Obesity

What is obesity?

Obesity is defined as the condition of being very overweight and having a body mass index, or BMI, of 30 or higher. The BMI is a measure of your weight relative to your height. You can find your BMI from a chart.

Your waist size is also important. It is a measure of your abdominal fat. Your health risks increase as your BMI and waist size get larger. A waist measurement greater than 40 inches for men or 35 inches for women indicates a significant increase in health risk.

What are the risks of obesity?

Nearly one third of adults are obese. Obesity increases as people age. It is a serious condition because it increases your risk of poor health and major illness, such as:

• high blood pressure
• breathing problems
• stroke
• heart disease
• diabetes
• hyperlipidemia, or increased fats in the bloodstream, often associated with higher cholesterol levels
• gallbladder disease
• gout
• some types of cancer
• osteoarthritis (stiffness and soreness of joints, especially the knees, which may occur with aging).

Obesity may make it harder for your healthcare provider to give you a good physical exam. Looking at the inside of your body with X-rays and other types of scans, as well as surgery, may also be more difficult.

How does it occur?

The causes of obesity are not clear. Overeating is not always the cause. The amount of energy (calories) your body needs when you are at rest is also important. You get energy from the food you eat. The energy you do not use is stored as fat. Obese people may use less energy when they are at rest than people who are not obese. Also, they may burn fewer calories than people who are not obese because it is harder to be physically active.

The genes you inherit from your parents can affect your weight. Children of obese parents are 10 times more likely to become obese than children whose parents are not obese. Unhealthy family eating habits may also be a reason several members of a family are obese.

Emotional problems, such as depression, anger, and anxiety can sometimes be a cause. Emotional problems can both contribute to obesity and result from it. Rarely, hormone imbalance causes obesity.

How is it diagnosed?

Your BMI can be determined by looking up your height and weight on a BMI chart. A BMI of at least 25 indicates overweight. A BMI of 30 or more indicates you are obese. Measure your waist at the point below your ribcage but above your navel. Use your BMI and waist size to determine your risk from the "Calculating Your Risk" table included with the BMI chart.

To tell whether your weight is a health risk, you can determine your BMI and health risk with the Body Mass Index chart.

Note that there are some limits to the usefulness of the BMI score. It may overestimate body fat in athletes and others who have a muscular build. It may underestimate body fat in older persons and others who have lost muscle mass. Your healthcare provider can give you a good sense of whether you have an increased risk of health problems because of your weight. Your provider can also help you find a weight-loss program that works for you.

The BMI chart is not for use in pregnancy. If you are pregnant and want a guide to normal pregnancy weight gain, ask your provider for a chart.

How is it treated?

Eating fewer calories while being more active is the key to lowering and controlling your weight. Evaluation of your diet is an important first step. A dietitian may prescribe a diet for you. He or she will make sure your new diet provides fewer calories but is healthy and allows you to lose weight safely. Your diet should allow you to lose 1 to 2 pounds a week. Do not fast or follow fad diets. You should not take drugs that curb your appetite without first checking with your doctor.

You will be taught to change patterns of behavior. For example, some people eat as a way to cope with emotional problems. If you have serious emotional problems, your healthcare provider may refer you to a counselor for therapy. You will need to deal with psychological and emotional problems if your weight-loss program is to be successful.

Physical activity is a very important part of a successful weight-loss program. Once you reach a lower weight, exercise also helps you stay at that weight. Having a total of at least 30 minutes of physical activity on most days of the week will lower your blood pressure, pulse, cholesterol, and blood sugar. Gradually building up to 1 hour or more of exercise a day, most days of the week, can significantly increase your metabolic rate. This means your body will burn more calories.

Physical activity alone may be the first step in your weight-loss or weight-maintenance program if you are not yet ready to make changes in your diet. The sense of well-being that you will get from exercise may motivate you to choose healthier foods.

Almost any activity that involves mild to moderate exertion is good. You may choose to walk, jog, swim, cycle, or do aerobics or a step aerobics program. Walking is a great way for almost everyone to start getting more exercise. Using a pedometer can be fun and motivating. A pedometer is a device that attaches to your clothing and tracks how many steps you take in a day. A good goal is to work up to 10,000 steps a day (5 miles). If your provider agrees, try increasing your steps each week by 500 a day until you reach 10,000 steps a day.

Exercise videos and DVDs are available for all levels of fitness, including people with disabilities. You can borrow them from your library or buy them at stores or on line at http://www.collagevideo.com.

Ask your healthcare provider what kinds and amounts of exercise might be right for you. If you have a physical disability, your provider will help you find exercise alternatives.

Support from other people can help motivate you. Your main support group can be your family and friends. Look also for weight-loss support groups in your community.

How can I take care of myself?

To help yourself, follow these guidelines:

• Stick to your diet and don't get discouraged.
• Learn how to prepare healthy meals. Take classes or look for health-conscious cookbooks. Check your public library or local county extension program. Also, there are many healthy recipe Web sites.
• Keep a daily record of the foods you eat and drink. Write everything down.
• Taking a multivitamin and mineral supplement can help you meet your nutritional needs, especially if you are following a diet that contains less than 1,500 calories or if you are unable to choose from all of the food groups. Ask your healthcare provider about which type would be best for you.
• Avoid alcohol. Alcoholic beverages add empty calories and may increase hunger.
• Join a weight-loss support group. Talk to people and stay in environments that keep you motivated.
• Read books and articles or watch TV shows that discuss losing weight.
• Get regular physical activity. To keep off the pounds you have lost, you may need to have moderate-intensity exercise 60 to 90 minutes most days of the week. Follow your healthcare provider's recommendations.
• Keep a daily record of your exercise.
• Find a friend to exercise with you.
• Keep your appointments with the dietitian or therapist.
• Learn to use relaxation techniques such as deep breathing to help you deal with stress.
• Discuss your feelings, challenges, and successes at a support group or with your healthcare provider.

Many obese people have trouble keeping weight off. Often this is caused by emotional problems that occur when they are trying to lose weight. Weight loss can trigger severe depression or even psychosis if you were obese as a child or if you have been depressed because of your obesity. If you feel compelled to eat excessively or raid the refrigerator late at night, you may be suffering emotional distress. If you are already under stress, your provider may decide that you should not try to lose weight until your life becomes more stable.

Be aware that after you lose weight, the ways you relate to other people may change because of your improved self-image.

How can I avoid obesity?

Gaining excess weight occurs over a long period. Losing that weight requires motivation and discipline. To maintain a healthy weight you must balance the amount of food you eat and your physical activity. Try to stay as close to a healthy weight as possible.