Obesity

Obesity, an epidemic in the U.S., is characterized by excess body weight. Being obese significantly increases one's risk of death from hypertension, stroke, heart disease, and other conditions.

Definition

Obesity is a condition of having excess body weight. Adults with a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) greater than 25 kg/m2 but less than 30 kg/m2 are considered overweight. Adults with a BMI greater than 30 kg/m2 are considered obese. An adult who is more than 100 pounds overweight or has a BMI greater than 40 kg/m2 is considered morbidly obese.

In the U.S., 97 million adults are overweight or obese. Being overweight significantly increases the risk of death from hypertension, dyslipidemia, type 2 diabetes, stroke, osteoarthritis, coronary heart disease, gallbladder disease, sleep apnea and respiratory problems, and endometrial, breast, prostate, and colon cancers. 

Obesity has reached epic proportions in the U.S. Rates of obesity have gone up from 12 to 20 percent of the population since 1991. This epidemic is not limited to adults; the percentage of young people who are overweight has more than doubled in the past 20 years. Sixteen percent of children and adolescents between 6 and 19 years old are considered overweight.

Your weight is the result of many factors. These factors include environment, family history, and genetics, metabolism (the way your body changes food and oxygen into energy), behavior or habits, and more. You can't change some factors, such as family history. However, you can change other factors, such as your lifestyle habits.

Symptoms

Obesity results from the consumption of more food than the body can use. Excess alcohol intake and sedentary lifestyle also contribute to weight gain as well as a host of other health problems. 

Three key measures are used in assessing obesity:

  • Body mass index (BMI)
  • Waist circumference
  • Risk factors for diseases and conditions associated with obesity

The BMI is a measure of your weight in relation to your height, and your waist circumference measures your abdominal fat. Combining these with information about your additional risk factors will give you an idea of your risk for developing obesity-associated diseases.

BMI is a reliable indicator of total body fat, which is linked to the risk of disease and death. While the score is valid, it may overestimate body fat in those with a muscular build, and it may underestimate body fat in older persons or others without much muscle mass.

Your waist circumference (which you can find by placing a measuring tape snugly around your waist) is a good indicator of your abdominal fat. This is another predictor of developing risk for heart disease and other illnesses. This risk increases with a waist measurement of over 40 inches in men and over 35 inches in women.

The combination of your BMI and your waist circumference informs you of an increased risk for developing obesity-associated diseases or conditions.

Other risk factors that are associated with obesity and can have a negative impact on health include: 

  • High blood pressure (hypertension)
  • High LDL-cholesterol ("bad" cholesterol)
  • Low HDL-cholesterol ("good" cholesterol)
  • High triglycerides
  • High blood glucose (sugar)
  • Family history of premature heart disease
  • Physical inactivity or a sedentary lifestyle
  • Cigarette smoking

For obese or overweight people who have two or more risk factors, federal guidelines recommend weight loss. Even a small amount of weight loss (such as ten percent of your current weight) lowers your chance of developing diseases associated with obesity. Patients who are overweight but have less than two risk factors and do not have a high waist measurement may just need to prevent further weight gain rather than lose weight.

Ask your doctor to evaluate your BMI, waist measurement, and others risk factors for heart disease. He or she can let you know your level of risk, and whether you should lose weight.

Causes

Inactive Lifestyle

Many Americans aren't very physically active. One reason for this is that many people spend hours in front of TVs and computers doing work, schoolwork, and leisure activities. In fact, more than two hours a day of regular TV viewing time has been linked to weight gain and obesity.

Other reasons for not being active include relying on cars instead of walking, fewer physical demands at work or at home because of modern technology and conveniences, and lack of physical education in schools for children.

People who are inactive are more likely to gain weight because they don't burn up the calories that they take in. An inactive lifestyle also raises your risk of coronary heart disease, high blood pressure, diabetes, colon cancer, and other health problems.

Environment

Our environment doesn't support healthy lifestyle habits; in fact, it encourages obesity. Some examples include:

  • Lack of neighborhood sidewalks and safe places for recreation. Not having nearby parks, trails, sidewalks, and affordable gyms makes it hard for people to be physically active.
  • Work schedules. People often say that they don't have time to be physically active because of long work hours and time spent commuting.
  • Excess food portions. Americans are surrounded by huge food portions in restaurants, fast food outlets, gas stations, movie theaters, supermarkets, and even home. Eating large portions means too much energy IN. Over time, this will cause weight gain if it isn't balanced with physical activity.
  • Lack of access to healthy foods. Some people don't live in neighborhoods with supermarkets that sell healthy foods, such as fresh fruits and vegetables. Or, for some people, these healthy foods are too costly.
  • Food advertising. Americans are surrounded by ads from food companies. Often children are the targets of advertising for high-calorie, high-fat snacks, and sugary drinks. The goal of these ads is to sway people to buy these high-calorie foods.

Genes and Family History

Studies of identical twins, who have been raised apart, show that genes strongly influence a person's weight. Vulnerability to weight gain and obesity tends to run in families. Your chances of being overweight are greater if one or both of your parents are overweight or obese.

Your genes also may affect the amount of fat you store in your body and where on your body you carry the extra fat. Because families also share food and physical activity habits, a link exists between genes and the environment.

Children adopt the habits of their parents. A child who has overweight parents who eat high-calorie foods and are inactive will likely become overweight too. However, if the family adopts healthy food and physical activity habits, the child's chance of being overweight or obese is reduced.

Health Conditions

Some hormone problems may cause weight gain and obesity, such as an under-active thyroid (hypothyroidism), Cushing's syndrome, and polycystic ovarian syndrome (PCOS).

Hypothyroidism is a condition in which the thyroid gland doesn't make enough thyroid hormone. Lack of thyroid hormone will slow down your metabolism and cause weight gain. You'll also feel tired and weak.

Cushing's syndrome is a condition in which the body's adrenal glands make too much of the hormone cortisol. Cushing's syndrome also can develop if a person takes high doses of certain medicines, such as prednisone, for long periods. People who have Cushing's syndrome gain weight, have upper-body obesity, a rounded face, fat around the neck, and thin arms and legs.

PCOS is a condition that affects about 5-10 percent of women of childbearing age. Women who have PCOS are often obese, have excess hair growth, and have reproductive problems and other health issues due to high levels of hormones called androgens.

Medications

Certain medications may cause you to gain weight. These include some corticosteroids, antidepressants, and seizure medications. Medication can slow the rate at which your body burns calories, increase your appetite, or cause your body to hold extra water. All of these factors can lead to weight gain. If weight gain is a side effect of a medication you are taking, talk to your doctor about potentially switching to a different medication that isn't associated with weight gain. 

Emotional Factors

Some people eat more than usual when they're bored, angry, or stressed out. Over time, overeating will lead to weight gain and may cause obesity.

Smoking

Some people gain weight when they stop smoking. One reason is that food often tastes and smells better after quitting smoking. Another reason is because nicotine raises the rate at which your body burns calories, so you burn fewer calories when you stop smoking. Smoking is a serious health risk, however, and quitting is more important to reaching a state of physical wellness than possible weight gain.

Age

As you age, you tend to lose muscle, especially if you're less active. Muscle loss can slow down the rate at which your body burns calories. If you don't reduce your calorie intake as you get older, you may gain weight. Midlife weight gain in women is mainly due to aging and lifestyle, but menopause also plays a role. Many women gain around five pounds during menopause and have more fat around the waist than they did before.

Pregnancy

During pregnancy, women gain weight so that their babies get proper nourishment and develop normally. After giving birth, some women find it hard to lose the weight. This may lead to obesity, especially after a few pregnancies.

Sleep

Studies find that the less people sleep, the more likely they are to be overweight or obese. People who report sleeping five hours a night, for example, are much more likely to become obese compared with people who sleep seven to eight hours a night.

People who sleep fewer hours also seem to prefer eating foods that are higher in calories and carbohydrates, which can lead to overeating, weight gain, and obesity over time.

Hormones that are released during sleep control appetite and the body's use of energy. For example, insulin controls the rise and fall of blood sugar levels during sleep. People who don't get enough sleep have insulin and blood sugar levels that are similar to those in people who are likely to have diabetes.

Also, people who don't get enough sleep regularly seem to have high levels of a hormone called ghrelin (which causes hunger) and low levels of a hormone called leptin (which normally helps curb hunger).

Treatments

A combination of healthy diet and exercise (when you stick to it) appears to work better than either one alone. Sticking to a weight reduction program is difficult and requires a lot of support from family and friends.

When dieting, your main goal should be to learn new, healthy ways of eating and make them a part of your everyday routine. Work with your doctor and nutritionist to set realistic, safe daily calorie counts that assure both weight loss and good nutrition. Remember that if you drop pounds slowly and steadily, you are more likely to keep them off. Your nutritionist can teach you about healthy food choices, appropriate portion sizes, and new ways to prepare food. Even modest weight loss can improve your health. Most people can lose weight by eating a healthier diet, exercising more, and adopting new behaviors such as keeping a food diary, avoiding food triggers, and thinking positively. The decision to keep fit requires a lifelong commitment of time and effort. Patience is essential.

Several simple behavioral changes can have an impact on your weight loss success:

  • Set realistic goals for weight reduction. One should engage in aerobic exercise for at least 30 minutes a day, three times a week, and try to increase physical activity in general.
  • Eat only at the table. No snacking in front of the TV, in bed, while driving, or while standing in front of the open refrigerator.
  • Learn about appropriate portion sizes.
  • Choose low-calorie snacks, such as raw vegetables.
  • Consider learning meditation or yoga as a way of managing stress, rather than snacking.
  • Find ways to socialize and enjoy your friends and family that don't involve a meal or dessert.
  • Consider keeping a diet and exercise journal. This may help you identify overeating triggers in your life.
  • Find a support group or consider psychotherapy to help support you in the difficult but worthy goal of weight loss.

The following are key recommendations from the National Institutes of Health expert panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults:

  • The initial goal of weight-loss therapy should be to reduce body weight by about 10 percent from baseline. For the first six months, weight loss should be approximately one to two pounds per week. If necessary, the patient can continue to lose more weight.
  • Reducing dietary fat alone without reducing calories is not enough to cause weight loss. However, reducing dietary fat along with reducing dietary carbohydrates can help reduce calories.
  • Drug therapy can also be used. However, drug safety and efficacy beyond one year of total treatment have not been established.

Some people lose weight on their own; others like the support of a structured program. If you decide to join any kind of weight-control program, here are some questions to ask before you join.

  • Does the program provide counseling to help you change your eating and personal habits?
  • Will this program teach you how to permanently change habits and lifestyle factors that have contributed to weight gain?
  • Is the staff made up of a variety of qualified counselors and health professionals such as nutritionists, registered dietitians, doctors, nurses, psychologists, and exercise physiologists? You need an evaluation by a physician if you have any health problems, are currently taking or plan on taking any medicine or plan to lose more than 15 to 20 pounds. If your weight-control plan uses a very low-calorie diet, you need an exam and follow-up visits by a doctor.
  • Is training available on how to deal with times when you may feel stressed and slip back to old habits? Is attention paid to keeping the weight off, and how long is this phase?
  • The program should provide long-term strategies for dealing with weight problems that may come up in the future. These strategies might include things like establishing a support system and establishing a physical activity routine.
  • Are food choices flexible and well-suited to the individual? Are weight goals set by the client and the health professional? The program should consider your food likes and dislikes and your lifestyle when your weight-loss goals are planned.
  • What percentage of people complete the program?
  • What is the average weight loss among people who finish the program?
  • What percentage of people have problems or side effects, and what are they?
  • Are there fees or costs for additional items, such as dietary supplements?

Quick weight-loss methods do not lead to lasting results. Relying on diet aids like drinks, prepackaged foods or pills don't work over the long term. No matter how much weight you wish to lose, modest goals and a slow pace will increase your chances of losing the weight and keeping it off.

Guide to Physical Activity

Exercise is an integral part of a weight loss and weight maintenance plan. It also reduces the risk of cardiovascular disease and diabetes, beyond that produced by weight reduction alone.

Your exercise can be done all at one time or intermittently over the day. Initial activities may be walking or swimming at a slow pace. Your regimen can be adapted to other forms of physical activity, but walking is a particularly smart choice because of its safety and accessibility. Increase activity by undertaking frequent, less strenuous exercises, such as walking up and down the stairs instead of the using the elevator. You may eventually be able to engage in more strenuous activities such as tennis or any form of group sport.

Guide to Behavior Change

Many people suffer from health issues due to their weight. Some people who need to lose weight for their health don't recognize it, while others who don't need to lose weight want to get thinner for cosmetic reasons.

Weight can affect a person's self-esteem. Excess weight is clearly visible and may attract ridicule. The amount of weight loss needed to improve your health may be much less than your total weight-loss goal. Your health can be greatly improved by a loss of five to 10 percent of your starting weight. That doesn't mean you have to stop there, but it does mean that an initial goal of losing five to 10 percent of your starting weight is both realistic and valuable.

Healthy Foods (National Heart, Lung, and Blood Institute Obesity Guidelines)

Shop for low-fat and low-sugar food items and fill your kitchen cupboards with a supply of basics like the following:

  • Fat free or low-fat milk, yogurt, cheese, and cottage cheese
  • Olive oil
  • Eggs/egg substitutes
  • Soft corn tortillas, low fat flour tortillas
  • Low-fat, low-sodium crackers
  • Plain cereal, dry or cooked
  • Brown rice, whole-grain pasta
  • White meat chicken or turkey (remove skin)
  • Fish and shellfish (not battered)
  • Beef: round, sirloin, chuck arm, loin and extra lean ground beef
  • Pork: leg, shoulder, tenderloin
  • Dried beans and peas
  • Fresh, frozen, canned fruits in light syrup or juice
  • Fresh, frozen, or no salt added canned vegetables
  • Low-fat or nonfat salad dressings
  • Mustard and ketchup
  • Jam, jelly, or honey
  • Herbs and spices
  • Salsa

Surgery

Weight-loss surgery may be an option if you are very obese and have not been able to lose weight through diet and exercise. However, these surgeries are not a "quick fix" for obesity. You must still be committed to diet and exercise after the surgery. Talk to your doctor to learn if this is a good option for you.

The two most common weight-loss surgeries are:

  • Laparoscopic gastric banding—the surgeon places a band around the upper part of your stomach, creating a small pouch to hold food. The band limits the amount of food you can eat by making you feel full after eating small amounts of food.
  • Gastric bypass surgery—helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, you will not be able to eat as much as before, and your body will not absorb all the calories and other nutrients from the food you eat.

References

  • Center for Disease Control
  • National Heart, Lung and Blood Institute
  • National Institutes of Health, National Library of Medicine
  • U.S. Department of Health and Human Services
  • National Institute of Diabetes & Digestive & Kidney Diseases

Last reviewed 04/19/2017