Losing Weight- The Elephant in the Room


Well, this is probably going to be the most controversial topic I write about (until we get to death, religion and the existence of God), but we gotta talk about it because obesity is a problem and it’s getting worse.

Confession- I was a fat kid.

I still feel fat. My BMI hovers round 25.5 so I’m mostly ok but at times I feel the need to lose weight. Just like watching the battery meters on our phones, not getting enough sleep, drinking too much coffee, not flossing enough, watching our weight and fighting the battle of the bulge is something we all seem to do. It’s part of the 2020 human condition (that and wearing a mask).

Every day, every clinic I see my patients who are struggling with weight. Knees hurt. Back hurts. Diabetes. Heart problems. The gamuts. It’s everywhere. Walk through a busy airport (if that ever happens again soon!) and look around. We are a fat country.

Some hard  facts to digest:

  1. 8% of all deaths worldwide are related to obesity
  2. 1/3 of Americans in 2016 were classified as obese
  3. We are the fattest generation (but our kids will beat us)
  4. It’s a worldwide problem but there is a correlation between wealthy nations and obesity.
  5. For the first time in the history of the human race, we are mostly living  at a time when we have a relative excess of food. We don’t have to worry about where our next meal comes from. We can eat as often as we want. We often don’t have to grow it, harvest it and process it ourselves. We can eat in season or  out of season. We can eat any time, night or day, as much as we like. It’s become a problem.

Whilst it affects the whole world it is truly an American problem. This is something we didn’t really want to be first in, but we own it:

And this problem had become a  BIG problem just over the past 30 years:



Is Obesity Bad?

The infographic below shows all the health risks from obesity:

Probably the biggest things that obesity does is increase your risk for high blood pressure,  diabetes and probably cancer.

We’ll talk about diabetes later, but diabetes is something most physicians would do anything not to have. Obesity is bad. It shortens your life. It makes your joints wear out prematurely. It gives you a host of other health issues. It’s a problem everyone seems to face. Let’s face it- it’s bad. It’s not a fat shaming thing. It costs the individual and society a lot.


How To Calculate if You are Obese

The BMI is a rough guide to how fat we are. It’s basically is a person’s weight in kilograms divided by the square of height in meters (kg/m sq). Here’s a calculator so you can work yours out. Look at the figure below.

If your BMI is >25 you are overweight. If it’s >30 you are obese. If it’s >40 you are morbidly obese. There are other measures, including skin fold thickness, omentum measures (the fat in your stomach around your intestines) and body fat percentage but it’s rough guide.  Women and men have different body images. Men think they are in better shape than they really are and women think they are fatter than they really are but the BMI generally does not lie. As of 2019  BMI of adults in the United States in 2015-2016 was 29.1 for men and 29.6 for women — about a point higher for both genders than a decade and a half earlier. We are inching towards obesity being the average.


How Did We Get Fat?


Historically we came from a time when physical exercise was guaranteed and food was scarce. We developed ‘thrifty genes’ that helped us gain or maintain weight. Even when food became plentiful, we were genetically designed to store for the ‘future’. These genes our ability to deal with scarce food sources have become our bane as we enter a period in humanity when physical activity is reduced and food is no longer scarce.


What Does Exercise Do?

Ever hopped onto an exercise bike for 30 minutes or an hour and realized you burned 300-500 calories? Most Americans take in an average of 3600 calories a day. The recommended daily intake is 2000 calories for women and 2500 for men. It will take a lot of exercise to burn off the wait. The truth is diet/exercise is an 80/20 gig. Eighty percent of weight loss is what we eat and drink. Twenty percent is exercise related. Our ability to burn off is far imbalanced by our ability to reduce caloric intake. Don’t think exercise is useless though. Exercise is great for the cardiovascular system and joints. It makes us feel good. It makes us want to eat better. It may change our basal metabolic rate (how hot our internal furnace burns). It helps but unless we do a ton, it’s not going to help us lose weight in itself. What we put in our mouths dictates that.


What Diet is Best?

Let’s get this out of the way. If you have to diet, it won’t work. Why? Because, it’s not sustainable. You can crash diet and lose a few pounds. Then get cranky and binge. You can starve but if it’s not something you can sustain in 6 months it won’t work.

You’re lifestyle change has to be be sustainable.

If it is not ,it  just won’t work.

Is Atkins better than Paleo or is South Beach the best? I have no idea. Everyone is different. Go to Amazon and look for diet books- there are hundreds:


Every time you see a hundred ways to do something you know there is not one right answer. Look at those options but keep a healthy scepticism.

Here is what we know. You need to have a negative balance between what goes in and what goes out- what you burn as fuel. If you have a negative balance, you lose weight. If you have a positive balance, your thrifty genes will kick in and over time, you put on weight. Whatever you decide, it has to be sustainable.


General Tips To Help You Lose Weight

Here are some general tips that mostly hold true:

  1. Portion size is a killer. Second helpings are often not realized. Use a smaller plate
  2. White foods are a killer. We acknowledge nowadays we probably eat too many processed carbohydrates and rice, bread and pasta, in large amounts are not good
  3. Sugar is a killer. It’s everywhere from soda to cookies to bread to fast food
  4. It’s better to make it  at home than eat out
  5. When you shop stay on the outside aisles and keep away from the center aisles. The center aisles have a lot of processed foods
  6. Try a food diary. Other than water, if you swallow it, you log it. It will blow you away when you eat when not hungry, eat when bored. You will also find that what you eat is not good. This is how Weight Watchers works. There are plenty of apps that can track food intake.
  7. Keep your plates colorful. What does that mean? Vegetables. The more roughage and the more unprocessed foods the better
  8. Soda pop like Coca- Cola are not good. We know they are a ton of sugar and even one can a week increases your diabetes risk
  9. Diet sodas are not good. Mayo Clinic looked at these and found people could not lose weight drinking them. The body expects sugar and does not get it. Messes with our insulin responses and sugar cravings
  10. Beware alcohol- it’s really just sugar
  11. Foofy coffees with extra pumps, cremes, flavors etc are probably not great
  12. Intermittent fasting (basically eating nothing between  say, 7 pm and midday) may work and is sustainable.
  13. Crash diets don’t work
  14. Drink lots of water. Full bellies want less food.
  15. Walking is under-rated
  16. For those truly in the obese or morbidly obese category it gets tough. At that point losing more than 50 lb without help is hard. That’s where behavioral therapy, medications and sometimes surgery help.


I see patients with back pain day in and day out. Most are obese, some are morbidly obese. As the BMI heads over 40, surgery gets dangerous. There’s a point, probably around 400 lb where out instruments and tables don’t work any more and can’t carry the weight. We talk about weight loss a lot. It’s common. It causes so much anguish and shame and pain and self loathing. It causes a lot of health problems.

In conclusion, what I’ve listed is what I’ve seen work and not work in 30 years of talking to patients about weight loss.  We have to acknowledge obesity is a problem. The answer is not a diet- it’s a lifestyle. Welcome to the age of prosperity- this is everyone’s problem!  Change your lifestyle and you will get healthier.

I think i’ll pass on the doughnut.

3 responses to “Losing Weight- The Elephant in the Room”

  1. kennsturtz Avatar

    Lali- I’d be curious of your take on the attached article from Triathlete Magazine. Tri-geeks are ‘outliers’ in terms of obesity (or lack of), but what are your thoughts?

    1. Lali Sekhon Avatar
      Lali Sekhon

      HI Kenn! Thank you for reading and the thoughtful reply! I read the article and there is no doubt that those who burn a lot of calories will tip the scales towards being thin. The article is sound. Absorption rates differ, glycemic index of foods vary so it makes sense to match them to activities. Problem is as an nation we are not triathletes. Too many processed foods, too many carbs, too much salt, too many big portions. It’s kind of like arguing the merits of literacy with a bibliophile. I wish we all had that mentality towards exercise. It’s not all good at that end though- wait for a future blog on secrets of aging gracefully!

  2. Dayna Titus Avatar
    Dayna Titus

    Excellent post! As usual, it is spot on. A friend from Europe once commented to me after visiting the U.S. “it seems like you eat all the day long here”. It’s true, we snack, we take a cookie here and there throughout the day, we reach for that soda… the calories add up. Great advice you are giving here about the realities of how to lose/maintain weight.

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