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Danger Zone

Obesity Can Lead to Myriad Health Problems for Men
Dr. Christopher Keroack

Dr. Christopher Keroack says many men don’t pay enough attention to their health, as they are focused on improving their performance and productivity at work.

Dr. Christopher Keroack says the psychology of men differs dramatically from women when it comes to their weight and self-image.

“When a man’s body-mass index goes up, he feels more powerful even though it puts him in a high health-risk category; men want to be warriors and leaders of their clan,” said the medical director of Pioneer Valley Weight Loss Centers in Springfield. “A man who is 35 pounds overweight won’t seek help because he feels good when he goes from a size large to extra large. Men view football players and knights in shining armor as heroes because it is ingrained in them that strength and size are connected.”

Dr. John Romanelli agrees. “Every year NFL players are getting bigger and bigger,” said the director of Baystate Medical Center’s Weight Loss Surgery Program. “In the ’70s, a defensive lineman weighed 225 pounds. But if they weigh that today, they are usually a cornerback or safety.”

In fact, today’s players often reach weights of 340 pounds. And although that size isn’t appropriate for the average man, many forget that these athletes engage in high-impact, high-calorie-burning exercise every day and also have a problem with weight gain when they stop playing, Romanelli said.

Studies show that the majority of American men weigh far too much. According to the Centers for Disease Control and Protection, 72% of men in the U.S. are overweight or obese, and many have no idea of how serious the consequences can be.

“Many obese men are oblivious to the damage that is happening within their bodies on a day-to-day, week-to-week, month-to-month, and year-to-year basis,” said Romanelli, citing a long list of conditions which include high blood pressure, high cholesterol, diabetes, coronary heart disease, vascular problems, obstructive sleep apnea, bladder incontinence, gallbladder disease, gastroesophageal reflux disease, osteoarthritis, some forms of cancer, and knee, back, and hip problems.

“If you are morbidly obese, you are four times more likely to die from sudden cardiac death — obesity is a silent killer,” he said. “It’s slow, it’s indolent, and it’s unfortunate. Every system is the body is negatively affected by it.”

And excess weight tends to settle differently in men than in women. “Fat or adipose deposition is driven by the sex hormone,” Romanelli said. “Estrogen drives fat to one location, while testosterone drives it to another.”

Which accounts for the term ‘beer belly,’ since estrogen causes fat to accumulate in females on the breasts, butt, hips, and thighs, whereas in men, it sits inside — not outside  — their stomachs. In fact, the difference is so pronounced that Romanelli said that, if he was given a CT scan which showed a cross section of a person’s stomach, he would be able to tell whether it was a male or female with almost 100% accuracy.

In addition, fat contains estrogen, and belly fat produces the hormone aromatase, which converts testosterone to estrogen. It’s the reason why some obese men grow breast tissue. “The estrogen conversion happens even if men are on testosterone supplements,” Keroack said, adding that testosterone is a key ingredient in building muscle.

The physical difference bodes trouble because belly fat is medically active. “It acts as a paracrine system, and the hormones secreted are very close to the liver, pancreas, intestines, and stomach,” he explained. “Belly or central abdominal fat also influences insulin, blood sugar, cortisol, and inflammatory processes.”

Romanelli concurs. “Inter-abdominal fat affects organs like the liver and can lead to a form of non-alcoholic hepatitis,” he said. “It also causes vascular problems and poor venous drainage, which causes blood to pool in the legs and ulcers to form on the skin.”

The cumulative result can lead to diabetes, high cholesterol, hypertension, and risk of stroke, which is the leading cause of death in both men and women, Keroack said.


Taking Stock

Dr. John Romanelli

Dr. John Romanelli shows off a model of a stomach with a gastric band around it. The surgery is a last resort for morbidly obese people.

Obesity can be divided into categories, which are based on a body-mass index scale that is calculated using a person’s height and weight. The formula is complex, but online calculators easily compute it.

A man who is 5-foot-10 and weighs 250 pounds falls into the obese category, Romanelli said, adding the ideal weight for a man of that height is 175 pounds. Those deemed morbidly obese weigh 100 pounds or more over their ideal body weight.

Although many people have not reached that point, one-third to one-half of all Americans have a BMI of 30 or higher, which puts them into the obese category. “We should all strive to be a normal weight. Anyone with a BMI over 30 needs to do something about it,” Romanelli said, adding that people with a BMI of 40 or over, which equates to 1% of the population, qualify for weight-loss surgery.

“But the vast majority recognize it is their last option,” he told BusinessWest. “It’s not easy — it’s the hard way out.”

Overall, losing weight and keeping it off is not a simple matter. “Obesity is a disease, and diseases need treatment,” Romanelli said. “You can’t be your own doctor and treat it any more than you can treat diabetes, high blood pressure, or cancer. If you are concerned about your weight, you need to be in a doctor’s office. Obesity is not a shape or measure of a person’s character. It’s also not a lack of willpower. In 12 years of practice, I have never met a single person who chose to be obese. And if it was easy to eradicate, half of America wouldn’t be overweight.”

But most men don’t go to the doctor willingly. “Women tend to be proactive about their health, while men are reactive,” Romanelli said. “They only see a doctor when they can’t take a problem anymore. Men tell me they have had hernias for years or had a problem with gallstones years ago, but never did anything about it.”

He attributes the difference to the fact that women bear children and, as a result, see a gynecologist on a regular basis and visit their doctors because they want to be healthy for their children. “But it is inexcusable for any man 40 and over who is overweight to avoid having his blood pressure checked,” he said. “It’s a heart attack waiting to happen.”

Keroack says men tend to push themselves beyond natural limits, and that factor, combined with poor sleep and recovery patterns, adds to the problem.


Winning the Battle

Although exercise is a critical component in weight loss, it’s almost impossible to achieve and maintain without permanent lifestyle changes, said those who spoke with BusinessWest.

“The reason weight comes back is because we don’t have a thermostat for eating or a system that regulates our input and output of calories,” said Romanelli, adding that Americans take in more calories than they burn.

Cardiovascular exercise such as running or walking will improve cardiovascular fitness, but doesn’t help pounds melt away. “If you run 45 minutes on a treadmill at a rate of five miles per hour at a 5% grade, you will be lucky if you burn 500 calories.”

Keroack agreed. “In order to lose one pound, you have to run 35 miles,” he said. “People only lose one pound when they run a marathon.”

He cited research that proves resistance training is key to building muscle and shedding pounds. “A six-month study done at the Cooper’s Clinic in Dallas showed that men who did aerobic exercise three times a week had no change in their body fat or muscle tissue. But a parallel study in which men did resistance training once a week for 20 minutes resulted in a 15% change in body fat, muscle, and metabolism,” he said. “Eighty to 90% of my new patients tell me they tried aerobic programs, but they did not help them lose weight.”

Resistance training includes yoga, tai chi, pilates, circuit training, and weightlifting. However, those who combine aerobic exercise with resistance training will improve their cardiac health as well as dropping pounds.

Keroack says combining protein with carbohydrates at each meal, along with low glycemic index foods, can decrease insulin resistance and assist with loss of belly fat.

But one of the most important factors in weight loss is stress reduction.

“If you eat properly and engage in an exercise regimen, but your level of stress is high and your sleep level is low, you are less likely to lose centralized fat and more likely to lose muscle. So you can actually ruin your body composition and make yourself worse,” Keroack said. “If you radically decrease your calories and overextend yourself in the gym, you may lose weight, but you might not lose fat, and if you lose muscle tissue, you will destroy your metabolism, which makes it very easy to regain weight,” he said.

He compared losing muscle mass to reducing the number of pistons in a car. “If you reduce them from 12 to eight by losing muscle tissue, your horsepower and ability to burn fuel will go down, along with your health.”

Stress of any type causes the body to produce cortisol, which is a hormone released by the adrenal gland. “Its job is to help the body prepare for danger and it affects the salt and sugar levels in the blood,” Keroack said. “In the short term, such as when cavemen had to escape from a wild animal, it was helpful. But in the long term, it breaks down muscle tissue and protects centralized [belly] fat. And the body can’t tell the difference between a stressful work environment or a stressful marriage and a famine.”

Keroack says many men are stressed because they focus on extrinsic goals such as money, status, and image. “People believe these things will make them happy. But intrinsic goals such as self-development, contributing to your community, and protecting the environment are things that lead to stress management.”

His weight-loss practice involves counseling, and he says not thinking too much or too little of oneself, having reasonable expectations, loving relationships, and a belief in God can help people gain inner peace. However, he says men usually also need physical activity to unwind, which can range from working on a car to going outside for a run.


Gaining Ground

Losing weight and keeping it off results in health and economic benefits, in addition to adding to a person’s energy and the type of activities they can enjoy. “It’s possible if men eat a nutritious diet, take part in healthy physical activity, especially resistance training, and manage their stress,” Keroack said. “Even taking off 20 pounds can make a real difference.”

So, in spite of the idea that size equates to power, when it comes to the scale, less is actually more.


Some Weight-loss Strategies That Work

Registered dietician Nancy Dell, of Nancy Dell and Associates Nutrition Counseling, says men typically eat once or twice a day, which dates back to prehistoric times when they hunted and had to go long periods of time without food.“Men can go all day without eating, which is an evolutionary adaptation that still exists today,” she said.
Dr. John Romanelli agrees. “Women graze, but men are volume eaters,” said the director of Baystate Medical Center’s Weight Loss Surgery Program. And because they don’t eat often, it takes a large volume of food for them to feel full.”
The tendency is to ‘starve and stuff,’ which wreaks havoc on their metabolism; “men go a long time without eating and then stuff themselves,” Dell said. “When you starve your body, it believes it needs to store fat to survive a famine, and when you overeat, it also stores extra food as fat.”
She tells clients to spread their meals throughout the day rather than eating once or twice. “You will lose more weight if you do because, when you eat all of your calories at once, it signals your body to store extra calories as fat,” she said. 
Dell also tells clients to drink two full glasses of water before each meal, which will help them feel full. After that, she suggests putting a smaller portion of food on their plates than they are used to eating, then waiting a half hour before eating more to allow their stomach time to feel sated. “Experts say it takes 20 minutes, but that time can vary,” she said, adding that in some people it can be longer.
Since men are used to consuming large amounts of food at each sitting, many avoid dieting because they don’t want to go hungry. But this can be avoided by “putting your recipes on a diet,” Dell said.
For example, instead of eating a double burger, a man could eat one burger with a full-sized Portabella mushroom on top. “They are meaty, and the burger will be just as big,” Dell said. And since many men enjoy chili, she suggests tripling the amount of vegetables in a recipe, which will “dilute” the calories while allowing the person to eat the same amount of food they normally consume. 
Men who don’t cook can also make easy modifications. Canned chili can be diluted by adding extra onions and peppers and mixing them in before heating the contents, Dell said, and for those who don’t want to cut up vegetables, frozen ones work just as well. “You can also mix macaroni and cheese with broccoli or other vegetables like zucchini and eat two cups instead of one without adding calories,” she added.
Favorite foods can also be enjoyed. “Instead of ordering a slice of combo pizza, get the pepperoni but leave off the sausage,” Dell said. “There will be a significant drop in calories, but the eye will be happy because it will look like the same amount of food.”
Romanelli says separating liquids and solids can also help. He suggests that men eat meals without drinking anything. “Liquid pushes food through your system more quickly. If you don’t drink when you eat, you achieve satiety or feel full faster,” he said, adding that he believes the stomach has to work harder to digest food when it is not being flushed through the digestive tract.
He suggests substituting soda with flavored seltzer water and adding more protein to the diet because it allows people to feel full for a longer period of time.
Lack of sleep also plays a role in weight gain. “Studies show that people who sleep less than seven hours a night gain 16 pounds over five years because they make 80% less leptin,” Dell said, explaining they have a difficult time knowing when they are full when the hormone is lacking.
Alcohol also adds weight. “It can increase appetite and alcohol, sugar and white flour all make belly fat,” Dell said. In addition, men should not have more than two alcoholic drinks a day. “And don’t save them up for Friday night,” she added.
But since consuming alcohol is the way many men handle stress, lifestyle changes are in order. “Take your stress out on the treadmill, not on the refrigerator or freezer,” Romanelli said. “Channel a negative into a positive and use stress to burn calories.”
Those who are too overweight to walk or run far may find that swimming works well for them, because it takes the weight off their joints.
But experts agree that none of this is easy. “It takes a lot of time to take care of yourself,” Dell said. “But it takes more time and costs more to be sick.”
Permanent changes in diet are the only long-term answer. “But men don’t have to change everything at once — and they should seek support,” she said, adding that dieticians, physicians, and other experts can offer suggestions about lifestyle changes that are easy to implement.

— Kathleen Mitchell


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