Obesity is a condition
in which an individual has
an excess of adipose (fatty)
tissue. It is a serious
medical condition that is
growing quickly in prevalence
and has become the second
leading cause of preventable
death (after tobacco smoking).
Obesity is measured in
a variety of ways, and your
bathroom scale is not the
best way to do it. Scales
measure only one's weight,
and a high weight may or
may not be associated with
having too much body fat.
The most popular way to
measure obesity is through
use of the BMI, or "Body
Mass Index." This is a calculation
based upon your height and
weight, (calculate
your BMI). However,
it is not a perfect tool
either, as some athletes
have high BMIs even though
they have much more muscle
than fat.
Another useful measurement
is waist size, since it
is often associated with
excess of fat in the central
trunk that is known to be
associated with higher disease
experience. Men who measure
over 40 inches at the upper
edge of the pelvis, and
women with measurements
above 35 inches, are often
at greater risk for illness,
particularly if they also
have a BMI greater than
30.
What
Causes Obesity?
Weight is largely determined
by the balance between a
person's intake of calories
and the energy he expends
each day. If you consume
more energy than you use,
your body stores the extra
as fat.
There are a variety of
factors that contribute
to the development of obesity.
Genetics: Some
people have a genetic predisposition
to gaining weight. However,
not everyone with this tendency
will become obese, and not
all obese people have the
genetic character.
Environment: Being surrounded
by bountiful amounts of
high calorie foods can lead
to more likely weight gain,
particularly if overeating
and avoidance of exercise
are practiced by those with
whom we associate.
Behavior: Avoidance of
obesity in an environment
of abundance requires discipline
and attention to one's food
intake and level of exercise.
Specific behavioral strategies
for weight loss and maintenance
include logging and tracking
diet and exercise patterns
in a diary, eating a low
calorie diet, limiting the
amount of calories from
fat, expending calories
routinely through exercise,
monitoring weight regularly,
setting realistic goals,
and developing a social
support network.
What
Are The Health Risks?
Patients with BMIs > 30
are at increased risk for
a variety of illnesses,
and those with BMI above
35, life expectancy is impacted
as well.
Among the illnesses seen
more often in the obese
are:
Type II diabetes
Cardiovascular disease
High blood pressure
Stroke
Arthritis
Various cancers
Together with problems
like the above, the obese
patient has greater likelihood
for back pains, carpal tunnel
syndrome, sleep disorders,
breathing difficulties and
wound healing difficulties.
What
About Diets?
Fad diets with rapid weight
loss are never affective
in removing weight and keeping
it off. In fact, most people
will experience weight rebound
after such losses to levels
higher than they ever were
before. Most of the weight
you lose is from water,
and it's not good for your
body to go without food
for extended periods.
Slow and steady weight
loss of 1 or 2 pounds a
week is considered the safest
way to lose weight and the
best way to keep it off.
In many cases, losing weight
can be accomplished by committing
to eating a healthier diet,
exercising and changing
behaviors. Other treatments
for obesity include prescription
medications and surgery
(see elsewhere).
Dietary changes
One way to lose weight
is to consume fewer calories.
The number of calories you
need to maintain weight
each day depends on several
factors, including your
age and activity level.
Ask your doctor to help
you. He may recommend that
you work with a dietitian
or a reputable weight-loss
program.
Very-low-calorie liquid
diets are sometimes prescribed
as an intervention for seriously
obese people. These diets,
such as Medifast or Optifast,
provide about 800 calories
a day, but these diets aren't
intended as a long-term
solution to weight management.
Over-the-counter liquid
meal replacements, such
as Slim-Fast, also cut calories.
They suggest that you replace
one or two meals with their
product and then eat snacks
of vegetables and fruits
and a healthy, balanced
third meal that is low in
fat and calories. Studies
have shown that this can
be effective.
Diet Rules To Live
By
Choose healthy foods
to include vegetables,
fruits, grains and lean
sources of protein. These
foods optimize nutrition
and taste and promote
a healthy weight. Eat
a variety of healthy foods
instead of junk foods.
Reduce fat. Because
fat has more than twice
the calories of carbohydrate
and protein ounce for
ounce, reducing the fat
content of your diet is
a good way to cut calories.
Foods high in fat include
fast foods, pastries,
red meat, dairy products,
butter, salad dressings,
mayonnaise and some nuts.
Choose the right carbohydrates.
Nutrition experts generally
agree that 45 percent
to 65 percent of your
total daily calories should
come from carbohydrates,
but be careful about those
you eat. Steer away from
simple carbohydrates such
as table sugar and other
sweeteners, and limit
fruit juice. Try to eat
plenty of complex, high-fiber
carbohydrates, such as
whole-grain bread and
pasta, brown rice, and
fresh fruits and vegetables.
Count calories and read
food labels. Foods that
are low in fat can sometimes
be very high in calories.
Watch portion sizes
because appropriate serving
sizes may be smaller than
you think. A single 3-ounce
serving of meat, for example,
is about the size of a
deck of cards.
Cut back on sweets by
limiting candies, cakes,
cookies, pies, doughnuts
and frozen desserts.
Can
Medication Help?
People have long wanted
to believe in some sort
of "magic bullet" pill that
would allow them to lose
weight without need for
restrictive diets or regular
exercise. The reality is,
however, that such remedies
remain "pie in the sky."
Many of the most heavily
advertised pills either
produce very mild appetite
supression or have no effect
whatever. We do not currently
know of any medicines that
will let you "dream the
pounds away."
Some drugs that were, in
fact, effective have unfortunately
proven to be too risky to
use, ("fen-Phen" being the
most notable example). Products
that are now on the market
have much better safety
records, but are usually
effective only when combined
with healthy diet and regular
physical activity.
Currently used medications
include:
Orlistat (brand name,
Xenical. This works by
blocking intestinal absorption
of about 30% of ingested
fat. A problematic side
effect of this drug can
be diarrhea that not uncommonly
leads patients to abandon
its use.
Phentermine is the still-used
appetite supressant that
was part of the "fen-Phen"
combination of the past.
By itself, it has an acceptable
safety record.
Sibutramine (known as
Meridia) is an appetite
suppressant approved for
long-term use.
If a person has a BMI of
greater than 30 without
obesity-related health conditions,
he/she may benefit from
the use of medications.
It is important that these
drugs be used under a physician's
care and that patients be
monitored by their doctors
regularly while using them.
With proper use and in combination
with behavior therapy, diet
and exercise, drugs may
assist patients to lose
weight. However, those with
severe obesity tend to loose
only 15-20% of the weight
they need to lose when employing
these methods.
What
About Surgery?
Surgery is a big step to
take, and it is definitely
not for everyone with a
weight problem. Mild to
moderate obesity can usually
be treated by less drastic
means, and the risks of
such obesity do not justify
the risks of major surgery.
Patients considered candidtaes
for surgery must meet certain
important criteria. They
should have a BMI > 40,
or should have a BMI >35,
together with obesity-related
illness (what are called,
"co-morbidities.")
Studies have been done
to look at the future expectations
for the severely obese.
These strongly suggest that
the risks of surgery are
justified by the benefit
that can be had from dramatic
and lasting weight loss
after surgery. Many patients
with high blood pressure
and adult onset diabetes
have their medication requirements
cut or eliminated by weight
loss from surgery, and it
appears that the risks of
remaining severely obese
are higher than those taken
by having an operation.
Still, surgery is an important
and difficult decision that
will mean not just short
term pain and risk, but
the need for life-long behavior
modification. The best candidates
for operative treatment
are those who have failed
to achieve notable weight
loss by other means, but
who are nonetheless well
motivated and committed
to a disciplined post-surgical
regimen. A full and proper
candidate
assessment by the surgeon,
dietitian and therapist
will help to identify those
most suited to surgical
treatment.
