Can A Secondary Medical Diagnoses Help Your Weight Loss Plan?

Evidence linking diet and chronic diseases has become more firmly established in recent years. In addition to obesity it is not rare for patients to have a secondary medical diagnosis with some relationship to obesity. Many health problems can be overcome by a successful weight loss program.

It is interesting to note that, in comparing results of a weight loss program, [The University of Massachusetts Medical Center. Study from 02/1987 - 12/1987.] patients with multiple diagnoses demonstrated better results, at 1-year follow-up, than patients with obesity and only one other diagnosis. Diets for these patients with multiple diagnoses were more complex, but perhaps these patients felt more concerned about their health and thus were more motivated.

Table 2.14 Results at 1-year follow-up of secondary diagnoses.

Diagnosis

No.

Maintained or lost weight

Success

Obesity alone

15

13

87%

Diabetes

11

9

82%

High cholesterol

12

6

50%

Hypertension

9

4

44%

Back pain

5

4

80%

Coronary artery disease

4

3

75%

Pulmonary disease

1

1

100%

Diabetes & hypertension

5

5

100%

Hypertension & high cholesterol

5

4

80%

Diabetes & high cholesterol

2

1

50%

Hypertension & arthritis

2

2

100%

Hypertension and lower back pain

1

1

100%

Hypertension and coronary artery disease

1

1

100%

Heart disease and cancer are the leading causes of death in the United States. Healthful eating habits can help prevent those diseases. Studies have identified three major risk factors for coronary heart disease: smoking, hypertension, and elevated plasma or serum cholesterol. Other studies have shown that quitting smoking, and reducing blood pressure and blood cholesterol reduce the risk for heart disease. Thus, considerable effort has been devoted to the modification of these risk factors.

Recently, the results of the Lipid Research Clinics Coronary Primary Prevention Trial prompted a nationwide effort to increase public awareness of cholesterol and coronary heart disease and to encourage the adoption of low-fat, low-cholesterol diets.

To implement a cholesterol-lowering diet effectively, a patient must acquire a substantial body of knowledge. The basic components of a diet to lower blood lipids include reducing total fat, particularly saturated fat, maintaining or increasing polyunsaturated fat and changing sources of monounsaturated fat, decreasing dietary cholesterol, and increasing carbohydrate and fiber.

In practical terms, this means that individuals must learn to identify major sources of these macronutrients in foods available for their consumption. It is not sufficient for patients to know that they must avoid saturated fats and cholesterol. You need to be able to implement changes when shopping, preparing food, or eating away from home. The knowledge required to implement a cholesterol-lowering diet is outlined as follows:

  • General knowledge:
    Understanding the relationship of blood cholesterol and dietary factors. Processing realistic expectations regarding the effects of diet. Knowing the effects of dietary lapses on blood lipids. Understanding genetic influences on blood lipids.

  • Fats:
    Understanding the difference between saturated and polyunsaturated fats. Knowing how to read product labels to determine appropriateness of fat content. Possessing sufficient knowledge to interpret ambiguous and sometimes misleading information on product labels, such as "may contain one of the following..." or "contains no cholesterol" (just lots of saturated fats).

  • Cholesterol:
    Understanding the difference between other fats and cholesterol. Awareness of which foods are high in cholesterol, including some awareness as to the amount of cholesterol present in various foods.

  • Fiber:
    Knowledge about which foods are high in fiber. Understanding the importance of soluble versus insoluble fiber.

  • Cooking techniques:
    Ability to identify cooking techniques that are least likely to contribute to high fat content in food. Ability to execute the appropriate cooking techniques.

  • Eating in restaurants and Purchasing prepared food:
    Ability to recognize which of a variety of food choices is lowest in fat and cholesterol and higher in fiber. Understanding which questions to ask the food preparer in order to make the best choices possible.

Eating is a social activity, and is one of the behaviours related to cardiovascular disease that is influenced by the social environment. Variability in blood lipids can also be attributed to the environment; there is evidence that spouses' cholesterol and triglyceride levels are similar and that husbands and wives consume similar quantities of eggs and whole milk. [Barret-Connor, E., Suarez, L., and Criqui, M.H.: Spouse concordance of plasma cholesterol and triglyceride. J Chronic Disease 35:333, 1982.]

The importance of including a patient's spouse or family in counselling to reduce the risk of cardiovascular disease has been recognized and has received some attention in the literature on weight loss. Including a spouse or other partner is advocated in obesity treatment programs. Although application to cholesterol-lowering diets is limited, there is some empirical evidence that inclusion of the spouse facilitates weight loss in the treatment of obesity.

Mere inclusion of the spouse as an observer may not be sufficient to enhance treatment effectiveness and may even be counterproductive. Spouses should be encouraged to assume an active role in assisting with adherence to low-fat, low-cholesterol diets.

Table 2.15 Estimated Total Deaths for the 10 Leading Causes of Death; United States, 1987.

Rank

Cause of Death

Number

%

1*

Heart diseases
(Coronary heart disease)
(Other heart disease)

759,400
(511,700)
(247,700)

35.7
(24.1)
(11.6)

2*

Cancers

476,700

22.4

3*

Strokes

148,700

7.0

4

Unintentional injuries
(Motor vehicle)
(All others)

92,500
(46,800)
(45,700)

4.4
(2.2)
(2.2)

5

Chronic obstructive lung diseases

78,000

3.7

6

Pneumonia and influenza

68,600

3.2

7*

Diabetes mellitus

37,800

1.8

8

Suicide

29,600

1.4

9

Chronic liver disease and cirrhosis

26,000

1.2

10*

Atherosclerosis

23,100

1.1

All causes

2,125,100

100.0

* Causes of death in which diet plays a part.

[Source: National Center for Health Statistics, 1988.]

Coronary Heart Disease. Despite the recent sharp decline in death from this condition, CHD still accounts for the largest number of deaths in the United States. In 1985, illness and deaths from CHD cost Americans an estimated $49 billion in direct health care expenditures and lost productivity.

Stroke. Strokes occur in about 500,000 persons per year in the United States, resulting in about 150,000 deaths. Approximately 2 million living Americans suffer from stroke-related disabilities, at an estimated annual cost of more than $11 billion.

High Blood Pressure (Hypertension). Hypertension is a major risk factor for both heart disease and stroke. About 58 million people in the United States have hypertension. The occurrence of hypertension increases with age and is higher for black Americans (of which 38 percent are hypertensive) than for white Americans (2 percent).

Cancer. More than 475,000 persons died of cancer in the United States in 1987. During the same period, more than 900,000 new cases of cancer occurred. In 1985 the total costs for direct health care and lost productivity due to cancer was estimated to be $72 billion.

Diabetes Mellitus. Approximately 11 million Americans have diabetes. In addition to the nearly 38,000 deaths in 1987 attributed directly to this condition, diabetes also contributes to an estimated 95,000 deaths per year from associated cardiovascular and kidney complications. In 1985, diabetes was estimated to cost $13.8 billion per year.

Obesity. Obesity affects approximately 34 million adults in the United States. Obesity is a risk factor for coronary heart disease, high blood pressure, diabetes, and possibly some types of cancer as well as other chronic diseases.

Osteoporosis. Approximately 20 million Americans are affected by osteoporosis, which contributes to some 1.5 million bone fractures per year in persons 45 years and older. The total costs of osteoporosis to the U.S. economy were estimated to be $10 billion in 1983.

Dental Diseases. Although dental caries among children, as well as some forms of adult periodontal disease, appear to be declining, the overall prevalence of these conditions imposes a substantial burden on Americans. The costs of dental care were estimated at $21.3 billion in 1985.

Diverticular Disease. Because most persons with diverticular disease do not have symptoms, the true prevalence of this condition is unknown. In 1980, diverticulosis was accountable for some 200,000 hospitalizations.

In assessing the role that diet might play in prevention of these conditions it must be understood that they are caused by a combination of multiple environmental, behavioural, social, andgenetic factors. The exact proportion that can be attributed directly to diet is uncertain. Although some experts have suggested that dietary factors overall are responsible for perhaps a third or more of all cases of cancer, and coronary heart disease, such suggestions are based on interpretations of research studies that cannot completely distinguish dietary from genetic, behavioural, or environmental causes.

Nonetheless, it is now clear that diet contributes in substantial ways to the development of these diseases and that modification of diet can contribute to their prevention. The magnitude of the health and economic cost of diet-related disease suggests the importance of the dietary changes suggested.

Clearly emerging as the primary priority for dietary change is the recommendation to reduce intake of total fats, especially saturated fat, because of their relationship to several chronic disease conditions. Because excess body weight is a risk factor for several chronic diseases, maintenance of desirable weight is also an important public health priority. Evidence further supports the recommendation to consume a dietary pattern that contains a variety of foods, provided that these foods are low in calories, fat, cholesterol, and sodium.

Taken together these recommendations promote a dietary pattern that emphasizes consumption of vegetables, fruits, and whole grain products - foods that are rich in complex carbohydrates and fiber and relatively low in calories. And of fish, poultry, prepared without the skin, lean meats, and low-fat dairy products selected to minimize consumption of total fat, saturated fat, and cholesterol.

The evidence presented here suggests that such overall dietary changes will lead to substantial improvements in the nutritional quality of the diet.

The evidence also suggests that most people generally need not consume nutrient supplements. Although nutrient supplements are usually safe in amounts corresponding to the Recommended Dietary Allowances, there are no known advantages to healthy people consuming excess amounts of any nutrient, and amounts greatly exceeding RDAs can be harmful. Toxicity has been reported for most minerals and trace elements, as well as some vitamins, indicating that excessive supplementation with these substances can be hazardous. [The Surgeon General's Report on Nutrition and Health, Prepublication copy, 1988.]

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