When the temperature reaches a balmy 48 degrees and folks shed their parkas to stand in line at Dairy Queen, you know spring has reached northern Michigan. With warmer temperatures, we discover that, beneath layers of winter clothes, we added layers to ourselves. Santa gave us his belly, Cupid his double chin, and the Easter bunny provided for thighs of proportions so ambitious our jeans are waving the white flag of surrender.

Levity aside, most people, unfortunately, gain weight every year, an unnatural and unhealthy choice, resulting in obesity for 39% of Americans, with over two-thirds of us now overweight (pre-obesity).

Obesity destroys health and shortens life by 15 years. Many medical conditions, including cancer, heart disease, sleep apnea, hypertension, diabetes, pregnancy complications, and osteoarthritis are driven by excess body fat, which destabilizes our body’s biochemistry. Obesity even affects our infants: Obese women are nearly 25% more likely to have babies with birth defects. Obesity has become a leading cause of liver failure, as well. Obesity is now known to be as lethal to the liver as chronic alcoholism.

For most people, those many medical conditions result from everyday unhealthful choices.

There is good news, however, in that one only need reverse the trend to improve health! Repeated studies show improvements in patient health even after losing just 10 pounds of fat. While still obese, blood tests improved and less medication was needed to control their conditions. Continuing the healthful behaviors that helped achieve the weight loss is critical.

How did America get so fat? For most Americans, that two to five pounds of fat gained per year inevitably leads to obesity. That weight gain over time results from, on average, simply eating 50 extra calories a day — basically one large mouthful of food. While that may seem an easy change to reverse to some, others cannot achieve it without help.

And there is help. In addition to ceasing poor food and beverage choices, one may seek medical and surgical assistance. The safest route is the tiered approach recommended by most physicians: lifestyle changes, pharmacology, and surgery, in that order. All of those approaches work well IF the patient treats them as “forever” changes, turning their now smaller backside forever away from their previously poor choices.

The lifestyle guides allowing excellent health are few: First, exercise at least two hours total each week. Second, eat nothing except what exists in nature in an unprocessed form. Learn that the sensation you call “hunger” is normal, and you should feel it at all times, save for the two or three times a day you are actually eating. Fasting, recommended for millennia by all three Abrahamic faiths but truly practiced by few, is an underutilized tool, as well. Those simple steps stop fat gain in everyone.

However, some find that path too narrow to follow in today’s society. Thus, the next step is drugs/supplements.

Pharmacology offers several helpful medications working through three methods. Orlistat blocks fat from being absorbed. Phentermine-topiramate, bupriopion-naltrexone, and lorcaserin work as appetite suppressants. Liraglutide slows stomach emptying, causing one to feel full longer, thereby directly and indirectly suppressing appetite, and is the preferred choice in diabetic patients. All medications and supplements have side effects and do not always play nicely with other medications.

Ensure you doctor knows EVERYTHING you are taking.

Depending upon the study cited, adding medication to lifestyle changes helped patients lose five to 20 pounds within a year, which is sufficient to generate improved health. Participating in a structured diet program, such as Weight Watchers or Nutrisystem, can be helpful in maintaining lower weight and, on average, yields an additional fat loss of five pounds over time.

For morbidly obese or super-obese patients, bariatric surgery is often recommended.

Morbid obesity is defined as a body-mass index (BMI) of 40 or higher, or as a BMI of 35 or higher with any associated medical condition, such as diabetes or obstructive sleep apnea. Those patients will have markedly unhealthy, shortened lives unless treated.

Bariatric surgery varies in technique. Gastric bypass is the most effective and most likely to cure diabetes, but is more extensive. Gastric sleeve techniques are less extreme and require less post-operative care, but result in less weight loss. The surgical risk is now similar to the risk associated with a simple gallbladder removal. However, the psychological risk is higher and requires pre-operative screening. Gastric band technique is no longer recommended, due to poor overall results.

I refer only to complete programs, including the psychological screening and follow-up. Nearly all my patients were successfully treated at Grand Traverse surgeons’ bariatric center (that should save me some phone calls). Following gastric surgery, nutrient levels must be monitored and replaced throughout the patient life to avoid deficiencies and toxicities.

You can be well.

Dr. Allan P. Frank is a physician with Northern Health and Wellness Inc. in Alpena.