DEAR DR. ROACH: I'm quite overweight, with some physical mobility and fatigue issues because of autoimmune-related inflammatory arthritis. Some days, I can get about a block at a fairly brisk pace but I have to stop for a few minutes because of the pain in my legs, pelvis and back or I will fall down. Other days, I can get two or three blocks at a brisker than usual pace without needing to stop.
When it comes to burning calories, is it better for me to walk slower and take less breaks or to walk faster and take more breaks to get my pain under control? Must I reach a certain heart rate and keep it there for a certain period of time in order to being doing anything meaningful for weight loss? Unfortunately, because of the pandemic restrictions, walking around is the only kind of exercise I'm able to do right now. The pools, gyms and yoga studios are closed. -- F.B.C.
ANSWER: For most people, longer and more intense workouts are generally more effective for weight loss. In your case, overly intense workouts are not a good idea. Overdoing it can lead to pain in the joints (and muscles and soft tissue). I recommend a slower, steadier exercise regimen, which I hope will help build up your stamina and reduce your risk of falls and injuries.
High-intensity exercise is needed to gain a high degree of cardiac fitness, and for maximal performance. However, for weight loss and overall longevity, moderate exercise is very nearly as good.
DEAR DR. ROACH: I have a large lipoma. I read that liposuction is an easy way to remove them. Is this true? -- N.E.
ANSWER: A lipoma is a benign fatty tumor. They're very common and usually removed only if cosmetically important. They can become so, especially when they get large.
The standard treatment is open surgical removal. Liposuction has been used successfully for the treatment of larger lipomas, but a recently published research paper maintains that further investigation is required before liposuction becomes an accepted option. I have seen occasional cases of lipomas that have required more extensive surgery than my patients were expecting, so a less-invasive option would be welcome.
Liposuction has been used routinely for treatment of gynecomastia (enlarged breast tissue) in men.
DEAR DR. ROACH: I am a 69-year-old female with a few minor varicose veins. They don't cause any symptoms; they're just a little unsightly. My dermatologist offered to treat them, but I wonder if I should be seeing a vein specialist instead. Your thoughts? -- C.H.
ANSWER: Cosmetic treatment of varicose veins can be done by a dermatologist, a vascular surgeon or other professional. There are several different procedures that can be effective. If your dermatologist is experienced, I think that would be fine, but a vein specialist is more likely to be experienced in multiple techniques. Without symptoms, there is no reason besides cosmetics to treat them. Symptomatic varicose vein treatment is normally covered by insurance, but asymptomatic treatment usually is not.