OBESITY

Definition


Obesity is defined as having an excessive amount of body fat. Obesity is more than just a cosmetic concern, though. It increases your risk of diseases and health problems such as diabetes and high blood pressure.

Doctors often use a formula based on your height and weight — called the body mass index (BMI) — to determine if you are obese. Adults with a BMI of 30 or higher are considered obese. Extreme obesity, also called severe obesity or morbid obesity, occurs when you have a BMI of 40 or more. With morbid obesity, you are especially likely to have serious health problems.


BMI Weight status

Below 18.5 Underweight

18.5 — 24.9 Normal

25.0 — 29.9 Overweight

30.0 and higher Obese


Today, about one in three American adults is considered to be obese, but obesity is also becoming an increasing health problem globally. The good news is that even modest weight loss can improve or prevent the health problems associated with obesity.

Symptoms

Symptoms associated with obesity can include:

• Difficulty sleeping 
• Snoring
• Sleep apnea
• Pain in your back or joints
• Excessive sweating
• Always feeling hot
• Rashes or infection in folds of your skin
• Feeling out of breath with minor exertion
• Daytime sleepiness or fatigue
• Depression

When to see a doctor

If you have symptoms associated with obesity such as the ones above, see your doctor or health care provider. You and your doctor can discuss your weight-loss options. Even modest weight loss can improve or prevent problems related to obesity. Weight loss is usually possible through dietary changes, increased physical activity and behavior changes. In some cases, prescription medications or weight-loss surgery may be options.

Causes

Although there are genetic and hormonal influences on body weight, the bottom line is that obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat. Obesity usually results from a combination of causes and contributing factors, including:

Inactivity. If you're not very active, you don't burn as many calories. Unfortunately, today most adults spend most of their day sitting, whether at home, at work or during leisure activities. With a sedentary lifestyle, you can easily take in more calories every day than you burn off through exercise or normal daily activities. Watching too much television is one of the biggest contributors to a sedentary lifestyle and weight gain.

Unhealthy diet and eating habits. Having a diet that's high in calories, eating fast food, skipping breakfast, eating most of your calories at night, consuming high-calorie drinks and eating oversized portions all contribute to weight gain.

Pregnancy. During pregnancy a woman's weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.

Lack of sleep. Getting less than seven hours of sleep a night can cause changes in hormones that increase your appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain.

Certain medications. Some medications can lead to weight gain if you don't compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers.

Medical problems. Obesity can sometimes be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome, polycystic ovary syndrome, and other diseases and conditions. Some medical problems, such as arthritis, can lead to decreased activity, which may result in weight gain. A low metabolism is unlikely to cause obesity, as is having low thyroid function.

Risk factors

Factors that may increase your risk of obesity include:

Genetics. Your genes may affect the amount of body fat you store and where that fat is distributed. Genetics also may play a role in how efficiently your body converts food into energy and how your body burns calories during exercise.

Family history. Obesity tends to run in families. That's not just because of genetics. Family members tend to have similar eating, lifestyle and activity habits. If one or both of your parents are obese, your risk of being obese is increased.

Age. Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs and can make it harder to keep off excess weight. If you don't decrease your caloric intake as you age, you'll likely gain weight.

Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to a weight gain of as much as several pounds a week for several months, which can sometimes lead to obesity.

Social and economic issues. Certain social and economic issues may be linked to obesity. You may lack access to safe areas to exercise, you may not have been taught healthy ways of cooking, or you may not have the financial means to buy fresh fruits and vegetables or foods that aren't processed and packaged. In addition, some studies show that your social networks influence your weight — you're more likely to become obese if you have obese friends or relatives.

Even if you have one or more of these risk factors, it doesn't mean that you're destined to become obese. You can counteract most risk factors through diet, physical activity and exercise, and behavior changes.

Complications

If you're obese, you're more likely to develop a number of potentially serious health problems, including:

• Blood (fat) lipid abnormalities
• Cancer, including cancer of the uterus, cervix, ovaries, breast, colon, rectum and prostate
• Depression
• Gallbladder disease
• Gynecological problems, such as infertility and irregular periods
• Heart disease
• High blood pressure
• Metabolic syndrome
• Nonalcoholic fatty liver disease
• Osteoarthritis
• Skin problems, such as intertrigo and impaired wound healing
• Sleep apnea
• Stroke
• Type 2 diabetes

What you can do


Being an active participant in your care can help your efforts to overcome obesity. One way to do this is by preparing for your appointment. Think about your needs and goals for treatment. Also, write down a list of questions to ask. These questions may include:


Why can't I get over obesity on my own?

What other health problems might I have?

What are the treatment options for obesity and my other health problems?

Is weight-loss surgery an option for me?

Will counseling help?

Are there weight-loss medications that might help?

How long will treatment take?

What can I do to help myself?

Are there any brochures or other printed material that I can take home with me?

What Web sites do you recommend visiting?

In addition to your prepared questions, don't hesitate to ask questions at any time during your appointment.


What to expect from your doctor

During your appointment, your doctor or other health provider is likely to ask you a number of questions about your eating, activity, mood and thoughts, and any symptoms you might have. You may be asked such questions as:

What do you eat in a typical day

How much activity do you get in a typical day?

During what periods of your life did you gain weight?

What are the factors that you believe affect your weight?

How is your daily life affected by your obesity?

How is your mood affected by your weight?

What diets or treatments have you tried to lose weight?

What other medical conditions, if any, do you have?

Do you have any family members with weight problems?

What are your weight-loss goals?

Are you ready to make changes in your lifestyle to lose weight?

What do you think might prevent you from losing weight?

How committed are you to losing weight?

What medications or over-the-counter herbs and supplements do you take?

What you can do in the meantime

If you have several days or weeks before your scheduled appointment, you can start making some changes on your own to your eating and activity levels as you begin the journey to lose weight.

Start making healthy changes in your diet, such as eating more fruits, vegetables and whole grains and reducing portion sizes. Eat breakfast.

Track how much you're eating or drinking each day so you get a sense of how many calories you're consuming. It's easy to underestimate how many calories you actually consume every day.

Begin increasing your activity level. If possible, take some walks. Otherwise, simply try to get up and move around your home more frequently. Start gradually if you aren't in good shape or aren't used to exercising. If you have any health conditions, or if you're a man over age 40 or a woman over age 50, talk to your doctor before you start a new exercise program.

Tests and diagnosis

If your doctor believes you are overweight or obese, he or she will typically review your health history in detail, perform a physical exam and recommend some tests. These can help confirm the diagnosis, check to see what may be contributing to your weight problem and also check for any related complications.

These exams and tests generally include:

Taking your healthy history. Your doctor reviews your weight history, weight-loss efforts, exercise habits, eating patterns, what other conditions you've had, medications, stress levels and other issues about your health. Your doctor also may review your family's health history to see if you may be predisposed to certain conditions.

Assessing other health problems. If you have known health problems, your doctor will evaluate them. Your doctor will also check for other possible health problems, such as high blood pressure or binge eating disorder.

Calculating your BMI. Your doctor will check your body mass index (BMI) to determine your level of obesity. Your BMI also helps determine what other health problems you may face and what treatment may be appropriate.

Measuring your waist circumference. Fat stored around your waist, sometimes called visceral fat or abdominal fat, may further increase your risk of diseases such as diabetes and heart disease. Women with a waist measurement of more than 35 inches and men with a waist measurement of more than 40 inches may have more health risks than people with smaller waist measurements.

A general physical exam. This includes measuring your height, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.

Laboratory tests. What tests you have depend on your health and risk factors. They may include a complete blood count (CBC), a check of cholesterol and other blood fats, liver function tests, fasting glucose, a thyroid test, and others depending on your health situation. Your doctor also may recommend certain heart tests, such as an electrocardiogram.

Gathering all this information helps you and your doctor determine how much weight you need to lose and what health conditions or risks you have. And this will shape what treatment options are right for you.

Treatments and drugs

The goal of obesity treatment is to achieve and maintain a healthier weight to reduce your risk of serious health problems and enhance your quality of life. You may need to work with a team of health professionals, including a nutritionist, dietitian, therapist or an obesity specialist, to help you understand and make changes in your eating and activity habits. Together, you can determine a healthy goal weight and how to achieve it. Your initial goal may be to lose 5 to 10 percent of your body weight within six months.

You can start feeling better and seeing improvements in your health with just minor weight loss, though — 5 to 15 percent of your total weight. That means that if you weigh 200 pounds (91 kilograms) and are obese by BMI standards, you would need to lose only about 10 to 30 pounds (4.5 to 13.6 kilograms) to start seeing benefits.

Specific treatment methods

There are many ways to treat obesity and reach a healthier weight. The treatment methods that are right for you depend on your level of obesity, your overall health, and your willingness to participate in your weight-loss plan. Think of your treatment plan as a way to make changes that you can stick with for a lifetime, so that you keep the weight off.

Treatment methods include:

Dietary changes

Exercise and activity

Behavior change

Prescription weight-loss medications

Weight-loss surgery

Achieving a healthy weight is usually done by making changes in your lifestyle — dietary changes, increased activity and behavior change. Prescription medication or weight-loss surgery is typically used in addition to lifestyle changes in more serious cases.

Dietary changes

Reducing your daily calorie intake and eating healthier are vital to overcoming obesity. Slow and steady weight loss of 1 or 2 pounds (1/2 to 1 kilogram) a week is considered the safest way to lose weight and the best way to keep it off permanently. Avoid drastic and unrealistic diet changes, such as crash diets, because they're unlikely to help you keep excess weight off for the long term. There are a number of different dietary strategies to choose from, all of which can lower your calorie intake.

Dietary ways to overcome obesity include:

Reducing your calorie intake. The key to weight loss is reducing how many calories you consume. You and your health care providers can review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You may be eating larger portions than you thought, or realize that your diet includes lots of fast food, sweets or sugary drinks. You and your doctor can decide how many calories you need to take in each day to achieve weight loss, but a typical amount is 1,000 to 1,600 calories.

Feeling full on less. The concept of energy density can help you satisfy your hunger with fewer calories. All foods have a certain number of calories within a given amount (volume). Some foods, such as desserts, candies and processed foods, are high in energy density. This means that a small volume of that food has a large number of calories. In contrast, other foods, such as fruits and vegetables, have low energy density. These foods provide a larger portion size with a fewer number of calories. By eating larger portions of foods less packed with calories, you squelch hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall.

Adopting a healthy eating plan, such as the Mayo Clinic Healthy Weight Pyramid. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole grains. Also emphasize plant sources of protein, such as beans, lentils and soy, choose lean meats, and try to include seafood twice a week. Limit salt and added sugar. Stick with low-fat dairy products. And make sure fats come from healthier sources, such as nuts and olive, canola and nut oils. When you adopt an overall healthier diet, rather than trying a crash diet, you're more likely to follow it for the long term. The Mayo Clinic Healthy Weight Pyramid is one way to adopt a healthy, lifelong eating plan. This means no severe restrictions on the foods you eat and no extreme hunger. The base of the pyramid focuses on generous amounts of healthy foods that contain a small number of calories in a large volume of food, particularly fruits and vegetables. Healthy choices in moderate amounts make up the rest of the pyramid, which focuses on whole-grain carbohydrates, lean sources of protein such as legumes, fish and low-fat dairy, and heart-healthy unsaturated fats.

Following a very low calorie liquid diet if medically recommended. These mainly liquid diets are meant to provide rapid weight loss over the short term. They provide only about 600 to 800 calories a day. Your doctor may recommend a very low calorie diet if you need to lose weight quickly before a medical procedure or if you have serious health problems. Don't try it on your own. You need close monitoring by your health care providers to avoid complications. You also may need to take vitamin or nutritional supplements. While you may be able to lose weight quickly on a very low calorie diet, you're also likely to regain it quickly once you stop the diet. To prevent weight regain after a very low calorie diet, you must make changes in your overall diet, activity level and behavior.

Meal replacements. These plans suggest that you replace one or two meals with their products — such as low-calorie shakes or meal bars — and eat healthy snacks and a healthy, balanced third meal that's low in fat and calories. In the short term, this type of diet can help you lose weight, and they may be a good option if they help you control portion size, limit calories and encourage healthy eating. Keep in mind that these diets likely won't teach you how to change your overall lifestyle, though. So while they may work for some, you might find it hard to maintain your weight loss over the long term.