Obesity
Live leaner, live longer
Obesity is not always due to overeating and under-exercising. Your genetic traits can have an impact as well. Other factors may include hormones, psychological traits, insulin imbalances, and drug therapies that can cause weight-gain.
While the self-image problems associated with obesity can often seem like the most serious worry, the most dangerous aspects of this condition are its increased health risks. Obesity has now been linked to diabetes, heart disease, and several types of cancer. Being overweight can also exacerbate back and foot pain, arthritis, and respiratory problems.
Pronunciation
o-BEE-se-tee
Synonyms
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- Overweight
- Adiposis
- Adiposity
Detailed Description
Obesity is currently defined as a body weight of at least 20% over an individual's optimum body weight. But wait -- who gets to decide what your optimum body weight is? This is where the definitions vary. Some systems of measurement use age, height, and the body mass index (BMI) to determine an optimum weight. Others measure an individual's percentage of body fat, and not overall body weight at all.
Different designations of obesity exist. The term "clinically severe obesity" is used when a person is 100 pounds or 60% over the optimum weight, putting them at risk for heart and lung problems, including heart failure and obstructive sleep apnea. A moderately obese person is more than 20% over their optimum weight. Some conditions linked to this degree of obesity include high blood pressure, type II diabetes, and gallstones.
Hyperplastic-hypertrophic obesity has an early onset and shows an increase in the body's number of fat cells. Hypertrophic obesity starts after sexual maturity and shows an increase in the size of the body's fat cells without an increase in their number.
Treatments for obesity range from nutritional programs to drug therapy to surgical procedures. In addition, because of the sometimes deep psychological effects of this condition, communication between patient and physician during treatment is of utmost importance.
How Common Is Obesity?
Approximately 50% of all Americans are overweight, and of these, up to 30% are obese. Obesity affects all age groups. According to some reports, a higher percentage of women develop obesity than men.
What You Can Expect
It is generally true that many people can control obesity to some degree. If you stay committed to your new lifestyle, or take the appropriate measures suggested by your doctor, you can expect to lose weight. Unless there is a complication, such as a thyroid or hormone imbalance, your level of commitment will determine the outcome of your treatment.
Established Causes
The causes of obesity are more complex than was once thought. However, it is now believed that up to 30% of the variance in an individual's body fat can be due to genetics.
Overeating and under-exercising are the most common causes. Genetic predisposition to a high percentage of fat cell distribution can also influence overall body weight.
Other causes include the following:
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- Endocrine disorders (Cushing's disease, hyperinsulinemia, primary hypothyroidism, polycystic ovary syndrome, and others)
- Psychological makeup
- Insulin imbalance
Risk Factors
The risk of developing obesity increases with any of the following:
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- Obese parents
- Pregnancy
- Sedentary lifestyle
- High-fat diet
- Low socioeconomic status
- Aging
- Cigarette smoking cessation
- Medical problems
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
Symptoms
Recognized signs of obesity:
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- Body fat measured at more than 25% for women or more than 20% for men
- Being more than 20% over your optimum body weight
How Obesity Is Diagnosed
Physical examinations
Doctors typically determine obesity by calculating the body mass index ratio (BMI) or by calculating the percentage of body fat. If there is a question, however, as to the cause, the following procedures may be in order:
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- Thyroid function tests
- Cardiac risk tests
Other diagnostic tests your doctor may order include the following:
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- Measurement with calipers -- instruments which measure skin folds
- Measurement of body fat by weighing a patient underwater -- thought to be the most accurate determination of overall body fat
Goals of Treatment
When obesity is caused specifically by overeating and under-exercising, it can be corrected, but only if the person remains highly motivated. However, when the condition involves genetic factors or other disorders, it is more a matter of controlling the condition, rather than curing it.
The goal of treatment is to lose a certain amount of weight slowly and consistently. In the case of obesity, losing this weight is expected to positively affect many areas of your life, including general internal health, cardiac fitness, physical fitness, and self-esteem, to name a few.
Treatment Overview
The approach to obesity includes a search for underlying conditions. Many approaches are based on changes in eating and dietary patterns, exercise, and behavior modification. Drug and surgical treatment may be useful for some.
The following may be recommended activities if you are obese:
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- Swimming
- Walking
- Low-impact exercise
In some instances, your doctor may suggest a very low calorie diet (VLCD). However, these VLCDs have been known to cause complications, including dehydration, orthostatic hypotension, fatigue, muscle cramps, constipation, headaches, and cold intolerance. These diets must be approved and closely monitored by your doctor.
Drug Therapy
Medication is not the total solution for weight control, but it may be a helpful part of some programs.
Drugs most commonly prescribed
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- Acutrim (phenylpropanolamine)
- Fastin (phentermine)
- Mazanor (mazindol)
- Meridia (sibutramine)
- Tenuate (diethylpropion)
- Zenical (orlistat)
NOTE: Both Pondimin (fenfluramine) and Redux (dexfenfluramine) have been removed from the market by their manufacturers for observed complications of valvular heart problems and rare irreversible lung problems.
Second choices
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- Benzphetamine
- Phendimetrazine
- Phenmetrazine
New drugs in development
Drugs in research include:
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- Leptin
- Leptin-receptor stimulants
- BTA-243
- CCK-agonist
- Urocortin mimic
- Neuropeptide Y blockers
- NGD-95-1
- Orexin
- GLP-1 and GLP-2
Surgery
When obesity becomes a life-threatening disorder, surgical measures can be taken:
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- Gastric bypass: This is a procedure that removes a part of the small intestine, allowing for reduced absorption of calories (and nutrients). The Roux-en-Y operation is one of the most prevalent and successful.
- Stapling procedure: This involves stapling a section of the stomach to reduce its size, which in turn causes the patient to eat less. The vertical banding gastroplasty is one of the most prevalent and successful.
- Jaw wiring: In rare circumstances some patients have had their jaws wired shut to prevent them from ingesting any solid foods. This is a controversial procedure.
A physician should closely monitor obesity therapies at all levels. However, in treatments involving very low calorie diets, drugs, or surgery, monitoring becomes imperative.
Healthcare Professionals Who May Be Involved in Treatment
The following health providers may help you manage this condition:
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- Family physicians
- Internists
- Pediatricians
- Endocrinologists
- General surgeons
Monitoring the Condition
Following up with your doctor is imperative if you have had surgery, drug therapy, or have been put on a very low calorie diet (VLCD).
Even with other treatments, follow-up is important to ensure your success and the continuation of your successful weight management.
Possible Complications
While not usually caused by obesity, conditions that are more likely to be involved with obesity include the following:
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- Diabetes mellitus
- Atherosclerosis
- Hypertension
- Coronary artery disease
- Congestive heart failure
- Thromboembolic disease
- Gout
- Osteoarthritis
- Restrictive lung disease
- Sleep apnea
Quality of Life
The quality of your life may be severely affected by the many and far-reaching psychological effects of obesity. Because of the social stigma placed on this condition, many of those affected suffer from negative body-image and low self-esteem. This in turn can lead to extreme self-consciousness, isolation, and discomfort in social situations. Counseling can be helpful in these situations.
Considerations for Women
Pregnancy
Pregnancy is sometimes a starting-point for the development of obesity. Women who follow their obstetrician's guidelines for diet and exercise during pregnancy will be less likely to develop obesity. Average anticipated/acceptable weight gain during pregnancy is between 15 and 35 pounds depending on prepregnancy weight, relative to one's ideal body weight.
Considerations for Children and Adolescents
The same factors that cause obesity in adults can also cause this condition in adolescents. And obesity in children is harder to treat than in adults, because fewer treatment options are available. Drugs and other treatments have not been tested to see if they are safe for those who are younger. Obesity at this stage in life can lead to psychological isolation and poor self-image. Counseling is helpful for children who are experiencing such problems.
Supplements
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- Fiber: If you don't care for whole-grain breads and cereals, or don't eat enough fiber, many studies show that fiber supplements help control weight and reduce hunger. British researchers gave 17 obese women either a placebo or a fiber supplement (20 g of psyllium seed in water) three hours before meals and immediately before meals. One hour after meals, those who took the psyllium seed ate less fat, reported feeling fuller, and were better able to control their weight. [1] Psyllium seed is the main ingredient in Metamucil.
- Chromium picolinate: Researchers in Texas gave 122 dieters either a placebo or chromium picolinate (400 mcg/day). After three months, the supplement group lost significantly more weight (16 pounds vs. 4 pounds). [2]
Relaxation
Hypnosis can help. Researchers placed 109 overweight individuals on a medically supervised weight-loss program, and in addition, deeply relaxed some with regular hypnotherapy. After eight months, the hypnosis group lost significantly more weight. [3] Meditation is similar to hypnosis, and presumably also helps. Exercise is also deeply relaxing -- plus it burns calories and increases your basal metabolic rate (BMR).
For more in-depth weight loss information, news, and products, visit the Weight Loss eCenter.
1 Turnbull, W.H. and H.G. Thomas. "Effect of a Plantago Ovata Seed-Containing Preparation on Appetite Variable, Nutrients, and Energy Intake," International Journal of Obesity (1995) 19:338.
2 Kaats, G., et al. "A Randomized, Double-Masked, Placebo-Controlled Study of the Effects of Chromium Picolinate Supplementation on Body Composition," Current Therapeutic Research (1998) 59:379.
3 Duncan, J.D., et al. "Women Walking for Health and Fitness: How Much is Enough?" Journal of the American Medical Association (1991) 266:3295.
Self-Care Measures
Your Diet
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- Eat! Don't starve yourself. Starvation leads to desperation and binge eating. It also slows your basal metabolic rate (BMR), which makes it harder to lose weight and easier to regain it.
- Watch what you eat. Eat foods high in fiber and complex carbohydrates (fruits, vegetables, beans, and whole-grain items) and low in fat (15% to 20% of the item's calories). Every so often, an expert comes along who says a high-protein, low-carbohydrate diet is the way to go -- the diet espoused in The Zone, for example. But weight-control experts generally agree that cutting fat and increasing plant foods is the nutritional path to permanent weight control. A little arithmetic shows why: Fat contains nine calories per gram, while carbohydrates and protein contain only four calories. You can eat twice as much carbohydrate and protein and still consume fewer calories that you would by eating fat.
- Eat breakfast. Several studies have shown that skipping breakfast is a set-up for weight gain. Eating a high-carbohydrate breakfast -- a whole-grain cereal or toast -- raises your basal metabolic rate (BMR) for several hours, which helps you burn calories and control your weight. But if you skip breakfast, eat a light lunch, and then have a big dinner and snacks until bedtime, your BMR stays low during the day and you consume most of your calories shortly before it goes even lower during sleep. That's a set-up for weight gain.
- "Nonfat" and "fat-free" don't mean "low-calorie." Calories count. Many people binge on nonfat cookies and cakes, thinking they can't contribute to weight gain. But they can -- and do. In fact, many fat-fee foods are almost as high in calories as their standard counterparts.
- Snack on fruits and vegetables. They fill you up but are low in fat and calories.
- Beware of "super-size" portions. Restaurant portions are much large today than they were 20 years ago -- and as a result, much higher in calories. Eat half your meal, and take the rest home.
- Drink water. Soft drinks, fruit drinks, alcoholic beverages, cappuccinos, and other fancy coffee drinks can contain up to several hundred calories. Try to drink six to 10 eight-ounce glasses of water a day.
Exercise
Dieting alone is not enough. Exercise is key! To control your weight, you must exercise regularly. In one study, University of Chicago researchers placed 23 obese women on one of three programs: a low-fat diet, a low-carbohydrate diet, or a daily aerobic exercise program with no diet restrictions. After 12 weeks, the exercisers lost significantly more weight and more fat.
In addition to burning calories, exercise also boosts your basal metabolic rate, so you keep burning more calories even when you're not exercising. And exercise elevates mood, reduces stress, and improves self-esteem, all of which help prevent eating triggered by emotional needs for comfort and stress relief.
Take a walk
This is one of the best ways to exercise. There's nothing to learn, no gym to join, and no special clothes to buy -- and possibly feel embarrassed in. Plus walking is fun, so you're more likely to keep doing it.
You don't even have to walk that briskly. Researchers at the Cooper Institute of Aerobics Research in Dallas divided 102 sedentary women into four groups. One group remained sedentary. The second engaged in leisurely 2.5-mile strolls five days a week. The third walked the same distance briskly. And the fourth group race-walked the distance. The results? The strollers controlled their weight almost as well as the brisk walkers and racewalkers, and actually lost more body fat.
Here are a few walking tips:
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- Take a 10-minute walk before lunch and/or dinner.
- Park farther away from work or shopping, and walk a little more.
- Take the stairs instead of the elevator. Start by walking down. Work up to walking up.
Websites & Organizations
American Dietetic Association
216 West Jackson Blvd., Ste. 800
Chicago, IL 60606-6995
Phone: 312-899-0040
American Obesity Association
Phone: 800-98-OBESE (800-986-2373)
Barbara's Obesity Meds and Research News
Calorie Control Council
Dr. Blumenkrantz on Obesity
National Heart, Lung, and Blood Institute
Information Office
P.O. Box 30105
Bethesda, MD 20892-0105
Phone: 301-251-1222
National Institute of Diabetes and Digestive Kidney Diseases
1 Information Way
Bethesda, MD 20892-3560
Email: ndic@info.niddk.nih.gov
Nutritional Institution of America
200 West 86th St., Ste. 17A
New York, NY 10024
Obesity.com
UCLA Obesity Center
Phone: 310-825-8173 or 818-501-3881
Email: mmaxwell@ucla.edu
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