Northern Westchester Hospital

The Inside Press recognizes that weight management is a multi-dimensional issue, one which encompasses a myriad of physical and mental health issues. The following article seeks to provide some key information, and is neither judgment by nor opinion of the writer, editor or publisher.

These days, “home for the holidays” isn’t exactly the exciting work-break or reunion most of us associated with the phrase in years past. No, sadly, many of us have been home for quite awhile now, carefully working from that same home (if we’re lucky enough to be able to do so), helping our school-age children to learn from that same home and even supporting grown-and-flown adult children and/or parents who’ve returned to the nest as well. Likely, even Hallmark would agree that coziness has its limits, and holidays might take more than the usual toll on some.

For example, weight gain. Most years, as we approach the holiday season, we are both invited to indulge and cautioned to simultaneously take care; mouth-watering special holiday recipes on one morning talk show, “how to handle the office party and make healthy food and drink choices” on another. Let’s face it, celebrating and enjoying ourselves while remaining on the alert for hidden calories and sneaky sugars isn’t easy. Now, it’s not only that time of year again, but it comes on the heels of a nearly nine-month lockdown during which some of us became more sedentary, ate and drank more, and, much to our dismay, have had to recognize we’ve put on few pandemic pounds.

Sound familiar? Many readers will likely shake their heads in agreement, but also shrug it off as something they can deal with. However, for seriously overweight and obese people, additional weight-gain is actually quite critical. According to a CDC COVID-19 alert: “Obesity May Increase Risk for Severe Illness”. When President Trump was diagnosed as positive for the coronavirus, he was considered at higher risk for complications due to his age (74) but also due to his weight (undisclosed, but notably overweight).

Understanding Obesity

But what exactly is obesity? How do we define it? And, more to the issue, once defined, what can we do to better understand and remediate how it affects our health? For answers to these and related questions, The Inside Press turned to three members of the team of experts at Northern Westchester Hospital’s Center for Weight Management at Chappaqua Crossing; specifically Ms. Rachel L. Goldman, FNP-BC, CDCES. (Family Nurse Practitioner- Board Certified, Certified Diabetes Care Education Specialist); Ms. Pat Talio, RD, CDCE; and Dr. Mitchell S. Roslin, MD, FACS, Director of Bariatric Surgery.

In broadest terms, the condition of being overweight or obese is defined as having too much body fat, and the most widely used determining measure for this is the Body Mass Index, commonly referred to as the BMI. A simple equation originally proposed by a Belgian mathematician in the nineteenth century, the BMI is the body mass or weight (kg) divided by the square of the body height (m) or kg/m2.

Category BMI range – kg/m2

Severe Thinness < 16
Moderate Thinness 16 – 17
Mild Thinness 17 – 18.5
Normal 18.5 – 25
Overweight 25 – 30
Obese Class I 30 – 35
Obese Class II 35 – 40
Obese Class III > 40

Of course, like most tools, the BMI is not perfect; it doesn’t distinguish between body fat and denser tissue like muscle and bone. An athlete may have a high BMI and be perfectly healthy. But, for most people and healthcare professionals, the BMI is the gold-standard for determining people at risk for health problems due to excess weight. All interviewed for this article concur with this and with the World Health Organization’s (WHO) recommended body weight based on BMI values for adults. It is used for both men and women, age 18 or older.

While the BMI is but a simple measurement tool, the Center for Weight Management is a full-on toolbox of state-of-the-art health help. According to Goldman, when a potential patient calls the Center, the first order of business is a comprehensive medical screening including “a really long conversation with the patient to discuss their weight struggle over time; our relationship with food is complicated with many possible factors at play including emotional issues, lack of time to cook, lack of time to exercise. We take blood, and screen for weight-related underlying conditions–hormonal or metabolic conditions that make weight loss hard and unsustainable–and look for side effects of medications taken for other things. I’ve seen people who’ve been struggling to lose weight for years without knowing they have an underlying thyroid condition.”

Goldman notes that patients have continued to work with the Center remotely during the pandemic lockdown, and that the Center’s online content has grown and greatly improved. She also shares that the team has seen new patients as well, “people who recognize they’re extra vulnerable and are searching for new ways to be successful. We’re here for them, and eventually we come up with a plan which may include any or all of the following: nutrition counseling, medical-nutrition therapy, FDA- approved medication, surgery.”

Nutrition Counseling is Key

Explains registered dietitian Pat Talio: the foods we use to fuel our body aren’t all created equal. Talio discovered this herself as a freshman away at college for the first time. Having come from a “family who always ate well, used fresh and healthy ingredients and got outside to play sports a lot”, Talio wasn’t prepared for the relatively nutrient-poor but abundant food choices at college, and soon found she was on her way to gaining the proverbial “freshman 15”. Fortunately, she also found her way to health services who recommended she meet with a dietitian. The dietitian not only opened up her eyes to healthy food choices, but also to a regular exercise program (she’d been unaware that her home-based backyard sports games were about more than fun and were actually a means toward an ongoing healthy lifestyle).

What’s more, this all led to an abiding interest in nutrition, and her ultimate choice of career; Talio has been a practicing Registered Dietitian since 1985, and is further certified as a diabetes specialist. She sees a variety of clients including cardiac and pulmonary rehab patients for whom she points out that “nutrition is an important part of recovery.”

When asked about the differences, if any, between her work pre- and post-COVID-19, Talio says, “I never thought I’d be working from home but the hospital has been very supportive with technology and thinking outside the box! There’s greater scheduling flexibility for their appointments–and all without traffic and waiting rooms.” Her patient roster has remained fairly steady, but she does allow that the virus has led to new inquiries and perhaps provided an extra push to people who have been on the fence about seeking help; “they’re re-evaluating their health and their choices”. And, she adds, “I’m so thankful I’m able to offer support.”

Bariatric Surgery Option

Patients whose Center personal plan includes surgery often see Dr. Roslin, considered one of the best bariatric surgeons in New York, and an innovator in the search for new and better treatments of obesity. Roslin is full of compassion for his patients and their struggle as he describes the importance of surgical intervention.

He begins with what he calls Point #1: obesity is a chronic relapsing condition. He then provides a useful visual to what that means by saying “it’s like a rubber band that always wants to bounce back.” “And,” he adds, “this makes treating obesity extremely challenging.” Explains Roslin, “There’s an assumption that obese people overeat. That’s wrong. It has to do with insulin resistance which encourages fat formation as well as other metabolic activity. It’s impossible to tease out which comes first and they can also be synchronous. It’s not lack of will power.

Surgery is the only reproducible mechanism we have; it breaks insulin resistance and blunts recidivism–and it’s underused. The number of people who are in their 30s and 40s with obese BMIs will likely not be able to lose weight without surgery.” Roslin shares that his patients rarely come in due to some seminal event–e.g., a death in the family–but because they’ve reached a point in their lives “when functional impairment overcomes the fear of surgery threshold.” And, further, he notes “a majority have gained a significant amount of weight during the pandemic, as much as 25-30 lbs in the last few months.” Unfortunately, that doesn’t mean that they’ll be able to shed the weight as quickly as they put it on.

To be sure, surgery is not a substitute for a healthy lifestyle, and even though Roslin sees it as the linchpin to starting that healthy lifestyle, he, like Goldman and Talio all agree that the only way to truly treat the complex issue of obesity is to help the patient learn to make a sustainable lifestyle change. Sums up Roslin, “the reason centers like ours are so important is because we teach you!”

For more information or to speak to a member of the Center for Weight Management team, call (914) 223-1780.