Obesity: A Life-long Disease
Edition: December 2002 - Vol 10 Number 12
Obesity is more than a cosmetic issue. It is a life-long disease that has been upgraded by the American Heart Association (AHA) from a contributing risk factor for heart attack to a major risk factor. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) regards obesity as a risk factor for the following diseases as well:
· Gallbladder disease.
· Sleep apnea and other breathing problems.
· Uterine, breast, colorectal, kidney and gallbladder cancer.
In addition, obesity is linked to:
· High blood cholesterol.
· Pregnancy complications.
· Menstrual irregularities.
· Stress incontinence.
· Increased surgical risk.
Nearly 280,000 adult deaths in the United States alone are attributed to obesity, according to the NIDDK.
Measuring Obesity and Overweight
Unbeknownst to many, obesity and overweight are two different conditions. An overweight individual carries an excess of body weight, which can come from bone, fat, or even muscle in the case of an athlete. Obesity refers to having an extremely high proportion of body fat. While many overweight individuals are also obese, the two conditions do not necessarily accompany one another, notes the NIDDK.
There are various methods for determining whether an individual is obese or overweight. Body Mass Index (BMI), a measurement based on height and weight, is frequently used to assess both overweight and obesity in adults. Although BMI does not provide a single measurement of body fat, it is considered a more accurate standard for measuring overweight and obesity than relying only on an individual’s weight, according to the NIDDK.
BMI is figured by following these steps:
1. Multiply the person’s weight in pounds by 704.5 (a figure used by the National Institutes of Health).
2. Divide the result by the person’s height in inches.
3. Divide that result by the person’s height in inches a second time.
BMI results also may be determined by visiting www.nhlbisupport.com/bmi. The formula for arriving at a BMI using kilograms and meters is: weight (kg) /height (m) squared. A BMI of 25 or more is considered overweight, according to the World Health Organization’s recommendation. And, the National Institutes of Health (NIH) considers a BMI of 30 or more an indicator of obesity.
In spite of the general reliability of BMI scores, some individuals can be inaccurately measured using this system. An example is when more muscular individuals fall into the overweight category. Or, elderly persons who have lost muscle mass may be assessed as “healthy” when they actually are nutritionally deficient. For this reason, health organizations tend to employ BMI as a general guideline to monitor population trends, rather than a final evaluation of an individual’s health, notes the NIDDK.
A second method for measuring overweight is a weight-for-health chart. Like BMI, these charts do not determine body fat. A number of different weight-for-health charts exist. The most updated version is the 2000 Dietary Guidelines for Americans, co-published by the U.S. Department of Agriculture and Health and Human Services.
Measuring Body Fat
In the past, body fat was measured by weighing an individual under water. However, this method required labs with special equipment. Easier methods include the skinfold thickness measurement – which measures body fat at certain locations such as the triceps – bioelectrical impedance analysis (BIA), and waist measurement. With BIA, an innocuous electrical current is sent through an individual’s body. The more water a body contains, the more easily it will conduct an electrical current. Higher water content suggests a greater amount of muscle and lean tissue.
The theory behind the waist measurement method is that health risks are said to increase with larger waist measurement. The American Obesity Association (AOA) attributes a waist circumference of 40 inches or more for men and 35 inches or more for women to an increased risk for disease.
The AOA offers a Weight Wellness Profile, which looks at weight assessment and lifestyle factors. For more information, visit www.obesity.org.
Over half of all adults in the United States (97.1 million) are considered overweight, says the NIDDK. Almost a quarter of adults – or 39.8 million – are obese. Overweight and obesity both increased across most racial and ethnic groups from 1960 to 1994. Overweight rose from 31.6 percent to 32.6 percent, while the prevalence of obesity climbed from 13.4 percent to 22.3 percent.
Childhood and adolescent overweight and obesity are on the rise as well. The rate of overweight increased from five percent in children and adolescents in the 1960s and 1970s to 11 percent in the period from 1988 to 1994.
The NIDDK provides the following statistics suggesting a strong connection between overweight and obesity and the prevalence of disease:
· Hypertension. 23.9 percent of overweight men and 23 percent of overweight women have high blood pressure. For obese adults, 38.4 percent of men and 32.2 percent of women have high blood pressure.
· Diabetes. Of the 15.6 million adults in the United States diagnosed with diabetes, 67 percent have a BMI of 27 or more, and 46 percent have a BMI of 30 or more.
· High blood cholesterol. Nineteen percent of overweight men and 28 percent of overweight women have high blood cholesterol (compared to 14.7 percent for healthy weight men and 15.7 percent for healthy weight women). For obese adults, 20.2 percent of men and 24.7 percent of women have high blood cholesterol.
· Cancer. Studies indicate that overweight and obese individuals have an increased risk for such cancers as endometrial, colorectal, gallbladder and renal cell. About half of post-menopausal women diagnosed with breast cancer have a BMI of 29 or more.
Individuals whose BMI is 30 or more have a 50 percent to 100 percent increased overall mortality risk than healthy persons. Cardiovascular problems account for much of this increased risk.
Today, a weight loss of 10 percent of excess body weight is considered beneficial in decreasing obesity-related risk factors, according to the AOA. A variety of healthcare professionals are trained to help patients with long-term weight loss, including physicians, nutritionists, exercise physiologists, psychologists and bariatric surgeons. Treatment options range from diet modifications to surgery. The AOA provides an overview of treatments available to overweight or obese people:
· Education on adjusting diet to reduce calorie intake.
· Moderation of calorie reduction, essential to achieving slow but steady weight loss.
· Education on the value, calorie content and composition of different foods, as well as how to read nutrition labels, learning what foods to purchase and how to prepare them.
· Examples of appropriate weight loss diets.
· Moderate physical activity of 30 minutes or more on most or all days to aid in weight loss.
· Physical activity to aid in the reduction of abdominal fat and, in some cases, waist circumference.
· Physical activity to maintain long-term weight loss.
· A gradual increase in intensity of activity such as aerobics, walking, jogging, cycling and swimming.
· Adjusting diet or exercise patterns to new ones that promote weight loss.
· Keeping a journal of diet and exercise.
· Identifying and avoiding high-risk situations that interfere with weight loss.
· Rewarding actions that promote weight loss.
· Developing realistic goals.
· Developing a supportive network of family and friends, or joining a support group.
· Advised for individuals with a BMI of 30 or more with no obesity-related conditions, or for those with a BMI of 27 or more and two or more obesity-related conditions.
· Drug treatment that accompanies appropriate lifestyle modifications.
· Patients regularly assessed to determine the effect and safety of a particular drug.
· Weight loss drugs currently approved by the FDA include Orlistat (Xenical), Phentermine and Sibutramine (Meridia). Orlistat works by blocking about 30 percent of dietary fat from being absorbed, while Phentermine and Sibutramine are appetite suppressants.
· A combination of diet and increased physical activity.
· A combination of behavior and drug therapy.
· A combination of drug therapy and diet.
· Recommended for individuals with a BMI of 40 or more, or a BMI of 35 to 39.9 with serious medical conditions.
· Modifies the stomach and/or intestines to limit the quantity of food an individual can eat.
· An accepted method for long-term weight control for severely obese people, and has become safer and more effective over the years.
· Must inform patients about risks and benefits prior to surgery.
· Requires lifestyle changes for procedure to be effective.
· Requires professional follow-up of patients.
Healthy People 2010, a federal health improvement initiative sponsored by the U.S. Department of Health and Human Services, the Public Health Service and Surgeon General David Satcher, M.D., has made overweight/obesity and physical activity its top two objectives. Foremost, Healthy People 2010 seeks to increase the percentage of adults who are moderately physically active for 30 minutes or more each day, and to increase the percentage of adolescents who engage in vigorous physical activity that stimulates cardiorespiratory fitness three or more days each week, 20 minutes or more each day. Currently, only 22 percent of U.S. adults exercise regularly, five days a week for 30 minutes or more, according to the NIDDK. About 25 percent of adults admit to doing no physical activity in their free time.
The second objective of Healthy People 2010 is overweight/obesity. The health initiative’s goal is for 60 percent or more of the American population to maintain a healthy weight with a BMI of 18.5 to 25. Today, only two of every five people nationwide fall within this range.
Obesity is the second leading cause of preventable death in the United States, according to the AOA. In addition to being at increased risk of illness from as many as 30 serious medical conditions, overweight or obese people often face social stigmatization and discrimination at work or school. A combination of diet modification and increased physical activity are key to a healthier, longer life.