Obesity

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Definition

Obesity is abnormally high proportion of body fat.

Causes

A person becomes obese when calorie intake is always greater than the number of calories burned through activity and basic metabolic processes.

Factors that can influence obesity are:

Risk Factors

Risk factors include:

  • Advancing age
  • Quitting smoking
  • Working varied shifts
  • Decreased activity
  • Sedentary lifestyle
  • 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)

Symptoms

Symptoms include:

  • Increased weight
  • Thickness around the midsection
  • Obvious areas of fat deposits

Diagnosis

Your doctor can determine if you are obese by looking at your body and assessing the percentage of body fat.

Methods of assessing body fat:

  • Height and weight tables
  • Body mass index
  • Measuring body folds with a caliper
  • Measuring waist-to-hip ratio
  • Water-displacement tests

Tests:

  • Blood tests—to rule out other medical conditions that may cause excess body weight

Treatment

Obesity is difficult to treat. Things that affect treatment are:

  • Cultural factors
  • Personal habits
  • Lifestyle
  • Genetics

Approaches to weight loss include:

Food Diary

Keep track of everything you eat and drink.

Physical Activity and Exercise

Ask your doctor about how to begin an exercise program right for you. Limit the amount of time you spend watching television and using the computer. This is especially important for children.

Calorie Intake

Your doctor or a dietitian can determine what your total calorie intake should be. This is based on:

  • Your current weight
  • Your weight loss goals

Portion size is also an important determinant of calorie intake. If you are obese and also have type 2 diabetes, using special portion-control plates may help you succeed in losing weight and reducing diabetes medications.*

Diet

Your doctor may recommend that you reduce saturated and trans fats, as well as limit the amount of refined carbohydrates that you eat. Keep fat intake under 35% of total calories eaten daily.

You may have more success at losing weight by following the Mediterranean diet or the low-carb diet, rather than the low-fat diet.

Behavior Therapy

Behavior therapy may help you understand:

  • When you tend to overeat
  • Why you tend to overeat
  • How to combat overeating tendencies

Weight-Loss Programs

Research on the effectiveness of weight-loss programs is limited. They do seem to work for some people, however.

Team Up With a Partner

Some studies suggest that a partner or group may help you improve your diet and fitness.

Medications

Medications for weight loss are available. Medications include:

  • Sibutramine (Meridia)
  • Orlistat (Xenical)
  • Metformin (Glucophage)
Some medications have led to serious complications. Do not use over-the-counter or herbal remedies for weight loss unless your doctor monitors you for side effects. Your doctor can make recommendations about prescription weight-loss drugs.

Bariatric Surgery

Surgical procedures reduce the size of the stomach and rearrange the digestive tract. The smaller stomach can only hold a tiny portion of food at a time. Operations include gastric bypass and laparoscopic gastric banding. These procedures are only an option for people who are dangerously overweight, due to the potential for serious complications.

Gastric Bypass

© 2008 Nucleus Medical Art, Inc.

Note:

Complications of untreated obesity include:

Prevention

Preventing obesity can be difficult because so 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 a medically approved, appropriate exercise program.
  • Limit the amount of time you spend watching TV, using the computer, and other sedentary activities.
  • Talk to your doctor or a qualified exercise professional about working physical 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.

RESOURCES:

American Dietetic Association
http://www.eatright.org/

The Obesity Society
http://www.obesity.org/

CANADIAN RESOURCES:

Canada's Food Guide
Health Canada
http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index_e.html/

Dietitians of Canada
http://www.dietitians.ca/

References:

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.

Goroll AH, Mulley AG, Mulley AG Jr. Primary Care Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.

Obesity. EBSCO Dynamed website. Available at: http://www.dynamed.com. Accessed December 20, 2007.

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.

*¹8/21/2007 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.

*²7/22/2008 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.



Last reviewed December 2007 by Jill Landis, 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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