Dear Dr. Roach: Does obesity have an inevitable result, as in the case of ALS and dementia, or is it a condition that an individual can improve or actually fully control? Are obese individuals predisposed to obesity, and therefore really unable to control their weight?
Dear C.O.: Obesity is defined as having a body mass index — a measure of weight (in kilograms) over height (in meters) squared — of greater than 30. This is an imperfect measurement, since there are very muscular people or truly “big-boned” people whose BMI is high but who have very little body fat. Waist size is a good measurement of body fat, and the combination of waist size and BMI provides more information about risk of chronic diseases with obesity. The list of diseases caused or worsened by obesity is long, but especially includes diabetes and osteoarthritis. Heart disease risk is increased by obesity, partly through blood pressure and cholesterol effects.
If you mean to ask whether obesity inevitably leads to heart disease, diabetes or arthritis, for example, the answer is no. It increases risk of these conditions, but the risk can be managed with a good diet and with exercise. This is important, because the diet and exercise themselves make you healthier. It’s not just a means to reducing weight; losing weight can be healthy, but just having a healthy diet and exercise will reduce risk of heart disease and diabetes, even if you don’t lose weight.
How well people are able to control obesity is a difficult question, but it is certainly not the case that losing weight is easy or simply a matter of willpower. There are many forces that act on eating behaviors, and attributing obesity to mere poor self-control is a disservice. Medications and many medical conditions are the cause of obesity in some people. The bacteria that live in our gut have some impact on obesity. The people in our social network have an impact.
There are effective treatments. Dietary considerations, exercise and psychosocial interventions all can be effective in helping people lose weight, but the treatment needs to be individualized.
Dear Dr. Roach: I have an itchy-ear problem. It even wakes me up at night sometimes. I’ve tried Cortizone-10, hydrogen peroxide solution, ear baths and cotton swabs. Nothing seems to work longer than temporarily. Can you help me on this?
Dear G.P.: Stop the hydrogen peroxide — it is very drying, and can be damaging to the sensitive skin in the ear. The hydrocortisone you have tried should work for many common conditions, but if it hasn’t, then your regular doctor, a dermatologist or ENT doctor should take a look in your ear and see what is going on.
Email questions to ToYourGoodHealth@med.cornell.edu.