankle because of the weight, requiring ankle reconstruction, Gafford decided that was enough.
At 36, she got another chance at developing a healthier lifestyle after a gastric bypass operation. “It’s not an easy road, but it’s an attainable goal,” she says. “It resets your mindset. It resets your body. It resets your metabolism.” ‘
Now, five years later, Gafford weighs about 200 pounds. “If I lose a few pounds, that’s great,” she says. “If I stay here at this weight forever, I’m good.”
As weight management coordinator at Bartow Regional Medical Center (BRMC), she is able to share lessons she’s learned by trial and error. Lessons like crash diets don’t work long-term: you only put more weight on when you stop dieting. “It’s an easy off 15,” she says. “Your weight only moves to a different location and it comes back. It’s a temporary vacation.”
THE SUPPORT FACTOR
She also helps patients make sound food choices. “I teach people now the value of how much an egg really costs, versus a bag of chips,” she explains. “Some people just don’t break it down to that simple equation.”
Her job involves working with surgery candidates to help them with the process. It’s one she knows well, having had her stomach reduced to roughly the size of a walnut. “What I tell my patients is, instead of living to eat, you eat to live,” she says. “I make better choices.” BRMC helps weight-loss patients through the laparoscopic sleeve and laparoscopic gastric bypass, plus nutritional and exercise therapy. “The sleeve is where we cut 80 percent of the stomach out and leave a long cylindrical sleeve tube,” she says. The bypass involves reducing the size your stomach and rerouting the intestines.
BRMC offers a monthly seminar taught by the general surgeon, Dr. Donald Fridley II, from 6 p.m. to 7 p.m. on the second Tuesday of the month in Classroom 1 at BRMC. There people considering surgery can learn more. Immediately following is a support group meeting. The one-year-old program at the BRMC Weight Management Center offers a team approach, including help with diet, behavioral health, and physical therapy— as well as assistance from bariatric-trained nurses.
THE METHOD FACTOR
While it’s possible to re-stretch the stomach after bariatric surgery, that’s not usually the case, points out Dr. Shiva Seetahal, a board-certified general surgeon trained in bariatrics who works at Heart of Florida Physician Group in Davenport. “Once they have that feeling, they like the person they’ve become, they don’t go back to bad eating habits,” he says. “They don’t go back to neglecting exercise.”
For those with bariatric surgery insurance, the cost of surgery can be covered 100 percent. Self-pay patients may pay about $11,000-$12,000.
Bariatric surgery isn’t for everyone, however. Not everyone qualifies. A patient typically must have a body mass index of at least 40 or be more than 100 pounds overweight, says Dr. Dale Wickstrom-Hill, president and medical director of Winter Haven’s Perfect Form Center for Wellness and Anti-Aging. Or they must have a body mass index of at least 35 and an obesity-related disease such as diabetes, hypertension, sleep apnea, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease. Additionally, they must have demonstrated an inability to sustain weight loss through prior efforts, she adds.
Some 71.5 percent of adults in Polk County were overweight or obese in 2013, according to the Florida Department of Health. That’s higher than the state average of 62.8 percent.
Many overweight individuals have tried several crash diets. They may wind up feeling guilty for failing on a diet, especially one that worked for a friend. But there may be a very good reason why that diet didn’t work. A new study at Texas A&M University reveals: Diets are not one size fits all.
THE GENETIC FACTOR
David Threadgill, PhD, with the Texas A&M College of Medicine and College of Veterinary Medicine and Biomedical Sciences, was the senior author of a study involving mice that shows individuals react to diets differently.
“What we found was that, yes indeed, there is a lot of specificities,” he explains. “Just because a diet is promoted as healthy doesn’t mean it’s healthy for everybody. Some individuals seem to be able to eat anything they want and stay completely healthy.”
The study was done on mice instead of people primarily because “these types of studies are very messy with humans for compliance reasons,” he says. With mice, they also were able to work with genetically identical animals. Humans are unique, even if they are born in the same family.
Researchers worked with four different strains of mice to study five different diets, mirroring an American-style diet higher in fat and refined carbohydrates, a Mediterranean diet with wheat and red wine extract, a Japanese diet with rice and green tea extract, a ketogenic or Atkins-like diet high in fat and protein with very few carbs, and a diet including typical commercial foods.
As might be expected, the mice didn’t too very well with the American diet. With the Mediterranean diet, there was a mix, with some having weight gain. One of four did poorly with the Japanese diet; two did very poorly with the Atkins-type diet.
So, what do you do if you’re looking to lose weight? “You have to sort of try a diet that you think is going to make you healthy,” Dr. Threadgill advises.
It could be several years before scientists develop a test that will tell you which diet works best for you. In the meantime, they’re hoping to find a blood test that will identify whether a diet is working after you’ve been on it, perhaps for two weeks.
“Different diets do affect different folks in different ways,” Dr. Seetahal agrees. “For those who are struggling with obesity, it’s been proven diet and exercise alone is usually not sufficient to result in sustained weight loss.”
Popular diets like the Paleo are helpful to lose “a few pounds in the short term,” he says. “They absolutely are ineffective for long-term or sustainable weight loss.”
THE ENVIRONMENTAL FACTOR
While there can be genetic tendencies inherent in weight problems, there also are important environmental considerations, he points out. “The choices we are taught as kids— that’s what we are going to carry with us and pass on to our children,” he says. “It’s a cycle.”
In your journey to a healthier you, you may also want to look at some other potential causes of weight gain to see if they apply to you. Dr. Wickstrom-Hill, suggests:
• Testing your thyroid
• Checking to see if medications are causing weight gain • If you’ve had head trauma, you’ll want to check hormone levels and possibly supplement them
• Avoiding high glycemic foods like sugar, pasta, and bread
• Cutting food additives like food dyes, monosodium glutamate, and aspartame • Choosing fresh, local foods that have more nutrients
• Avoiding produce with higher levels of pesticides, and
• Preparing your own food so you can control what goes into it
Ultimately, the diet that works is one you can stick with long-term, advises Dr. Seetahal. “It has to be sustainable,” he says. “That’s always the rule of thumb I tell everybody.”
story by CHERYL ROGERS portrait by LUIS BETANCOURT
