Like many people, you may have made a New Year's Day resolution to finally get serious about losing weight. Like many people, you might already find your commitment wavering a bit.

Todd Burstain, MD, is a specialist with UI Weight Management at University of Iowa Hospitals and Clinics, helps people deal with this issue year-round. His comments include:

Why is managing our weight such a challenge?

We were designed to survive through periods of starvation, and we do not have any genetic protection against periods of chronic calorie excess or chronic physical inactivity, which has become part of our daily society life here. These systems are controlled by the way that the brain and body talk to each other when it comes to nutrition and your metabolic rate. It's a dysfunction in that system that leads to the loss of the natural feedback loops that help manage our rate and the further development of a lot of destructive abnormal loops that perpetuate the weight gain and the complications of the weight gain. To understand this system, you need to know a little bit about the brain.

You have a small area in the brain called the hypothalamus and in that area you have two different types of cells we'll call the hunger cell and the satiety cell. When the hunger cell gets turned on, it causes you to want to go out and find donuts, and tricks the metabolic engines and turns them off. When the satiety cell gets turned on, it does just the opposite, it makes you feel full and it turns on the engines and increases your metabolic rate.

Those cells are under the control of lots of different chemicals in the body, but they're under the primary control of two hormones.

• The first of those is called leptin, which is produced by your fat, and it goes to the brain and turns off the hunger cell and turns on the satiety cell.
• The other hormone is called ghrelin, and it's produced by the stomach and it goes to the brain and does just the opposite, it turns on the hunger cell and turns off the satiety cell.

Now normally those hormones balance each other and provide feedback to the brain and tell us when to eat and how much to eat and when to turn on our engines and when to turn off the engines, but when we gain weight and become obese, then those hormones become unbalanced, and that leads to the loss of the feedback loop between the brain and the body.

In addition to that, we develop a lot of other vicious cycles that occur in the body that compound the problem. The first of those is depression and it turns out that when folks become obese, that results in a decrease in the levels of serotonin, which makes depression worse, and depression in turns feeds back on that hypothalamus to make obesity worse.

Similarly, when folks become obese, they often develop sleep disturbances and we know that sleep is critically important in the functioning of those areas as well. And similar vicious cycles also occur with pain, with chronic stress, and with physical activity; all of which have become kind of a daily part of our lives here, so all those things really make the management of our weight quite difficult.

What is a healthy weight and what are the keys to achieving a healthy weight??

One of the ways that we judge a healthy weight is through something called the body mass index, which basically says if you're taller, you get to weigh more. You can look online through multiple Web sites for BMI calculators and be able to calculate your own body mass index.

The body mass index is a marker for the three types of toxicity that occur with obesity:

• The first is the mechanical way weight affects the body; it's hard on the joints, hard on the back.
• The second is another hormonal imbalance called insulin resistance that occurs when the body starts storing fat in muscle and then the liver, causing the development of insulin resistance.
• The third is over stimulation of the immune system which puts folks at risk for heart disease, for cancer, osteoarthritis, and multiple other problems.

In addition to that, what we know from looking at death rates across the country is that a normal BMI is 18-25 and being overweight is defined as 25-30, but both of those categories are not associated with any loss of life.

However, once you cross that threshold of the BMI of 30, you start to decrease life expectancy. And if you get your BMI between 30 and 35, you lose about one to two years; between 35 and 40, about five to eight years; and over 40, about 10 to 20 years.

This is a very important marker of the effect of obesity on your health. As far as the keys to achieving healthy weight, there are no currently medications approved in the United States to rebalance these hormones that cause these problems, so we are dependent upon lifestyle changes in order to be successful with this.

And what we know from making those lifestyle changes is the key is motivation.

When it comes to motivation, we know three important factors that are at the heart of that.

• The weakest has been shown to be fear, which is what physicians do best.
• Stronger than fear is desire, which I think a lot of folks have this time of year.
• The strongest motivating factor, which I think a lot of folks are still missing, is that belief in themselves. That they can actually be successful with these types of lifestyle changes.

So those three motivating factors are really the key in being able to achieve a healthy weight and achieve these lifestyle changes.

For the average person, what type of approach should he develop for weight management in terms of eating, exercise, etc.?

We believe in a comprehensive approach. Because obesity affects so many different systems and parts of the body, we believe that all of those things need to be addressed in order to achieve a healthy weight.

There are several things we focus on.

• The first and probably the most important, is calorie restriction. We calculate what your basic metabolic rate is, and there are calculators, again, that you can look at online to calculate that. We then subtract 500 calories from that to result in a deficit, and therefore, weight loss, and furthermore, we split those calories evenly across the day, so we mandate that folks have breakfast, lunch, and dinner every day and that's critically important to keeping the metabolic rate high.
• The next thing we do is ask people to try to get eight hours of sleep at night because we know that sleep is important
• We actively treat depression
• We actively treat pain
• We actively treat chronic stress and talk about stress management
• We promote physical activity.

All of those things are really at the focus behind developing a plan for weight management. And really, most of those do not really require physician visits to get going.

Speaking of physician visits, if people do need help managing their weight, what should they do?

They could definitely give us a call at the UI Weight Management service. We have openings.

The unfortunate thing, statewide, and actually national-wide, is that the insurance coverage for the management of obesity is not always covered. It's something that we think is a legislative issue that needs to be addressed. When you call us, we can check to see if you qualify for insurance coverage for this service.

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