by Jason Schexnayder, PT, DPT, CMTPT

“Knowledge Is Power”

The entire purpose of our blog, in general, is to provide you with the knowledge you need to better understand a condition, a treatment, or anything that involves the rehabilitation, health, and wellness world. By doing so, we can equip you with the knowledge you need to improve the quality of your life.

This is a personal blog topic for me. I’m not overweight and never have been, but my wife and I have family members who are overweight or obese. Outside of being physical therapists, my wife and I are also pretty big “health nuts”. So naturally, we’ve tried to promote this type of lifestyle to the people we love. I’ve said it 100 times…I could care less about how they look…selfishly, I just want them to live as long as possible because I love these people and they’re important in my life. This is especially true now that we have our son, Graham. For his sake, I want them to stick around so they can spoil him, play with him, and teach him the important lessons of life.

This blog is for EVERYONE: for the people like me that this topic hits home for, for overweight people themselves, or for anyone who is simply interested in improving their knowledge and health. To our overweight readers, this isn’t meant to make you feel bad about yourself. Actually, it’s meant to empower you so you can have a better, healthier life. 🤛🏻💥💪🏻

Now, to lighten the mood, here’s a funny clip from Austin Powers…

Let’s Cover the Basics.

There are 4 different weight categories. Your BMI, or body mass index, determines these weight categories. BMI is your weight in kilograms divided by your height in square meters. If you’re interested in figuring out your BMI then click on this link.

According to the CDC (Centers for Disease Control and Prevention), the 4 classifications of weight are:

  • Underweight = BMI of < 18.5
  • Normal = BMI of 18.5 – 25
  • Overweight = BMI of 25 – less than 30
  • Obese = BMI of 30 or higher
    • Morbid or severe obesity is a BMI of 40 or more

Well Known Health Risks

As you may, or may not know, being overweight or obese puts you at risk for many health conditions. The CDC, among many other resources, list a few of those health issues that you may be at increased risk for:

  • All causes of death (mortality)…yes, that says ALL
  • High blood pressure (Hypertension)
  • High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
  • Type 2 diabetes
  • Coronary heart disease
  • Stroke
  • Gallbladder disease
  • Osteoarthritis (a breakdown of cartilage and bone within a joint)
  • Sleep apnea and breathing problems
  • Many types of cancer
  • Low quality of life
  • Clinical depression, anxiety, and other mental disorders
  • Body pain and difficulty with physical functioning

How much increased risk you ask?

Well, Harvard did a review of multiple clinical research papers and found the following:

  • Type 2 Diabetes
    • 7x more likely for men with BMI > 30
    • 12x more likely for women with BMI > 30
  • Coronary Artery Disease (CAD) – these are clots that form in the arteries of the heart and can lead to heart attacks
    • Overweight – 32% increased risk
    • Obese – 81% increased risk
  • Ischemic Stroke (due to a lack of oxygen to the brain)
    • Overweight – 22% increased risk
    • Obese – 64% increased risk
  • Depression
    • 55% increased risk
  • Asthma
    • 50% increased risk in obese men and women
  • Alzheimer’s Disease
    • As much as a 42% increased risk if you’re obese

And these are only numbers from 1 source…

What You Might Not Know.

Excess Weight Causes Chronic Systemic Inflammation. Wait. What?

Systemic inflammation, in the simplest explanation, is inflammation throughout the entire body. Scientific research shows that being overweight, and especially being obese, causes chronic, low-grade systemic inflammation. “Metabolic inflammation” is the term used for inflammation caused by excess weight. Not surprisingly, this inflammation is likely the primary driver behind the increased disease and mortality risk for overweight people.

However, some forms of inflammation are necessary. ACUTE inflammation is necessary in the presence of an injury, wound, infection, cold, etc. in order to promote healing and restore homeostasis. This type of inflammation is necessary and important.

On the contrary, CHRONIC SYSTEMIC inflammation is unnecessary and can have a significant negative impact on your health.

How does it happen?

Well, as a response to certain stimuli, the adipose tissue (fat) present in the body releases excess pro-inflammatory cells (cytokines). The pro-inflammatory cells cause a low-grade, whole-body, inflammatory state. The main cytokines responsible for this inflammatory state are:

  • Tumor Necrosis Factor-∝ (TNF-∝)
  • Interleukin-6 (IL-6)
  • Interleukin-1β (IL-1β)

Surprisingly, adipose tissue in leaner or normal-weight people produces and secretes anti-inflammatory cells and has beneficial effects. So, quite literally, being overweight is what’s causing the inflammatory process to occur and continue.

Examples of Biological Impacts due to this Inflammatory State.

  • Insulin Resistance – Insulin is the compound your body uses to regulate glucose (sugar) in the body. Insulin resistance commonly leads to the development of Type 2 Diabetes.
  • Increased C-Reactive Protein (CRP) – CRP is the most important marker associated with an increased risk of cardiovascular disease and a predictor of future cardiac events like a heart attack.
  • Leptin Resistance – part of leptin’s purpose is to influence the brain to DECREASE food intake and INCREASE metabolism. Therefore, leptin resistance may be the primary reason why it’s difficult for overweight people to lose weight.

Soft-tissue health, surgical outcomes, injury risk, & recovery are impacted too!!!

Unfortunately, being overweight or obese doesn’t just put you at risk for developing severe diseases and disorders. It also puts you at increased risk for poor soft-tissue health, injury, surgical complications, and recovery from said injury/surgery.

  • I.A. Bielska et al. Physical & Rehabilitation Medicine 2018

    • A research study of 500 people, 31% of whom were classified as obese, showed that 6 months after an ankle sprain obese people hadn’t recovered to the same extent as their normal-weight counterparts.
  • I. Janssen, E. Bacon, W. Pickett. Journal of Obesity 2011

    • A Canadian study of 7,678 working adults showed that obese workers were 40 – 49% more likely to suffer a work-related injury compared to their normal-weight counterparts.
  • B. Werner et al. Journal of Shoulder and Elbow Surgery 2015

    • 6,928 patients received surgery to their distal humerus (the end of your large arm bone). The obese subjects in this study were at significantly higher risk of post-operative complications like infections and venous thromboembolism (a clot that could potentially kill you). In terms of post-operative infections, obese people were anywhere from 3 – 4 times more likely to develop an infection.
  • N. Patel et al. Journal of Neurosurgery: Spine 2007

    • A study of 84 patient’s receiving spinal surgery showed that as BMI increased the rate of significant post-surgical complications also increased:
      • 14% for patients with a BMI of 25
      • 20% for patients with a BMI of 30
      • 36% for patients with a BMI of 40
  • M.M. Dowsey et al. The Journal of Bone and Joint Surgery (Br) 2010

    • 521 people had a total knee replacement. 318 of these patients were classified as obese or morbidly obese. Post-surgical complications in the first 12 months were 35.1% for morbidly obese patients, 22.1% for obese patients, and 14.2% for non-obese patients. So, with increasing weight, the risk of post-surgical complications increased. Also, the authors of this study pointed out that for every 1 unit increase in BMI there was an 8% increase in the risk of post-surgical complications, regardless of age or gender. Finally, the two obese groups showed poorer pain and functional outcomes compared to the non-obese group at 12-months post-surgery.
  • A. Wroblewski et al. Physician and Sports Medicine 2011

    • This study was actually conducted to determine whether or not an active person maintains their muscle mass, among other things, as they age. This is relevant because sedentary living is consistently associated with being overweight or obese. Also, it’s relevant because consistent exercise is one of the best ways to lose weight and live a healthier life.
    • They studied 40 Masters Athletes, 20 men and 20 women, and attempted to determine if aging caused a loss of muscle mass and an increased amount of fat infiltration into the muscle, despite being active. They took MRI’s of the mid-thigh in these subjects to make a comparison to other active and sedentary individuals. It was found that chronic, intense exercise preserved muscle mass and prevented fat infiltration of muscle in masters athletes despite aging. The below image is the MRI comparison between 3 different people: 1 younger active person, 1 older sedentary person, and 1 older active person.

  • If it’s hard to see, the outer white portion is adipose tissue (fat), the dark area is the quadriceps muscle, and the white portion in the middle is bone. However, pay specific attention to the 40-year-old triathlete and the 74-year-old triathlete…not much difference is there? Isn’t that amazing?!?! EXERCISE IS MEDICINE!!!

Economically speaking…

Obesity has become such a problem that a research study estimated that obesity contributed to anywhere from $86 – $147 BILLION in medical costs in the USA in 2006 ALONE (E. Finklestein et al. Health Affairs 2009). In 2006, on a per-person basis, obese people spent $1,429 per year more (42%) than their normal-weight counterparts (E. Finklestein et al. Health Affairs 2009). Disturbingly, prescription drug costs were approximately $568 more per year for obese people, which is an 80% increase from 1998 to 2006 (E. Finklestein et al. Health Affairs 2009). Unfortunately, obesity has only increased in the USA and around the world so it’s safe to assume that the medical costs attributable to obesity have as well. 







This is the End…Finally

I think we’ve made a good case as to why it’s important to manage your weight. We’re not saying it’s easy. Most things in life are hard and weight loss can certainly be difficult. However, I think Tom Hanks said it best in A League of Their Own. “It’s supposed to be hard. If it wasn’t hard, everyone would do it. The hard…is what makes it great.”

Weight loss isn’t baseball, but it’s not rocket science either. If you’re committed and you make the right choices you can make a positive change in your life. Here are a few examples of how you can help manage your weight:

  1. A balanced, healthy diet – preferably a more plant-based diet, low in calories, and high in nutrients
  2. Exercise consistently – at least 3x/week of moderate-intensity exercise, if not more
  3. Good sleep – about 8 hours/night of undisturbed, deep sleep
  4. Manage distress – meditate, take a walk outside, socialize, or anything that helps you mitigate the distress in life and add more eustress…yes, that’s a real word
  5. Cut out preserved foods and low-nutrient, sugary drinks – this alone will help you lose a substantial amount of weight…put down the coke slowly!
  6. Patience and positive attitude – don’t focus so much on the scale because weight loss takes time, you’ll have plateau’s, and some weeks you might even gain weight. But if you stay consistent, are patient, and maintain a positive attitude your efforts will pay off.

For Inspiration…

One of my favorite people to follow on Instagram is BJ Gaddour. I have a lot of respect for him because of his dedication to health and exercise as well as his own battles with being overweight. He’s a perfect example of how commitment and patience can change your life. Let people like him be your inspiration for change. Remember, we believe in you and so should you.

Before vs. Now