Well, it's that time again, the New Year is upon us and you are considering the courageous test of will power by going on a diet. I'm pretty much the average guy and I put on more than a few pounds in the past several years. My dear patients helped by sending me all kinds of great Christmas gifts of food and beverage. Being average, I couldn’t help myself. All the same, I really enjoyed the gifts and thank all my patients. Now I have to do something to drop the accumulated tonnage of appended adipose. But why? Am I obese or just overweight? So what if my gut resembles the 1959 Morris Minor I drove in high school (I tend to exaggerate, but when we weigh more than we would like we all have a self-assessment bordering on the absurd).

Today, both thin and fat doctors define “overweight” as being between 10 and 20% over ones “desirable body weight (DBW)” and “obese” as being greater than 20% of the DBW. DBW is not the weight you want in your best dream, but is actually derived from Metropolitan Life Insurance Company tables of height, weight, and mortality or from similar guidelines published by the National Institutes of Health. Such tables tell you two things:

First, the more fat you carry, the greater the risk to your health. Next to smoking, obesity is the most controllable health hazard. That fact is what led 43 million folks to start a diet last year. As a nation, we are growing almost as fast as the Dow – almost 70 million Americans could benefit from a successful weight reduction effort. Interestingly and very worrisome are the facts that childhood obesity is the fastest rising age group and the 50 year olds have a current highest proportion of obese individuals. Thus, moms and dads are setting a poor household example for the kids who are following in our fat footsteps.

The second thing national norm tables tell you is what you generally should weigh. I have to laugh at such tables because we all know when we are overweight. In any event, a rough rule of thumb for the DBW for a female is 100 pounds for five feet tall, plus 5 pounds per inch of additional height. The rule for males is 106 pounds, plus 6 pounds for each additional inch. Thus, I am 5’11” and my DBW is 172 pounds. I weigh 185, so I am about 10% overweight. So what? I am depressed by the facts.

For each 10% increase in weight over the DBW, the blood sugar, blood pressure, and cholesterol rise by a notable amount. That is why obesity is a cause of diabetes, hypertension and heart attacks. In a less well-understood manner, obesity is associated with a higher incidence of breast, colon, uterine, and ovarian cancer. The data is inescapable. That extra poundage is really risky. So let’s belly up to the bar and figure a way out of this problem. First, how did this happen? Second, how do we get the pounds off?

We don't have to lay our large rears on a psychiatrist's couch to figure out why we gained weight. We consumed more calories than we needed to maintain our weight. With normal activities a male needs 12 times his weight in daily calories (for me that would be 12 x 185 or 2200 calories per day). For a female the rough rule of thumb is 11 times the body weight. I have gained 15 pounds in two years – at 3500 calories per pound that is a whopping (as in Whopper) 52,500 excess calories. If I had been counting calories that would be only 70 calories per day in excess of what I needed. Almost always such calories are those in fat. Of course, life is not that simple. Medical science recognizes that hormonal disorders, genetic factors, and psychological factors may play a role in weight gain. Eighty percent of fat kids are fat adults, but only twenty percent of fat adults were fat earlier in life. If you have gained twenty pounds since your senior prom, you probably should lose some weight for the best interests of your health. Obesity is about 70% diet and environment and 30% genetically influenced. But even if both your parents were obese and you, therefore, have an 80% chance of being obese yourself, you still can lose weight by following the same rules as your corpulent comrades without a genetic excuse. It will be a bit more difficult, but here is some good news. Your health risk profile improves with any "that's right" any drop in weight over almost any period of time. That means none of us have to lose a lot and we don’t have to do it in a hurry to gain a real health benefit.

The cornerstones of a weight reduction program are diet, exercise, and behavior modification. Although there are a ton of diets on the market, there is no scientific evidence that any work in a special way beyond limiting total calories. I don’t find any science or magic in a low carbohydrate or high protein or low elephant tusk diet. You must cut your calories. I will try to cut out 100 calories per day. In 360 days that is 36,000 calories or 10 pounds. Wow!

I will need some exercise. We all used to do something, but now we are overworked, stressed, too tired, too sick, too old, etc. Data suggests exercise helps all ages and infirmities, so stop whining. Carve out 20 minutes per day. You already spend 10 hours per year sitting in a doctor’s office for problems that could go away if you lost that gut. Find some activity you enjoy and do it with a friend or group. Walking 3 miles burns 139 calories – that can be increased to 300 calories by jogging. People are too hard on themselves. In medical circles a “successful” weight loss program is defined as losing and maintaining a 5% weight reduction -- Heck, even I could lose 9 pounds. But I need some behavior modification and perhaps something extra. As far as a behavior modification goes, I guess I could stop eating these pistachio nuts as I type this article. I could also stop snacking on the Klondike ice cream bars that my dogs and I split late in the evening while I do some reading. Hamlet could lose a few pounds as well. If you are looking for a pill to fix all this, forget it. With the Phen-Fen and Redux scare, doctors and patients of all sizes are checking for drug-induced heart disease and promising never to eat another doughnut if their heart is ok.

Finally, group weight loss programs are probably better than individual programs. I have always wondered why we use the term "lose" weight. When we put it on, we didn't "find" it. When we get rid of these pounds that we have carried with us for years, wouldn't it be comforting to know where it has gone – rather than simply being lost? I would like all of you to send me your weight reductions over the next 6 months. Write the amount on a post card and send it to me at Georgia Gastroenterology Group, 501 Eisenhower Drive, Savannah, Georgia 31406. I will tabulate all of our useless fat and send it to that fine city to the northwest that has given so much to Savannah over the years. Let's send a ton of useless fat to FATLANTA , we deserve the benefits of weight reduction and all Savannah would love to forward this treasure to the capital city fathers with the following message from Savannah. Our loss is your gain. I'm serious. Have a carrot stick, walk a mile, and send me your "Fatlanta" contribution. Happy New Year.