(Obesity; Morbid Obesity)
Being overweight or obese means your weight is above an ideal weight range. Excess weight creates increased risk of heart disease, certain cancers, and other serious illnesses like diabetes. One tool used to estimate ideal and overweight ranges is called the body mass index (BMI). This scale determines weight ranges based on height. BMI levels include:
- Ideal weight range: 18.5-24.9
- Overweight: 25.0-29.9
- Obese: 30.0 or above
- Morbid obesity: 40 or above (35 and above with current health condition like diabetes or high blood pressure)
Calories are taken in through food. They are used through physical activity and basic body functions. Excess weight gain occurs when this relationship is not kept in balance. High caloric intake and low usage will cause weight gain. If this happens regularly it will lead to obesity.
Factors that can influence obesity are:
- Biologic factors (eg, amount and activity of certain chemicals in the body)
- Medications (eg, corticosteroids, antidepressants, and antipsychotics)
- Underactive thyroid]]>
- ]]>Cushing's disease]]>
- ]]>Polycystic ovary syndrome]]>
- Froehlich's syndrome
- ]]>Prader-Willi syndrome]]>
- Laurence-Moon-Biedl syndrome
Risk factors include:
- Advancing age
- Working varied shifts
- Decreased activity
- Sedentary lifestyle—Getting too little exercise and spending too much time in front of a TV or computer can contribute to obesity in children and adults.
- Imbalance of excess calories versus decreased activity
- High level of fast food]]> intake
- High ]]>alcohol]]> consumption
- Eating foods with a high glycemic index such as refined carbohydrates (eg, instant mashed potatoes, baked white potatoes, instant rice)
- Eating until full and eating quickly
- Not getting enough sleep (a risk factor in children)
- Increased weight
- Thickness around the midsection
- Obvious areas of fat deposits
Complications of Untreated Obesity
- Decreased energy
- Heart disease]]>
- Increased risk of blood clots
- Increased risk of ]]>stroke]]>
- Increased levels of cholesterol and triglycerides in the blood
- ]]>High blood pressure]]>
- Pregnancy complications, including ]]>high blood pressure]]> , ]]>diabetes]]> , complications during labor and deliver, malformations of the baby
- ]]>Type 2 diabetes]]>
- Liver disease
- ]]>Gastroesophageal reflux disease]]>
- Worsening ]]>arthritis]]> symptoms
- Joint problems, back pain
- Increased risk of certain cancers
- Increased risk of death from cancer
- ]]>Sleep apnea]]>
- Poor self-image, ]]>depression]]>
- ]]>Urinary incontinence]]>
Being overweight or obese in late adolescence has been shown to increase the risk of death in adulthood. This risk is also found in obese people over age 65. Researchers have found that adults who have a high waist circumference or a high waist-to-hip ratio have an increased risk of death, as well. Whether you are a teen or an adult, losing weight now will lower your risk of serious complications later.
Obesity is diagnosed by visual exam and body measurements using:
- Height and weight tables
- Body mass index
- Measuring body folds with a caliper
- Measuring waist-to-hip ratio
- Water-displacement tests
To rule out other medical conditions that may cause excess body weight, your doctor may order:
- Blood tests
Obesity is difficult to treat. Things that affect treatment are:
- Cultural factors
- Personal habits
There are many different approaches to treating obesity. You are more likely to successfully lose weight and keep it off by using a combination of strategies, like diet, exercise, counseling, and/or medication. Talk to your doctor or ask for a referral to a dietician . They can help you develop a plan that is best for you. Plans for weight loss may include:
Your doctor may recommend that you:
- Reduce saturated and trans fats]]>
- Limit the amount of refined carbohydrates that you eat
- Keep fat intake under 35% of total calories eaten daily
According to a recent study, the key to weight loss is in reducing the amount of calories that you consume, rather than following a specific kind of diet (like a low-carb diet). It is much more important to choose a low calorie diet you can stick with for the long haul. A dietitian can help you with your total calorie intake goal. This is based on your:
- Current weight
- Weight loss goals
Portion size also plays an important role. Using special portion control plates may help you succeed.
Keep track of everything you eat and drink.
Ask your doctor about an exercise program.
Add bits of activity through your day. Take stairs instead of elevators. Park a little further away. Limit the amount of time you spend watching television and using the computer. This is particularly important for children.
Behavior therapy may help you understand:
- When you tend to overeat
- Why you tend to overeat
- How to combat overeating habits
Weight Loss Programs
Weight loss programs do seem to work for some people. Some studies also suggest that a partner or group may help you improve your diet and fitness.
Weight loss medications include:
- ]]>Sibutramine (Meridia)]]> —suppresses appetite
- ]]>Orlistat (Xenical)]]> —interferes with the absorption of fat from the intestines
Medications alone are not a viable option for losing weight and keeping it off. Some have led to serious side effects. Do not use over-the-counter or herbal remedies without talking to your doctor.
Treatment for Children and Teens
The problem of obesity, of course, is not restricted to adults. There is evidence that the same changes in diet, exercise, and other behaviors can help children and teens lose weight. For example, kids may find success by participating in group therapy that focuses on diet and behavior changes.
When added to lifestyle changes, medicines (eg, sibutramine, orlistat) have also been shown to help obese children and teens lose weight, though careful monitoring for potential adverse effects is required. In some cases, bariatric surgery, such as gastric banding, may be an option for teens who are obese.
Bariatric surgery reduces the size of the stomach. In some cases, it will also rearrange the digestive tract. The smaller stomach can only hold a tiny portion of food at a time. Procedures include:
These procedures may be a good option for people who are severely obese who are having trouble losing weight by other means.
Preventing obesity can be difficult. There are many factors influence your weight. General recommendations include:
- Talk to your doctor or a dietician about an appropriate number of calories to eat per day.
- Eat a diet]]> with no more than 35% of daily calories from fat.
- Follow an appropriate exercise program.
- Limit the amount of time you spend doing sedentary activities. This includes watching TV or using the computer.
- Talk to your doctor or an exercise professional about working activity into your daily life.
- Ask a dietitian for help planning a diet that will help you maintain a healthy weight or lose weight if necessary.
- Learn to eat smaller portions of food. Most Americans eat portions that are too large.
American Dietetic Association
The Obesity Society
Canada's Food Guide
Dietitians of Canada
Cecil R, Goldman L, Bennett J. Cecil Textbook of Medicine . 21st ed. Philadelphia, PA: WB Saunders Co; 2000.
Dietary guidelines for Americans. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.health.gov/dietaryguidelines/dga2005/document/default.htm . Accessed June 8, 2008.
Glycemic index—a new way of looking at carbs. Canadian Diabetes Association website. Available at: http://www.diabetes.ca/Section_About/glycemic.asp . Updated June 2005. Accessed January 23, 2008.
Goldman L, Ausiello D, eds. Cecil Textbook of Internal Medicine. 23rd ed. Philadelphia, PA: Saunders, 2008.
Goroll AH, Mulley AG, Mulley AG Jr. Primary Care Medicine . 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.
Kronenberg HM, Melmed S, Polonsy KS, Larsen PR. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Saunders Elsevier, 2008.
Obesity. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 2008. Accessed July 29, 2008.
Obesity, bias, and stigmatization. The Obesity Society website. Available at: http://www.obesity.org/information/weight_bias.asp . Accessed June 8, 2008.
Thompson WG, Cook DA, Clark MM, Bardia A, Levine JA. Treatment of obesity. Mayo Clin Proc . 2007;82:93-101.
8/21/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Pedersen SD, Kang J, Kline GA. Portion control plate for weight loss in obese patients with type 2 diabetes mellitus: a controlled clinical trial. Arch Intern Med . 2007;167:1277-1283.
7/22/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229-241.
9/30/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Samuels-Kalow ME, Funai EF, Buhimschi C, et al. Pre-pregnancy body mass index, hypertensive disorders of pregnancy, and long-term maternal mortality. Am J Obstet Gynecol. 2007;197:490.e1-6. Epub 2007 Aug 21.
12/2/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Maruyama K, Ohira T, Maeda K, et al. The joint impact on being overweight of self reported behaviours of eating quickly and eating until full: cross sectional survey. BMJ. 2008;337.
12/2/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008;359:2105-2120.
2/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Subak L, Wing R, Smith West D, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360:481-490.
4/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360:859-873.
4/16/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Neovius M, Sundström J, Rasmussen F. Combined effects of overweight and smoking in late adolescence on subsequent mortality: nationwide cohort study. BMJ. 2009 Feb 24;338:b496.
5/11/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Luttikhuis HO, Baur L, Jansen H, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev. 2009;(1):CD001872.
7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Seo DC, Sa J. A meta-analysis of psycho-behavioral obesity interventions among US multiethnic and minority adults. Prev Med. 2008;47:573-582. Epub 2008 Jan 16.
9/25/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Garipağaoğlu M, Sahip Y, Darendeliler F, Akdikmen O, Kopuz S, Sut N. Family-based group treatment versus individual treatment in the management of childhood obesity: randomized, prospective clinical trial. Eur J Pediatr. 2009;168:1091-1099.
10/16/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Krul M, van der Wouden JC, Schellevis FG, van Suijlekom-Smit LW, Koes BW. Musculoskeletal problems in overweight and obese children. Ann Fam Med. 2009;7:352-356.
11/10/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Laurson KR, Eisenmann JC, Welk GJ, Wickel EE, Gentile Da, Walsh DA. Combined influence of physical activity and screen time recommendations on childhood overweight. J Pediatr. 2008;153(2):209-214.
1/15/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171(2):135-54.
1/29/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Kuk JL, Ardern CI. Influence of age on the association between various measures of obesity and all-cause mortality. J Am Geriatr Soc. 2009 Sep 15.
1/29/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Berkey CS, Rockett HR, Colditz GA. Weight gain in older adolescent females: the internet, sleep, coffee, and alcohol. J Pediatr. 2008;153(5):635-639.
2/19/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13:1-190, 215-357, iii-iv.
2/19/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: O'Brien PE, Sawyer SM, Laurie C, et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA. 2010;303(6):519-526.
Last reviewed November 2009 by ]]>Rosalyn Carson-DeWitt, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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