The measurements that count

Know your Body Mass Index (BMI)

Over the past twenty years, Americans have become more familiar with specific measurements related to health, such as cholesterol levels and blood pressure readings. When it comes to weight-related health risks, there are three important numbers that you should know. The first is your actual weight in pounds; the second is your Body Mass Index, or BMI; and the third is your waist measurement.

Your BMI is based on your height and weight. Doctors consider BMI to be a better measure of health risk than your actual weight. In fact, the medical terms “overweight” and “obesity” are based on BMI values. A BMI of between 23 and 25 is defined as overweight, and a BMI of 25 or more is considered obese. The higher your BMI, the greater your risk of developing a weight-related illness, such as type 2 diabetes or heart disease.

What is your waist circumference?

Body fat that accumulates in the stomach area (described as “abdominal obesity”) is more of a health risk than body fat that builds up in the buttocks and thigh areas. For this reason, your waistline provides valuable information about your risk for heart disease, high blood pressure, high cholesterol, and type 2 diabetes. Doctors consider a waist circumference too high if it is 40 inches or more in men, or 35 inches or more in women.

What is metabolic syndrome?

A high waist circumference can be one sign of a condition called metabolic syndrome. Although most people have never heard of it, this syndrome is quite common; it affects about one out of every four adults in the United States. Metabolic syndrome often progresses to type 2 diabetes—and treating the syndrome can help prevent this form of diabetes.

A person has metabolic syndrome if they have at least 3 of the 5 conditions listed in the table below. If you think you may have metabolic syndrome, it is important to discuss the possibility with your doctor so that you can undergo the appropriate diagnostic tests. Treatments for metabolic syndrome involve basic lifestyle changes, such as losing weight, eating a healthier diet, and increasing your activity level. Your doctor can help you develop a specific plan for making the necessary changes.

More Information on Metabolic Syndrome
ConditionTreatment: Lifestyle ChangesPractical Suggestions
Abdominal obesit y(measured by waist circumference) – Men: greater than 40 inches, Women: greater than 35 inchesWeight loss, Increased physical activityCut 250 calories a day*; lose 1/2 pound a week; aim for losing 20 pounds in a year30 minutes of moderate activity 5 days a week
High blood pressure130/85 mm Hg or greaterWeight loss,Reduced salt intake, More fruits and vegetables, Low-fat dairy productsAim for 20-pound loss/year, Salt shaker off the table; no salt when cooking, Get at least 5 servings/day, Get 3 glasses of skim milk, low-fat yogurt, cheese/day
Low HDL (good) cholesterol – Men: less than 40 mg/d, LWomen: less than 50 mg/dLStop smoking, Weight loss, Increased physical activity, Cut carbohydrates, eat more monounsaturated fatAim for 20-pound loss/year30 minutes of moderate activity 5 days a week, Replace cookies, candy, cakes with unsalted almonds, walnuts, peanuts
High triglycerides level150 mg/dL or greaterWeight loss, Reduce simple carbohydrates, Limit alcoholRaise omega-3 fatty acids Aim for 20-pound loss/year, Replace soda, juices with seltzer, water, diet soda, Limit: 2 drinks/day for men; 1 drink/day for women, Eat fish twice/week
High blood sugar after fasting110 mg/dL or greaterWeight loss, Increase soluble fiberAim for 20-pound loss/year*, Replace white bread with brown bread, whole grains, cereals

*(For example: replacing two 12-ounce cans of sugar-sweetened soda with a beverage sweetened with a sugar substitute can cut over 350 calories per day.)

How to get active

Regular physical activity has been shown to help prevent heart disease, type 2 diabetes, osteoporosis and other chronic conditions. It is important for maintaining good health in all adults and children, regardless of whether their weight is a problem or not. Lifestyle changes do not have to be drastic to be effective. Simple measures applied every day can make a significant difference over time. Here are a few examples:

  • Increase whatever physical activity you are currently doing by adding 10 minutes a day, or increase the intensity from low to moderate. (See the box below for an idea of different activity intensity levels.)
  • Limit time spent online, watching TV and playing video games to less than two hours total per day.
  • Take the stairs instead of the elevator.
  • Park at the far end of the parking lot and walk to your destination, rather than parking as close as possible. You can also get off the bus one stop earlier and walk the rest of the way.
  • Do more household chores (such as dusting, vacuuming or weeding).
  • Walk or run with the dog and/or the kids.
  • Use an exercise machine (such as a treadmill or bike) while watching TV.
  • Take “active” vacations—go hiking or ride bicycles.
  • Walk to do errands (such as to the grocery store or post office) instead of driving.
  • Buy a pedometer, which measures how many steps you take each day. Gradually increase your daily number of steps. (Pedometers can be purchased at sporting good stores.)
  • Don’t be embarrassed about exercising!
How Active Are You?
Moderate physical activityHard physical activityVery hard physical activity
Walking a mile in 15-20 min (3-4 mph)Walking or jogging (12 min/mile)Jogging (10 min/mile)
Treading waterSwimming laps (light effort)

Swimming laps (vigorous effort)

Bicycling (10 mph)Bicycling (12 mph)Bicycling (> 14 mph)
Dancing or tai chiHigh impact aerobicsStep aerobics (6- to 8-in steps)
Yard work/gardeningMowing lawn with hand mowerDigging a ditch
HikingPlaying doubles tennisPlaying singles tennis
VacuumingMoving furniturePlaying basketball or soccer
Playing actively with childrenWeight liftingIn-line skating

Adapted with permission from Blair SN, Dunn AL, Marcus BH, et al. Active living every day: 20 Weeks to lifelong vitality. Champaign, Ill.: Human Kinetics; 2001.

Conditions and medicines that may prevent weight loss

In some people, overweight or obesity may be related to a medical condition or a medicine they are taking, which interferes with their weight loss efforts. If you have, or think you might have, any of the conditions on this list, or you are taking any of the medications listed, speak with your doctor about measures you should take to manage your weight. In some cases, specific treatments for your medical condition or a change in medicines can make a difference in your efforts to manage your weight.

Some Medical Conditions that May Make it Difficult to Lose Weight
Hormonal DisordersHormonal disordersPolycystic ovarian diseaseCushing’s diseaseDiabetesHypothyroidism
CardiovascularCongestive heart failureIdiopathic hypertrophic cardiomyopathyHeart valve disorders
SleepObstructive sleep apneaUpper airway resistance syndrome
Eating DisordersBulimiaCarbohydrate craving syndrome
Medicines that May Cause Weight Gain
High blood pressureAlpha blockersBeta blockersMethyldopa
DepressionTricyclic antidepressants


Manic-depressive illnessLithium
Can diet pills and supplements help with weight loss?

Although diet drugs may help you lose weight at first, they usually don’t help you keep the weight off and may have damaging side effects. Most diet pills have not been tested by the Food and Drug Administration, which means you can’t be sure if the drugs are safe. Taking drugs also does not help you learn how to change your eating and exercise habits. Making lasting changes in these habits is the way to lose weight and keep it off.

Osteoporosis FAQ’s: Frequently asked questions
What is osteoporosis?

Osteoporosis means “porous bone”. It is a progressive disease where bone loss and skeletal deterioration leads to fragile bones which are likely to break, or fracture.

Osteoporosis is a “Silent Killer” since it remains unnoticed for many years, with no symptoms or discomfort, until a fracture occurs.

What are common sites of Osteoporotic fractures?

Most common sites for Osteoporotic fractures are hip, spine, and wrist. Many of these fractures occur due to trivial trauma. Simple household tasks can produce a fracture of the spine if the bones have been weakened by osteoporosis. These fractures often lead to chronic pain, disability and a reduced quality of life.

Why should I be concerned about osteoporosis?

Fractures due to osteoporosis are common. One in two women and one in four men over age 50 will sustain a bone fracture in their remaining lifetime. For women, the chance of having a fracture is greater than the combined chances of having breast, ovarian and uterine cancer.

Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person’s ability to walk unassisted and may cause prolonged or permanent disability, or even death. Most hip fracture patients who previously lived independently will require help from their family or home care. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.

What are the causes of osteoporosis?

The exact medical causes of osteoporosis are not completely known. However, many of the major factors that can lead to the disease have been identified, and are listed below:

Ageing: Peak bone mass is achieved around 25-30 years of age. After age 35, the body builds less new bone to replace losses of old bone. Everyone loses bone with age. In general, the older you are, the lower your total bone mass and the greater your risk for osteoporosis.

Heredity: A family history of fractures; a small and slender body build can increase the risk for osteoporosis. Heredity also may help explain why some people develop osteoporosis early in life.

Nutrition and lifestyle: Poor nutrition, including a low calcium diet, low body weight and a sedentary lifestyle have been linked to osteoporosis. Smoking and excessive alcohol use have also been linked to osteoporosis.

Medications and other illnesses: Osteoporosis has been linked to some medications, including steroids, and to other illnesses, including some thyroid problems.

What are the risk factors for osteoporosis?

Risk factors for low bone mineral density, future fractures and falls include:

  • if either parent has had a hip fracture,
  • having had a prior fracture with minimal trauma,
  • long-term (more than 3 months) use of glucocorticoid therapy such as prednisone,
  • rheumatoid arthritis,
  • current smoker,
  • history of falls in the past 12 months,
  • vertebral fracture apparent on x-ray,
  • high alcohol intake (3 or more drinks per day) and
  • weight loss greater than 10% since age 25.
How is osteoporosis diagnosed?

The diagnosis of osteoporosis is usually made by your doctor using a combination of a complete medical history and physical examination, skeletal X-rays, bone densitometry and specialized laboratory tests.

If your doctor finds low bone mass, he or she may want to perform additional tests to rule out the possibility of other diseases that can cause bone loss, including osteomalacia (a vitamin D deficiency) or hyperparathyroidism (overactivity of the parathyroid glands).

Bone densitometry is a safe, painless X-ray technique that compares your bone density to the peak bone density that someone of your same sex and ethnicity should have reached at about age 20 to 25, when it is at it’s highest. It is often performed in women at the time of menopause.

What can I do to prevent osteoporosis, or to keep it from getting worse?

There is a lot you can do throughout your life to prevent osteoporosis, slow its progression and protect yourself from fractures.

  • Adequate intake of calcium and vitamin D in your diet.
  • Regular exercise
  • Avoid smoking and alcohol
  • Start prevention early
What is the dose of calcium?

During the growing years, your body needs calcium to build strong bones and to create a supply of calcium reserves. Building bone mass when you are young is a good investment for your future. Inadequate calcium during growth can contribute to the development of osteoporosis later in life.

However, whatever your age or health status, you need calcium to keep your bones healthy. Calcium continues to be an essential nutrient after growth because the body loses calcium every day. Although calcium can’t prevent gradual bone loss after menopause, it continues to play an essential role in maintaining skeletal health. Even if you’ve gone through menopause or already have osteoporosis, increasing your intake of calcium and vitamin D can decrease your risk of fracture.

  • Men and women, aged 9 to 18 years: 1,200 mg per day
  • Men and women, aged 19 to 50 years: 1,000 mg per day

  • Pregnant or nursing women: 1,200 mg per day
  • Men and women, aged over 50: 1,200 mg per day

Dairy products, including yogurt and cheese, are excellent sources of calcium. A glass of milk contains about 300 mg of calcium. Other calcium-rich foods include sardines with bones and green leafy vegetables, including broccoli and collard greens.

How much vitamin D is needed to keep bones healthy?

Vitamin D helps your body absorb calcium. The recommendation for vitamin D is 200-600 iu daily. Food products supplemented with vitamin D are rarely available in India.

Vitamin supplements can be taken if your diet doesn’t contain enough of this nutrient. A multivitamin usually contains 400 to 800 iu of vitamin D. Again, consult with your doctor before taking a vitamin supplement. Too much vitamin D can be toxic.

Which exercises are considered best to keep bone strong?

Like muscles, bones need exercise to stay strong. No matter what your age, exercise can help you minimize bone loss while providing many additional health benefits. Doctors believe that a program of moderate, regular exercise (three to four times a week) is effective for the prevention and management of osteoporosis.

Weight bearing exercises such as walking, jogging, hiking, climbing stairs, dancing, treadmill exercises, and weight lifting are probably best.

Falls account for 50 percent of fractures, therefore, even if you have low bone density you can prevent fractures if you avoid falls. Programs that emphasize balance training, especially Tai Chi, should be emphasized. Consult your doctor before beginning any exercise program.

How is osteoporosis treated?

Although there is no cure for osteoporosis, there are steps you can take to prevent it, or to slow its progress. A healthy diet, including adequate calcium and vitamin D, and healthy lifestyle, including adequate exercise, are important for maintenance of skeletal health. In some instances, medication may be useful for improving skeletal health.

Currently several therapies are approved for the prevention and/or treatment of osteoporosis, includes:

  • Bisphosphonates (alendronate, risedronate, ibandronate)
  • Calcitonin
  • Estrogens<
  • Selective estrogen receptor modulators (raloxifene)
  • Strontium ranelate
  • Parathyroid hormone

These agents have been shown to increase bone mineral density and reduce fracture risk in women with osteoporosis. Some of these therapies work mainly by slowing bone loss, whereas others promote new bone formation.

If you and your doctor have decided that medical therapy is appropriate for prevention and/or treatment of your osteoporosis, it is critical that you follow the plan that you and your doctor have agreed to. Most people do not feel their bones getting stronger or weaker, so if you decide that a particular treatment is not right for you, please discuss your concerns with your doctor first, before stopping or interrupting your treatment.

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