Obesity is one of the major medical problems in the western world. The clinical definition of obesity is a body mass index (BMI) of 30 or higher. The BMI is the body’s weight in kilograms divided by the square of the body’s height in meters.
Obesity results when a person ingests more calories than he or she can burn off. If this happens regularly over a period of time, the body will store the extra calories as fat. The body is able to burn off calories as energy needed throughout the day, but if the energy is not burned away, it will be stored as fat.
Every person has his or her own metabolic rate. This is the rate at which calories are used or burned off within the body. People who take a lot of exercise or are employed in strenuous jobs usually have a very high metabolic rate. They require a lot of calories, but burn them off easily. People who do not take a lot of exercise or are involved in jobs such as office work do not need as many calories.
The body stores extra calories as fat as a precaution against times of starvation. In the western world, starvation rarely affects people who eat regularly. If a person continually eats calories that he or she cannot burn off, obesity may occur.
Obesity is very serious health problem. Research has shown that it can shorten life expectancy by at least nine years. In the last two decades, the obesity rate in adults has quadrupled. Obesity can also lead to many other health complications, including infertility, depression, heart disease and stroke.
More than one-third of U.S. adults (35.7%) are obese.
Approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese.
[Data from the National Health and Nutrition Examination Survey (NHANES)]
During the past 20 years, there has been a dramatic increase in obesity in the United States and rates remain high. In 2010, no state had a prevalence of obesity less than 20%. Thirty-six states had a prevalence of 25% or more; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had a prevalence of 30% or more.
Although there are genetic and hormonal influences on body weight, 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:
If you're not very active, you don't burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you use through exercise and normal daily activities.
Having a diet that's high in calories, eating fast food, skipping breakfast, eating most of your calories at night, drinking high-calorie beverages and eating oversized portions all contribute to weight gain.
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.
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.
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.
Being a little bit overweight may not cause too many noticeable problems. However, once you are carrying a few extra kilograms (or pounds), you may develop symptoms that affect your daily life.
Day-to-day, obesity causes problems such as:
breathlessness,
increased sweating,
snoring,
difficulty sleeping,
inability to cope with sudden physical activity,
feeling very tired every day, and
back and joint pains.
Obesity can also cause changes that you may not notice, but that can seriously harm your health, such as:
high blood pressure (hypertension), and
high cholesterol levels (fatty deposits blocking up your arteries), and
type 2 diabetes - a chronic (long-term) condition that is caused by too much glucose in the blood.
In the longer term, obesity greatly increases your risk of a number of serious medical conditions.
In addition to the day-to-day problems of obesity, many people may also experience psychological problems (problems to do with mental health). These may include:
having low self-esteem,
having a poor self-image (not liking how you look),
having low confidence levels,
feeling isolated in society, or
These can affect your relationships with family members and friends, and if they become severe, may lead to depression.
The goal of obesity treatment is to reach and stay at a healthy weight. 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.
You can start feeling better and seeing improvements in your health with just modest weight loss — 5 to 10 percent of your total weight. That means that if you weigh 200 pounds (91 kg) and are obese by BMI standards, you would need to lose only about 10 to 20 pounds (4.5 to 9.1 kg) to start seeing benefits.
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. Treatment methods include:
Dietary changes
Exercise and activity
Behavior change
Prescription weight-loss medications
Weight-loss surgery
Losing 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.
Reducing calories and eating healthier are vital to overcoming obesity. Although you may lose weight quickly at first, slow and steady weight loss of 1 or 2 pounds (1/2 to 1 kilogram) a week over the long term 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.
Dietary ways to overcome obesity include:
Taking in fewer calories. The key to weight loss is reducing how many calories you take in. 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 and your doctor can decide how many calories you need to take in each day to lose weight, 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, fats 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 more of foods less packed with calories, you reduce 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. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole-grain carbohydrates. Also emphasize lean sources of protein, such as beans, lentils and soy, and lean meats. Try to include fish twice a week. Limit salt and added sugar. Stick with low-fat dairy products. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as nuts and olive, canola and nut oils.
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. Keep in mind that these diets likely won't teach you how to change your overall lifestyle, though, so you may have to keep this up if you want to keep your weight off.
You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no such foods or quick fixes. Fad diets may help in the short term, but the long-term results don't appear to be any better than other diets. Similarly, you may lose weight on a crash diet, but you're likely to regain it when you stop the diet. To lose weight — and keep it off — you have to adopt healthy-eating habits that you can maintain over time.
Increased physical activity or exercise also is an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking.
To boost your activity level:
Exercise. The American College of Sports Medicine recommends that people who are overweight or obese get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to lose a modest amount of weight. But to achieve significant weight loss, you may need to get as much as 250 to 300 minutes of exercise a week. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve. To make your own exercise goal more doable, break it up into several sessions throughout the day, doing just five or six minutes at a time.
Increase your daily activity. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Making simple changes throughout your day can add up to big benefits. Park farther from store entrances, rev up your household chores, garden, get up and move around periodically, and wear a pedometer to track how many steps you actually take over the course of a day.
A behavior modification program can help you make lifestyle changes, lose weight and keep it off. Steps to take include examining your current habits to find out what factors or situations may have contributed to your obesity.
Behavior modification, sometimes called behavior therapy, can include:
Counseling. Therapy or interventions with trained mental health or other professionals can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers and cope with food cravings. Counseling may be available by telephone, email or Internet-based programs if travel is difficult. Therapy can take place on both an individual and group basis.
Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area.
It's best to lose weight through a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may be an option. Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them. If you don't make these other changes in your life, medication is unlikely to work.
Your doctor may recommend weight-loss medication if:
Other methods of weight loss haven't worked for you
Your body mass index (BMI) is greater than 27 and you also have medical complications of obesity, such as diabetes, high blood pressure or sleep apnea
You need close medical monitoring while taking a prescription weight-loss medication. Also, keep in mind that a weight-loss medication may not work for everyone. If the medication does work, its effects tend to level off after six months of use like any other method of weight loss. You may need to take a weight-loss medication indefinitely. When you stop taking a weight-loss medication, you're likely to regain much or all of the weight you lost.
In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery offers the best chance of losing the most weight, but it can pose serious risks. Weight-loss surgery limits the amount of food you're able to comfortably eat or decreases the absorption of food and calories, or both.
Weight-loss surgery for obesity may be considered if:
You have extreme obesity, with a body mass index (BMI) of 40 or higher
Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure
You're committed to making the lifestyle changes that are necessary for surgery to work
Weight-loss surgery can often help you lose as much as 50 percent or more of your excess body weight. But weight-loss surgery isn't a miracle obesity cure. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits.
There are numerous types of weight-loss surgery. Some types cause weight loss by restricting how much your stomach can hold. Others prevent your body from absorbing calories and nutrients. Others are a combination of these two types.
Unfortunately, it's common to regain weight no matter what obesity treatment methods you try. But that doesn't mean your weight-loss efforts are futile.
One of the best ways to prevent regaining the weight you've lost is getting regular physical activity. Keep track of your physical activity if it helps you stay motivated and on course. As you lose weight and gain better health, talk to your doctor about what additional activities you might be able to do and, if appropriate, how to give your activity and exercise a boost.
You may always have to remain vigilant about your weight. Combining a healthier diet and more activity is the best way to lose weight and keep it off for the long term. If you take weight-loss medications, big chances are to regain weight when you stop taking them. You might even regain weight after weight-loss surgery if you continue to overeat or eat foods laden with fat and calories.
Take your weight loss and weight maintenance one day at a time and surround yourself with supportive resources to help ensure your success. Find a healthier way of living that you can stick with for the long term.