Obesity

If you have been diagnosed as obese, it means you have a high amount of extra body fat. Being obese raises your risk for health problems, including coronary heart disease, type 2 diabetes, high blood pressure, sleep apnea, and certain types of cancer.

Who is considered obese?
A waist that's bigger round than 40 inches in men and 35 inches in women may raise your risk of health conditions connected to obesity or being overweight.

Overweight and obesity are different points on a scale that ranges from being underweight to being morbidly obese. Where you fit on this scale is determined by your body mass index (BMI).

BMI is a measure of your weight as it relates to your height. BMI usually gives you a good idea of the amount of body fat you have. Your health care providers use BMI to find out your risk for obesity-related diseases. Occasionally, some very muscular people may have a BMI in the overweight range. But these people are not considered overweight because muscle tissue weighs more than fat tissue.

In general, a BMI from 20 to 24.9 in adults is considered to be ideal. A BMI of more than 25 is considered overweight. A person is considered obese if the BMI is greater than 30 and is considered to have extreme obesity if the BMI is 40 or greater. In general, after the age of 50, a man's weight tends to stay the same and often decreases slightly between ages 60 and 74. In contrast, a woman's weight tends to increase until age 60, and then begins to decrease.

Obesity can also be measured by waist-to-hip ratio. This is a measurement tool that looks at the amount of fat on your waist, compared with the amount of fat on your hips and buttocks. The waist circumference tells the amount of abdominal fat. Increased abdominal fat is associated with type 2 diabetes, high cholesterol, high blood pressure, and heart disease. A waist circumference of more than 40 inches in men and more than 35 inches in women may increase the risk for heart disease and other diseases tied to being overweight.

Talk with your health care provider if you have questions about healthy body weight.

What causes obesity?
In many ways, obesity is a puzzling disease. Experts don't know exactly how your body regulates your weight and body fat. What they do know is that a person who eats more calories than he or she uses for energy each day will gain weight.

But the risk factors that determine obesity can be complex. They are usually a combination of your genes, socioeconomic factors, metabolism, and lifestyle choices. Some endocrine disorders, diseases, and medications may also affect a person's weight.

Factors that may affect obesity include:
  • Genetics. Studies show that the likelihood of becoming obese is passed down through a family's genes. Researchers have found several genes that appear to be linked with obesity. Genes, for instance, may affect where you store extra fat in your body. But most researchers think that it takes more than just one gene to cause an obesity epidemic. They are continuing to do more research to better understand how genes and lifestyle interact to cause obesity. Because families eat meals together and share other activities, environment, and lifestyle also play a role.
  • Metabolism factors. How your body uses energy is different from how another person's uses it. Metabolism and hormones differ from person to person, and these factors play a role in how much weight you gain. One example is ghrelin, a hormone that regulates appetite. Researchers have found that ghrelin may help trigger hunger and give you a feeling of fullness. Another example is polycystic ovary syndrome (PCOS), a condition in women caused by high levels of certain hormones. A woman with PCOS is more likely to be obese.
  • Socioeconomic factors. How much money you make may affect whether you are obese. This is especially true for women. Women who are poor and of lower social status are more likely to be obese than women of higher socioeconomic status. This is especially true among minority groups.
  • Lifestyle choices. Overeating and a lack of exercise both contribute to obesity. But you can change these lifestyle choices. If many of your calories come from refined foods or foods high in sugar or fat, you will likely gain weight. If you don't get much if any exercise, you'll find it hard to lose weight or maintain a healthy weight.
  • Medicines. Medicines like corticosteroids, antidepressants, and antiseizure drugs can cause you to gain some extra weight.
  • Emotions. Emotional eating – eating when you're bored or upset – can lead to weight gain. Too little sleep may also contribute to weight gain. People who sleep fewer than five hours a night are more likely to become obese than people who get seven to eight hours of sleep a night.
Health effects of obesity
Obesity has a far-ranging negative effect on health. Each year in the U.S., obesity-related conditions cost more than $100 billion and cause premature deaths. The health effects linked with obesity include:
  • High blood pressure. Excess weight requires more blood to circulate to the fat tissue and causes the blood vessels to become narrow (coronary artery disease). This makes the heart work harder, because it must pump more blood against more resistance from the blood vessels and can lead to a heart attack (myocardial infarction). More circulating blood and more resistance also means more pressure on the artery walls. Higher pressure on the artery walls increases the blood pressure. Excess weight also raises blood cholesterol and triglyceride levels and lowers HDL ("good") cholesterol levels, adding to the risk of heart disease.
  • Type 2 diabetes. Obesity is the major cause of type 2 diabetes. Obesity can make your body resistant to insulin, the hormone that regulates blood sugar. When obesity causes insulin resistance, your blood sugar level rises. Even moderate obesity dramatically increases the risk for diabetes.
  • Heart disease. Atherosclerosis, or hardening of the arteries, happens more often in obese people. Coronary artery disease is also more common in obese people because fatty deposits build up in arteries that supply the heart. Narrowed arteries and reduced blood flow to the heart can cause chest pain called angina or a heart attack. Blood clots can also form in narrowed arteries and travel to the brain, causing a stroke.
  • Joint problems, including osteoarthritis. Obesity can affect the knees and hips because extra weight stresses the joints. Joint replacement surgery may not be a good choice for an obese person because the artificial joint has a higher risk of loosening and causing further damage.
  • Sleep apnea and respiratory problems are also related to obesity. Sleep apnea causes people to stop breathing for brief periods during sleep. Sleep apnea interrupts sleep and causes sleepiness during the day. It also causes heavy snoring. Sleep apnea is also linked to high blood pressure. Breathing problems tied to obesity happen when added weight of the chest wall squeezes the lungs. This restricts breathing.
  • Cancer. Being overweight or obese increases your risk for a variety of cancers, according to the American Cancer Society. Among obese women, the risk increases for cancer of the endometrium, or the lining of the uterus in younger women, and breast cancers in those who have gone through menopause. Men who are overweight have a higher risk for prostate cancer. Both men and women who are obese are at increased risk for colorectal cancer.
  • Metabolic syndrome. The National Cholesterol Education Program says that metabolic syndrome is a risk factor for cardiovascular disease. Metabolic syndrome has several major parts: abdominal obesity, high blood cholesterol, high blood pressure, and insulin resistance (severe type 2 diabetes). 
  • Psychosocial effects. People who are overweight or obese can have problems socially or psychologically. This is because the culture in the U.S. often values a body image that's overly thin. Overweight and obese people are often blamed for their condition. Other people may think of them as lazy or weak-willed. It is not uncommon for people who are overweight or obese to earn less than other people or to have fewer or no romantic relationships. Some people's disapproval and bias against of those who are overweight may progress to discrimination, and even torment. Depression is more common in people who are overweight and obese.

Treatments

Regardless of the type or combination of obesity treatment, goal setting is an important part of any obesity treatment plan. While a person may want to lose a large amount of weight because of societal or fashion reasons, it is important to realize that setting and achieving a realistic goal of reducing weight by as little as 3% to 5% of body weight will yield important, positive gains in health.

Treatment goals work best if they are individualized. For example, it is safe to lose one to two pounds per week, but a person may be more comfortable losing at a lower rate of one-half pound per week. Over one year, that is a 26-pound loss and, if that rate is maintained over 3 years, will lead to a significant weight loss of 78 pounds. Whatever treatment plan a person follows, losing weight slowly will be more effective and healthy over the long term because quick weight loss often spurs weight regain.

Specific treatment for obesity will be determined by your health care provider based on:
  • Your age, overall health, and medical history
  • Extent of overweight or obesity
  • Your tolerance for specific medications, procedures, or therapies
  • Your ability to exercise
  • Expectations for the course of the condition
  • Your opinion or preference
In addition, treatment for obesity may include a combination of different types of treatment. Always consult your health care provider for a diagnosis and treatment recommendations.

There are a variety of methods used to treat obesity. Incorporating multiple methods, such as making diet changes as well as adding exercise, are beneficial. These methods include, but are not limited to, diet, exercise, environmental factors, support groups, medical treatmen and surgical treatment.

Diet
Although diet plans high in protein and fat and low in carbohydrates are popular, some of these diets may pose serious health risks in the long run because of the emphasis on saturated fat. Successful weight loss that is maintained over a long  time depends more on limiting energy consumed (calories) and increasing energy expenditure (exercise and daily activity) than just the composition of the diet.

Fasting may result in rapid weight loss, but lean muscle mass is lost as well as fat. All-liquid diets must be medically supervised. They may be used for a short time in people who are obese. Although these liquid diets may be effective in the short term, they are not the long-term answer to weight loss.

Fads, fasting, and popular diets in which health effects have not been determined by rigorous clinical trials may not be healthy options for weight loss. However, there are dietary recommendations that, if followed, will lead to weight loss:
  • To lose weight and keep it off for a lifetime, begin thinking about an individualized eating plan instead of a "diet." A plan tailored to your personal likes and dislikes will have a better chance of producing sustainable weight loss. A balanced diet that is restricted in calories--1,200 to 1,400 calories a day for women and 1,500 to 1,800 calories a day for men--may work well. A registered dietitian can help to make an individualized diet plan based on a person's particular situation.
  • Include a variety of foods in the diet.
  • All fats are not bad. It is now known that polyunsaturated and monounsaturated fats provide health benefits, such as helping to keep the heart healthy. This means that nuts, seeds, and some types of oils, such as olive, safflower, and canola, have a place in a healthy eating plan.
  • Choose whole grains, such as brown rice and whole wheat bread, rather than white rice and white bread. Whole grain foods are rich in nutrients compared to more processed products. They are higher in fiber and therefore absorbed by the body more slowly so they do not cause a rapid spike in insulin, which can trigger hunger and cravings.
  • Choose at least 5 servings daily of fruits and vegetables. Be sure to choose a variety of fruits and vegetables because different fruits and vegetables contain varying amounts and types of nutrients.
  • When dining out or ordering take-out food, ask for a take-home box (and use it) and avoid super-size selections when you order. Many restaurant portions are too large for one person, so consider sharing an entree or ordering an appetizer instead of a main dish from the entree menu.
  • Read food labels carefully, paying particular attention to the number of servings contained in the product and the serving size. If the label says a serving is 150 calories but the number of servings per container is 3 and the contents of the entire container are consumed, the calories consumed is triple, or 450 calories.
Exercise
A formal regular exercise program benefits people who are obese by helping to keep and add lean body mass, or muscle tissue, while losing fat. It also helps to increase the rate at which weight is lost if a person is eating healthy food according to a meal plan, because muscle tissue has a higher rate of metabolism, thus burning calories faster.

Walking is an excellent choice of exercise for people who are obese. A walking program should start slowly by walking 30 minutes a day a few days a week and increase gradually to the goal of walking for longer periods most days of the week. If you have severe arthritis and walking is difficult, water walking in a swimming pool is a very effective means of exercise, and there is minimal weight bearing on the knees.  Some fitness centers also off water aerobics.

Exercise lowers blood pressure and can help prevent type 2 diabetes. Exercise also helps to improve emotional well-being, reduce appetite, improve sleeping ability, improve flexibility, and lower LDL cholesterol (the bad cholesterol).

Check with your health care provider before starting any exercise program.

Environmental factors
A typical day for most U.S. adults all too often involves a sedentary lifestyle, and becoming active takes effort on your part. Use of the automobile and working at a desk restrict activity. Watching television is a sedentary activity that can contribute to an inactive lifestyle.

There are simple steps that can be taken to increase daily activity:
  • Take the stairs instead of the elevator or escalator.
  • Park the car at the far end of the parking lot and walk to the store or the office.
  • Get off the bus one stop early if you are in an area safe for walking.
  • Turn off the television or video game and head for the garden, rake the leaves, wash the car, or take a walk.
  • Walk on a treadmill when you watch TV.
  • Find activities that the whole family will enjoy, such as tennis, in-line skating, biking, or hiking.
By looking at a person's daily routine, it may be easier than first imagined to find ways to pack more activity into the day in addition to exercising.

The workplace may be part of a person's environment that is not helpful to a weight loss plan. However, there are strategies that may help to keep a weight loss plan on track at work. Bring healthy snacks, such as cut-up fruits and vegetables, to keep on hand when the pastry cart rolls by. Avoid going to office social gatherings hungry. Plan ahead to avoid the temptation of treats that are high in sugar and fat. Ask your employer if he or she can allow an exercise program to be built into your work schedule. You may be able to use a treadmill while you work.

Support groups
Join a support group of people for encouragement and reinforcement of efforts to help with success in changing lifestyle behaviors. Some groups meet weekly and are run by volunteers, psychologists, nutritionists, or exercise therapists. There are also online communities that can help provide support and information to strengthen efforts to lose weight and make lifestyle changes. Friends and family can also provide important support when making lifestyle changes. Although commercial weight loss programs can be expensive, many of them offer the convenience of preprepared food. Some of these programs also provide professional consultation to help a person to individualize his or her weight loss efforts.

Medical treatment
Treatment by a doctor may be necessary when an individual's own efforts to lose weight have failed and/or when coexisting medical conditions make it crucial for a person to lose weight. Medication may be necessary for those having obesity-related health problems and, while medicines may help, they are not the "magic" bullet. Behavioral measures play an even more important part in any weight loss regimen. Behavioral strategies can be used to help change dietary habits and increase activity levels. Eating disorders require treatment by a therapist and may also require medication.

Surgical treatment
Weight-loss surgery (bariatric surgery) is the only option today that effectively treats morbid obesity in people for whom more conservative measures, such as diet, exercise, and medication have failed. Potential candidates include:
  • People with a Body Mass Index (BMI) greater than 40
  • Men who are 100 pounds over their ideal body weight or women who are 80 pounds over their ideal body weight
  • People with a BMI between 35 and 40 who have another serious weight-related condition, such as obesity-related type 2 diabetes, sleep apnea, or heart disease
There are several different types of bariatric surgery, but all procedures are either malabsorptive, restrictive, or a combination of the two. Malabsorptive procedures change the way the digestive system works. Food is rerouted past a large portion of the stomach and part of the small intestine that absorbs some calories and nutrients. With some procedures, a portion of the stomach is removed. These procedures are commonly referred to as "gastric bypass" procedures or the more aggressive duodenal switch with biliopancreatic diversion. 

Restrictive procedures severely reduce the size of the stomach to hold less food, but the digestive functions remain intact. This type of procedure may be referred to as a "gastric banding," or vertical sleeve gastrectomy.

Typically, malabsorptive procedures result in more weight loss than restrictive procedures, but they also lead to more nutritional deficiencies.

Always talk with your doctor to find out more information.
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Symptoms and Screenings for Obesity

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Causes and Preventions for Obesity

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Education and Resources for Obesity

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Support groups for Obesity

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