According to most clinicians, a person is obese when he or she weighs more than 130% of their ideal weight, but it's not that simple. In some cases, additional weight is the result of working out to build muscle. Additionally, not all obesity is the same. Some cases of obesity are a result of simple overeating, and other types of obesity are regulated by altered hormones caused by chronic HIV infection and exacerbated by some of the treatments. If you are overweight, you should know the causes before you start any weight-loss plan.
In the case of overeating, most of your additional weight is fat that can be 'pinched' up off your muscle. Moderating intake will be the most effective way to trim this fat. In this case, portion size is king, and you can reevaluate the amount of food you eat in a meal and throughout the day to bring your calories in line with your energy needs. You may have to train your body to know what it feels like to eat only what you need. It takes the body about three days (72 wafer-thin hours) to reprogram if you eat approximately the same amount each day during that time. It is the psychological change that takes a while. So start with the physical change by establishing a reasonable 'diet' with help from a dietitian. Then you must learn to trust your body to tell you when it is hungry and when to stop eating. Such habits take a few weeks to really kick in, and you may find that smaller changes are more easily kept for the long term.
There is another type of obesity that occurs'in the belly or elsewhere on the torso'as extra fat that is more resistant to pinching. A dietitian who is trained in taking anthropometric measures, such as fat pinches with reliable equipment, can help you to figure out your type and can monitor your progress as you work toward a healthier you.
When hormonal changes come into play, such as those seen in cases of diabetes, the diet issue becomes more complex. The need to lose weight slowly still applies, but in this case you will want to talk to your dietitian about well-rounded meals spread throughout the day. This could mean changing your pattern from eating one or two meals a day to eating three or four meals with more evenly distributed calories. And in this case, the composition of your meals is especially important. Consuming some of each of the major macronutrients (carbohydrates, fats, and proteins) at each meal will help to control the hormonal responses that usually come with storing calories. You can learn to recognize those foods that give you the most carbs (starches, milk and yogurt, and fruit) and distribute them evenly while including the other core macronutrients (fat and protein) with each meal or snack to keep blood sugar and insulin levels even.
Either way, the changes you make should be reasonable for you, creating a lifestyle you can stick to for the long run. Fast weight loss comes with some risks, such as too much fat lost under the skin, changes in metabolism and hormonal balances, and compromised immune function. Taking it slow will likely yield the best and most long-lasting results. Small changes may take time to show big weight-loss results, but you will be better able to maintain your progress and keep some of the unwanted effects of fast weight loss at bay.
Fields-Gardner is the director of services for the Cutting Edge, an HIV nutrition company in the Chicago area. She is a member of the International AIDS Society and the American Dietetic Association's Dietetic Practice Group on HIV and AIDS. She has written a book on HIV medications and a guide to nutritional management of HIV for clinicians. Write to Fields-Gardner at cade@hivplusmag.com.
