Gina asks: “I am reaching 47 years old. What should I know about the effects of menopause on heart disease?”
This is an important question. Menopause signals the start of a progressive loss of estrogen and unfortunately also an increase in cardiovascular risk in women. It is not always appreciated that roughly the same number of women die of cardiovascular disease as men, but the onset
appears to be delayed by almost a decade. In men, the 50’s and 60’s are when most heart attacks occur. In women, it is the 60’s and 70’s. This
was thought to be due, in part, to a protective effect of estrogen which raises HDL or the good cholesterol. Clinical trials in women with
heart disease have shown, however, that estrogen actually seems to raise cardiovascular risk. As a result, physicians have counseled patients
not to begin estrogen supplementation in the post-menopausal period except for severe symptoms such as unremitting hot flashes. For those
with heart disease, the general recommendation is to taper estrogen to the lowest effective dose or preferably stop estrogen supplementation
altogether.
John asks: “I am 56 years old and trying to lose weight. My doctor wants me to lose 50 pounds. I am relatively healthy and somewhat active. Are prescription diet pills appropriate for me?”
Probably not. Diet prescription drugs should be reserved for those who are medically obese (BMI> 30) who are unable to lose after consultation with a physician specializing in medical nutrition therapy or with a registered dietitian. Health plans may set specific cutpoints for
the starting BMI below which the drugs will not be covered or weight loss rates below which the drugs will not be covered. Generally accepted prescription diet pills include orilstat (Xenical) which blocks some fat absorption, as well as sibutramine (Meridia) and phentermine
(Obenix, Adipex P) which help suppress appetite.
“How do I determine how much weight I should try to lose?”
This is a complicated question which your physician may help answer. BMI is calculated by taking the weight in pounds multiplying it
by 703 and dividing the result by the height in inches squared. A BMI >or =30 is the medical definition of obesity; a BMI >25 but <30 is
defined as overweight; a BMI of 20-25 is considered normal. If you are 50 pounds above your ideal weight you may consider losing most if
not all of it; however, even a lesser weight loss will have medical benefit. Blood pressure may begin to drop for most people with hypertension after only 5 pounds of loss. Blood sugar and cholesterol may show significant improvement after 20 pounds of loss. Weight loss targets
should also be practical and achievable and you probably should not plan to weigh less than you did at age 21.
“Once I lose the weight how do I keep it off?”
The national weight loss registry suggests that certain changes in lifestyle are essential. If you go back to old habits you will most probably
go back to your old weight. A physician specializing in medical nutrition therapy or a registered dietitian may help you avoid weight re-gain.
You must, however, be willing to take on new healthy habits such as eating breakfast daily and engaging in exercise such as walking at least
one hour per day.
“What type of activity is best to lose the weight and keep it off?”
The best type of activity is one which you enjoy, can do on a daily basis, has low risk of injury, and does not require specialized equipment.
Walking fits the bill as long as your feet, ankles, knees, hips, and back are not already a problem. Cross-training with different exercises or
activities which you enjoy is also a winning strategy for many.
“How much food should I eat and how often?”
Most people find multiple small meals each day is a good strategy. As long as your energy expenditure exceeds your intake you will lose
weight. Six small meals per day with a total caloric intake of 1100-1200 calories is optimal for most people. An alternative approach would
be to reduce your total daily calories about 400 calories below your current intake. Again, a registered dietitian is the best person to help you
come up with a practical plan for weight loss.
44 SUCCESS JULY 2009