Ask the Doctor: Obesity and HIV

Ask the Doctor: Obesity and HIV

HIV specialist Theresa Mack, M.D., M.P.H.—an associate medical director at St. Luke’s Medical Group in Harlem, N.Y.—answers your most pressing HIV/AIDS questions.

Obesity is a medical condition in which you have too much body fat, which can negatively affect your health. We define obesity using the body mass index (BMI), which measures your weight in relation to your height and assigns a number.

* If your BMI is less than 18.5, you’re considered underweight.

* If your BMI is between 18.5 and 24.9, you’re considered a healthy weight.

* If your BMI is between 25 and 29.9, you are considered overweight.

* If your BMI is 30 or higher, you are considered obese.

If you’re not sure what your body mass index is, click here to calculate your number.
Obesity is an epidemic. More than one-third of American adults are obese. In the Black community, almost half of adults are obese.

Obesity is associated with a decreased life span, particularly when it is combined with other health conditions. For example, you can have a disease such as hypertension, diabetes, cancer or sleep apnea, and you may die earlier from the condition just because you are also obese.
A number of factors contribute to obesity, including excessive food intake and a lack of physical activity. It’s important to note that obesity is a preventable cause of death.

Obesity and HIV

Although obesity is harmful to all populations, PLWHA have unique reasons to be concerned about excess fat on their bodies. Many people with HIV/AIDS experience lipodystrophy, which is a redistribution of fat around the body. Of particular concern are the following:

* Lipoatrophy, a type of lipodystrophy that was seen early in the HIV/AIDS epidemic, in which people would experience wasting and lose body fat in different parts of their bodies.
*Lipohypertrophy, a type of lipodystrophy in which lipomas, or benign tumors of fat, appear in different parts of the body, such as the abdomen, around the waist or back of the neck.

Lipodystrophy is diagnosed through a physical exam. Your doctor measures your abdomen, arms and legs and then, over a period of time, periodically checks to see if you’ve lost weight or if the distribution of fat on your body has changed.

PLWHA must also be concerned about obesity as it relates to metabolic syndrome, which is a group of conditions that occur together and increase your risk of such ailments as heart disease, stroke and diabetes. Metabolic syndrome occurs when you have at least three of the following conditions:

*      Abdominal obesity, or a large waistline;

*      A high level of triglycerides, a type of fat in the blood;

*      A low level of high-density lipoprotein (HDL) cholesterol. HDL is often referred to as “good” cholesterol because it helps to remove cholesterol from the arteries; it’s healthier to have a higher HDL cholesterol level.

*High blood pressure;

*A high fasting blood sugar level.

A large percentage of people who are on highly active antiretroviral therapy (HAART) have metabolic syndrome. For that reason, if you are on HAART it’s important that you take steps to treat obesity or, better yet, avoid it.

How to Treat Obesity

Obesity is a condition that you have the power to control. To fight obesity, take these steps:
*      Decrease your calorie intake

*      Increase your physical activity

*      If you smoke, stop smoking.

While these may seem simple, they require a change in behavior, so adopting them may be more difficult than you think. Keeping a food journal may help you stay on track, as can hiring a personal trainer or a nutritionist. Before you make any major lifestyle changes, you should always consult your doctor.

There are also a couple of medications that you can speak with your doctor about. For example, a growth-hormone-releasing factor called tesamorelin, and a growth hormone called somatropin, have both been found to reduce the excess fat around the abdomens of PLWHA, though they don’t take the place of diet and exercise. They may also increase the glucose level in your bloodstream, predisposing you to diabetes.

If you’re morbidly obese, with a BMI greater than 40, gastric bypass surgery is an option that has yielded great results for HIV/AIDS patients.

Bottom line: If you are obese and have HIV, you must control both diseases in order to live a healthy life.

Tamara E. Holmes is a Washington, D.C.-based journalist who writes about health, wealth and personal growth.