(Obesity is defined as excess fat tissue. For adults and young people, obesity generally has been defined as a body weight that is 30% over the ideal body weight for your height. Body-mass index*, and other anthropometric measurements such as ratios of weight to height, waist and hip circumferences are other ways to define and measure body fat and body fat distribution.
Your body weight is tied into your body systems and their functioning. The more calories you overeat, the more fat that your body carries. This overeating and extra body fat produces more stress on your internal organs, your joints, and possibly your outlook on life. Obesity needs to be prevented or treated because of the number of lifestyle and medical problems it may cause you. You may have trouble walking, breathing, muscular or bone problems, skin problems, infertility, and more serious complaints, such as heart disease or diabetes (see Symptoms).
In addition, obesity is a disease that may lower your self-esteem or make you feel depressed or anxious. In children and adolescents, peers may make fun of you or ignore you, which may lead you to withdraw at a time when being active and trying sports is a great way to become more fit. Obesity can also lead to discrimination in employment. Choosing healthy eating, exercise and body weight control may prevent and improve your feelings in social situations.
There are many known causes for obesity:
- You may have a genetic problem. An estimated 80% of obesity cases include genetic traits that affect appetite, energy expenditures and your hormones and other organ systems in your body. Hormones are substances, made in organs called glands, which have an effect on different parts of the body. Currently the hormone leptin, a protein produced by the ob (obese) gene, is being studied by endocrinologists and others who see this hormone as a promising target in the fight against obesity. Many other genes and gene products also are being studied by researchers;
- There are infrequent hormonal imbalances that contribute to being overweight, but usually not the main reason. These conditions include damage to the brain/brain dysfunction, polycystic ovarian syndrome, and Cushing’s disease (which causes high levels of steroid hormones);
- You may have a eating disorder or other behavior problem that causes you to eat too much;
- Most often your weight may be linked with your environment – your socioeconomic status, your race, where you live, and your family size. You may have cultural reasons or other factors that affect the caloric density of the foods you eat, portion size or speed of eating. Because of sedentary jobs, lack of exercise, television watching and computer games, gaining weight has become more common. Aging itself appears to be a culprit, as older men and women tend to put on a few pounds a year. However, this is related to decrease in exercise and fitness.
You may feel that your weight is a very difficult problem to solve. Obesity is one disease, however, in which you must play an active part in solving the problem and becoming healthier.
The most obvious symptom of obesity is your energy level, breathing /snoring and appearance – your body size. In obesity, the symptoms you may not be aware of are those that could tell you more about your health status.
Obese men and women are more at risk for many diseases:
- Gall bladder disease
- Heart and blood vessel problems, such as stroke and coronary heart disease
- High blood pressure
- Bone-related arthritis
- Abnormal levels of fat in your blood
- Gout, and
- Sleep apnea (interrupted breathing while you sleep) syndrome.
Many medical problems associated with obesity are silent; you may feel healthy and still have health problems that have not yet caused symptoms you notice.
Because losing weight and keeping it off is an everyday undertaking, you will benefit with family and health care support as you start a therapeutic lifestyle change. The first step is a full health and physical exam and the involvement/inclusion of your doctor’s advice. Remember, treatment can only begin and be successful when you have the motivation to change your eating and physical activity habits. The most successful programs are when you take charge of these important lifestyle changes. They will always need to be individualized and achieved “a step at a time” (incremental) over a lifetime.
Obesity Treatment Options
This section will discuss the medical treatments options, including drugs and surgery. For information on how to manage weight through dieting and exercise programs, go to the Lifestyle Issues and Prevention Section.
Eating fewer calories and becoming more active are the two activities that are essential to help you speed up your weight loss process. Some individuals will benefit from counseling or medical treatment. This is particularly true if you identify barriers to controlling portion size and caloric intake or physical exercise.
Before doctors recommend the best treatment for you, they need to assess how much weight you need to lose, your risk for other diseases and, if possible, the cause(s) of your condition.
People with the highest risk of heart disease or diabetes, for example, will need the most intense treatment. Those who have a healthy heart but who need to lose several pounds may need only modest changes in diet and exercise to become as healthy.
It may help to remember that you may not reach your dream weight; few people do. Most experts agree that a weight loss of 5-10% of your body weight produces significant improvement on your health and can be maintained for prolong periods of time is a success. Losing more than 15% of your starting weight requires intensive lifestyle changes and is difficult to maintain.
If you are going to take a medication for weight loss, this is only appropriate as part of a larger treatment of diet, exercise and changing your eating behaviors.
Drugs for weight loss fall into several categories:
- Drugs that change appetite (sympathomimetic drugs):
Sibutramine – Today sibutramine is the only medication approved for long-term use. The drug suppresses your appetite by keeping your nerve endings from taking up the substances norepinephrine and serotonin. Side effects may include dry mouth, inability to sleep, and constipation. You should not take sibutramine if you have a history of heart disease or stoke.
NOTE: Maybe you have heard of the Fen-phen combination drug.[fenfluramine and phentermine] Fenfluramine has been pulled out of the marketplace because it had unacceptable side effects causing heart valve and lung problems.
- Metabolism-changing drugs:
Orlistat – Orlistat is the only drug that alters the way your body responds to fat intake. It works by preventing the action of lipases (enzymes that break down fat) produced in your pancreas, a gland behind your stomach. The pancreas secrets lipases into your intestine and block dietary fat digestion. The result, particularly in individuals who eat a high fat meal, are some gastrointestinal side effects, including stomach cramps, gas and a feeling like diarrhea or inability to control your bowels.
- Other substances that cause you to reduce your eating:
The following hormones and other substances are still being studied and are not yet approved as drugs for obesity:
Leptin is a hormone made in fat tissue. Mice without leptin become very fat, and taking leptin has helped mice and human subjects reduce their food intake and lose weight. High doses of leptin seem to be necessary and still need further testing.
Neuropeptide-Y is a substance found in nerve tissue which stimulates eating. Drugs that block the Y-receptors lower food intake.
Cholecystokinin plays a key role in facilitating digestion in the small intestine. It stimulates delivery of digestive enzymes and bile from the gall bladder.
Melanocortins are a group of pituitary peptide hormones. One of the receptors for these hormones is found in the hypothalamus gland in the brain and the protein that binds to it seems to play an important role in controlling body weight.
Glucagon is a protein hormone produced in the pancreas that helps to regulate your body’s use of carbohydrates and helps to decrease food intake. A part of the glucagons molecule, glucagon-like peptide 1, also helps to reduce food intake.
Two forms of surgery have been recommended by government consensus panels that can be performed to treat severe obesity. Both are for people with severe cases of obesity, over 100 lbs above ideal body weight (e.g., BMI >40 kg/m2*) who have not had effective weight loss with diet, exercise and drugs.
Gastroplasty involves surgically reducing the size of the stomach. About 40% of patients lose half of their extra weight the first year.
Gastric bypass surgery creates a small stomach pouch and connects this pouch to the second portion of the intestines. This surgery is more extensive and difficult to perform than gastroplasty, but it is also more effective. From initial evaluation to post-operative follow up, requires careful monitoring for the first two-year period by a multidisciplinary teams of surgeons, physicians, psychologist and allied health professionals to counsel on special diets, exercise and monitoring for a lifetime.
Liposuction is not a treatment for obese patients. It is a way to remove fat cells at certain points of the body for cosmetic reasons, but this operation alone does nothing to solve problems like overeating.
Obesity Lifestyle and Prevention
Obesity is not a condition that can be cured with a simple pill or that will clear up in a few weeks. Your body took time to assume its shape, and it will take time to change it. The good news is that change can begin ad soon as you change your eating and physical activity habits.
It helps to be reasonable in your approach and in what you expect. Remember: Even the first 5 % change in body weight is considered successful. Keep in mind that a weight loss of 15% from your starting weight requires intense lifestyle changes. With these modest goals, you will improve your health and reduce your risk of disease.
Before you begin any weight loss program, see your doctor. If a hormone imbalance is causing you to gain weight, you may need to see an endocrinologist for the best care.
Your doctor will have good ideas about what type of diet or weight loss plan might suit you best, which foods to eat, which times of day to eat, and so on. Don’t just try a diet in a magazine, for example. You will need support and information, and your doctor should be the source. You doctor also can monitor your weight loss and take you off of treatments that are not working.
If possible, you should exercise while you diet. You should consult your doctor to learn which forms of exercise may be more useful for your body and your health. Be sure that you can handle the exercise you want to do. Try not to get frustrated if dieting and exercise seem difficult. If you slip up in your program – overeating, not exercising – don’t beat yourself up. Instead, immediately start again with good patterns and you will stay on track.
One more aspect of care may help you to eat more moderately, if overeating is a problem. Learning to modify your behavior is often a suggested part of obesity treatment. In general, you need to become aware of situations and moods that make you feel like eating. Certain techniques can help you to slow down your eating, such as drinking water between bites or chewing your food longer. You may need to learn ways to become more assertive so that you can say “no” to food when necessary.
You may want to try losing weight with a buddy who is doing the same, or think about and lower your stress levels, or visit a counselor or a psychiatrist if your eating problems are more psychological than physical.
There is no one right way to lose weight. You may need to experiment with many of the suggestions made in this section to find the combination that helps you lose weight and keep it off.
Go to your endocrinologist or doctor for assessment, information and help. Find others in your life who will support your decision to lose weight. Good luck!