Your discomfort is undoubtedly due to your weight. Osteoarthritis and muscle and tendon flare-ups can be caused by excess weight, as can a condition known as plantar fasciitis, which causes pain in the soles of the feet. A diet and exercise plan that would help you lose 10 percent of your body weight would improve or eliminate your symptoms. Aerobic exercise and strength training are both important in helping your hips, back, and feet feel better and in helping to strengthen your muscles so that you can exercise and walk without this pain. I recommend you join a gym that employs personal trainers who can get you headed in the right direction. If that’s not available where you live, a weight management center may be able to help you with a diet and exercise program. Once you lose a little weight and feel better, the exercise part will become easier and more fun. You only need to lose about 20 pounds to reap tremendous benefits in cardiovascular fitness and musculoskeletal improvements. Q2. I am 68 and in great physical health. I exercise twice per week, but I am getting flabby anyway, especially in the arms and thighs. Is this inevitable with aging? — Linda, Michigan Flabbiness, especially in the arms and thighs, occurs in part because of a syndrome called sarcopenia — age-related muscle loss combined with the loss of elasticity in the skin. The loss of muscle mass is not inevitable, however. To preserve muscle mass, you can do cardiovascular exercise and weight lifting or resistance exercise training. The Obesity Society recommends resistance exercise training to avoid both sarcopenia and obesity as a person gets older. If you have never done resistance exercise, it’s best to start with a trainer to avoid injury. Resistance training has been shown to increase muscle mass even among 70- to 90-year-olds. We now have an aging population combined with an epidemic of obesity in this country, a phenomenon now being called sarcopenic obesity — as people get older, they are getting heavier and losing muscle mass. A healthy diet along with aerobic and resistance exercise is the antidote. It may be possible to prevent most of the sarcopenia seen in the older population if resistance exercise training is incorporated into a workout routine two to three times per week, especially for perimenopausal and postmenopausal women and older men. Not only is weight lifting and weight-bearing exercise important for your muscles, it’s also important for maintaining your bone mineral density, which decreases in women dramatically at perimenopause. In addition to exercise, a healthy diet with adequate amounts of protein, fruits, vegetables, and whole grains can enhance muscle and decrease body fat. If you don’t consume milk products, it’s essential to take a vitamin D supplement with calcium. All these dietary and exercise recommendations will help with muscle mass and can prevent sarcopenia. Q3. My boyfriend is obese. He has lost his desire for sex almost completely. Is it due to the actual weight problem or to depression about being so heavy? — Jill, Arizona Probably both — and he’s not alone. In a study conducted at Duke University’s Diet and Fitness Center, up to 30 percent of the participants indicated problems with sex drive, desire, performance, or all three. (Many reported avoiding sex entirely.) Quite often, these problems can be traced to physical ailments brought on by obesity. Conditions such as high cholesterol and insulin resistance (a marker of type 2 diabetes) can affect sexual performance, and that in turn affects desire, particularly in men. Both conditions can cause tiny arteries in the penis to constrict, particularly when fatty deposits begin to form. The likely result is impotence, or erectile dysfunction, which ultimately leads to a decreased sex drive. In addition, obese people often have an altered hormonal state, which can also dampen desire. Psychologically speaking, your boyfriend may be suffering additionally because sexual satisfaction helps balance stress, including feelings of anger, sadness, anxiety, and loneliness. Plus, oxytocin, the hormone that promotes calmness, is released by arousal and orgasm, so he’s missing out there as well. He may also be facing another huge hurdle when it comes to enjoying sex: poor body image. If he doesn’t find himself to be sexually appealing, he will believe he is not, even if you tell him he is. So how can he help himself (and you) rediscover the joy of sex? First of all, he should lose weight — even just a little. Studies show that losing just 10 pounds can stimulate sex hormones. Also, instituting dietary changes (like following a low-fat diet and eating more fruit and vegetables) that get blood sugar and cholesterol levels under control can help increase sex drive, whether he loses weight or not. One more way to reignite his fire: He needs to get moving! Physical activity that increases blood flow to the lower body also increases circulation — and sensation — to the genitals. One last word of advice: Your boyfriend might benefit from therapy about self-esteem problems, so I suggest that he speak to his doctor about a referral. Good luck to both of you. Q4. How should someone like me — with abdominal obesity (which goes along with metabolic syndrome) — adjust my weight-loss program to promote fat loss around the middle, as well as general weight loss? Should I exercise more, or eat even fewer calories (and fat calories) than someone who’s just generally trying to lose weight? — Alice, Virginia That’s a good question, because many people are in the same situation as you. First, if you smoke, you should stop because smoking promotes abdominal obesity. In terms of whittling your waist, fat loss around the middle will be more pronounced if you exercise along with decreasing caloric intake, both total and fat calories. As you probably know, abdominal fat is the most important to lose because it is the most strongly related to diabetes and heart disease. So diet and exercise are very important both for general weight loss and for abdominal fat loss. How much exercise? A lot — but that doesn’t mean you have to run a marathon or become a bodybuilder. Recent studies have shown that people who are the most successful at losing weight and keeping it off exercise at least one hour a day at an intensity equivalent to brisk walking. Genetics plays a role as well — those who are predisposed to gain and lose weight in certain places will continue to do so no matter what kind of diet and exercise program they are on, but again, the first place the weight usually comes off is in the abdominal area. Remember, the road to a healthy weight begins with that first step, so my best advice is to watch what you eat and get out there and start walking! Q5. What should parents know about childhood obesity? How can childhood obesity be prevented? – Lee, Delaware That’s a pretty broad question, but I’ll try to shed some light on this ever-increasing problem. Parents should know that childhood obesity is definitely on the rise in this country and elsewhere. Most experts feel that this problem is the result of the combination of what we are feeding children and a lack of physical activity. Compared with past eras, our times are defined by strip malls stocked with fast food and a myriad of ways to avoid physical activity, such as elevators, escalators, cars, and other transportation. In fact, doctors and scientists still do not know whether childhood obesity can be prevented. However, experts strongly believe that healthy eating patterns are important, as well as regular physical activity. Healthy eating patterns start not with nursing but before birth and include the eating habits of the mother-to-be. Preventive measures against childhood obesity therefore include prevention and treatment of obesity (or underweight) in the mother-to-be as well as nursing for as long as possible and healthful eating afterward. As far as what kids (or anyone, for that matter) should eat, a nutritious diet should include plenty of fresh fruits and vegetables, lean protein, whole grains, and “good” fats, such as olive and canola oils. Just as important is avoiding processed foods, fast foods, fried foods, trans fats, sweets, and junk foods such as chips. Furthermore, kids today don’t play outdoors as they did years ago. Most children now sit at the computer or watch TV during their downtime. Curtailing TV time in childhood is a preventive strategy because excessive viewing (four hours a day) has been associated with both weight gain and the development of type 2 diabetes, which is related to obesity. A great book to read on this topic is Food Fight, by Kelly Brownell and Katherine Battle Horgen. Another great resource is the Internet. There are several Web sites devoted to keeping kids from becoming obese. Here are two to check out: https://www.healthiergeneration.org/ and www.cdc.gov. I hope that gives you a good place to start and I encourage you to stay on top of the situation. That may well be the best favor you can ever do for your children. Q6. I am an overweight woman, African-American, in my 50s. I’ve heard that I may be at greater risk of breast cancer than white women the same age. Is that true? If so, why? – Nancy, Jamaica Overweight women who are postmenopausal do have a higher risk of breast cancer than postmenopausal women who are not overweight, but the exact causes have not been fully explained as yet. Genetics, diet, exercise, and other factors may play a role. African-American women have higher prevalence rates of overweight and obesity than do Caucasian women, and this seems to play a role, although once again we’re not sure why. It may have to do with elevated levels of estrogen. Women who are overweight have higher levels than women of normal weight, and we know that estrogen stimulates the growth of breast tissue. So it could be that overweight women are exposed to higher levels of estrogen over time, stimulating the development of breast cancer in some of them. There are guidelines for healthy eating to help prevent breast and other cancers, and these include eating lots of fruits, vegetables, and whole grains and limiting total and saturated fats and alcohol. Because there have been studies linking alcohol intake to breast cancer, if you drink more than one glass of wine, beer, or spirits a day, you should give serious thought to cutting back. This will also help you shed some of the extra pounds you’re carrying. Learn more in the Everyday Health Diet and Nutrition Center.
