Category: Obesity

Obesity


Obesity is defined as an excessively high amount of body fat or adipose tissue in relation to lean body mass. The amount of body fat includes concern for both the distribution of fat throughout the body and the size of the adipose tissue deposits. The percentage of children and adolescents who are defined as overweight has more than doubled since the early 1970s. Nearly 68% of Anne Arundel County adults are obese or overweight.

This trend continues to increase at an alarming rate, keeping up with national trends. Overweight and obesity result from an imbalance involving excessive calorie consumption and/or inadequate physical activity. For each individual, body weight is the result of a combination of genetic, metabolic, behavioral, environmental, cultural and socioeconomic influences. Behavioral and environmental factors are the primary contributors to overweight and obesity and provide the greatest opportunity for action and interventions designed for prevention and treatment.

Recent data identifies residential areas in which people must drive to shopping and other services as having increased the risk for obesity. The role of the environment is receiving more attention, but solutions may take time and will be controversial.
Information on the following is included below:

Clinical Presentation

The accumulation of body fat, particularly in a visceral distribution, promotes insulin resistance and diabetes, and contributes to increased premature coronary artery disease. Increases in circulating levels of insulin and insulin-like growth factor 1 may increase blood pressure. In addition, obese patients are more likely to suffer from sleep apnea and other sleep-disordered breathing, liver failure, and to suffer from the emotional and psychosocial sequelae of obesity. Increased body mass significantly increases lifetime chances of osteoarthritis. Obesity makes physical and radiological examinations more difficult, leading to challenges in screening and diagnosis.

Diagnosis

The most common means of diagnosis and screening for obesity is the Body Mass index (BMI). BMI is a common measure of obesity expressing the relationship (or ratio) of weight-to-height. Body weight in kilograms is divided by the square of his or her height in meters (i.e., wt/(ht)2. The BMI is more highly correlated with body fat than any other indicator of height and weight. Individuals with a BMI of 25 to 29.9 are considered overweight, while individuals with a BMI of 30 or more are considered obese. Waist circumference is the most common measure used to assess abdominal fat. The presence of excess body fat in the abdomen, when out of proportion to total body fat, is considered an independent predictor of risk factors and ailments associated with obesity. Waist circumference is a more accurate indication of abdominal fat, and easier to administer than hip to waist ratio. Sex-specific cutoffs for waist circumference can be used to identify increased risk associated with abdominal fat in adults with a BMI in the range of 25 to 34.9.

Treatment

Current guidelines from the U.S. Preventive Services Task Force call for screening for obesity at each patient visit. It is already widely accepted to weigh patients at each visit. Follow through to BMI calculation could be done by the admitting nurse or physician. For overweight patients, physician counseling should focus on recommendations to lose weight, the risks of increased weight and the benefits of weight loss. The unique physician/patient relationship might be the only format in which patients are receptive to the message that they need to lose weight. It is well documented that a 10% decrease in bodyweight brings substantial health benefits, and is easier to obtain and maintain for patients than often unrealistic expectations people want to obtain. Patient handouts and other information can then be used to facilitate weight loss. Primary efforts to lose weight should focus on the following:

Physical Activity

Current American Heart Association dietary guidelines should be the guideline for sensible eating and weight loss. The current food guide pyramid is due to change by the end of 2005 to encourage increased exercise along with proper eating habits. Generally, a diet only works if a person is willing to stick to it. Any diet that reduces caloric intake over output will reduce body weight. Long-term attention to a balanced diet and active lifestyle is essential to good health and maintaining healthy body weight. Click here for physical activity resources, or see Learn To Live Food and Fitness

Healthy Eating

Current American Heart Association dietary guidelines should be the guideline for sensible eating and weight loss. The current food guide pyramid is due to change by the end of 2005 to encourage increased exercise along with proper eating habits. Generally, a diet only works if a person is willing to stick to it. Any diet that reduces caloric intake over output will reduce body weight. Long-term attention to a balanced diet and active lifestyle is essential to good health and maintaining healthy body weight. Click here for more information on healthy eating.

A few words on popular diets.

Very low-fat diets. In addition to weight loss, these diets have been shown to decrease cholesterol and has been scientifically proven to reverse coronary artery disease. Those on the diet show decreased size of atherosclerotic lesions. The diet and related regimen may include the following features: a 10% fat, vegetarian diet; moderate aerobic exercise; stress management training including yoga and meditation; smoking cessation; and group psychosocial support. It should be noted that it is not certain which components of the regimen are necessary to produce the desired results. The American Heart Association warns that very low-fat diets can increase triglycerides. Increasing exercise and taking a flaxseed or fish oil supplement can minimize this risk. It goes without saying that complying with a very low-fat diet is difficult for all but the most motivated and disciplined people.

Low carbohydrate diets. These diets include an induction phase that is about 2 weeks or more, depending on the amount of weight a person needs to lose. During this phase, carbohydrates are restricted to less than 20 grams per day. This excludes most fruits and vegetables and relies on a diet containing mostly animal fats and protein. Simple carbohydrates such as sugar, white flour, pasta, rice, and alcohol are rapidly absorbed; increase blood glucose level; chronically increase insulin levels; and cause weight gain when consumed in excess. Complex carbohydrates such as wheat, brown rice, fruits, vegetables, grains, beans and soy products are rich in fiber that slows absorption. These high-fiber carbohydrates also decrease insulin levels. However, numerous studies have shown that excess animal protein increases the risk of breast and prostate cancer, heart disease, kidney disease, and osteoporosis. A diet that is high in fat and protein with very low carbohydrates induces a ketotic state. Urinary clearance of the ketones will cause rapid weight loss; however, weight loss is due to water loss and not true fat reduction. This is not lasting weight loss. This diet is especially dangerous for diabetics and pregnant or nursing women. It also establishes unhealthy eating habits, and has been shown to increase kidney stones and gout. It should also be noted that starvation diets also cause the formation of ketones.

Medications
The following medications have been used for weight loss, they are now known to be harmful to the health of those that take them, or illegal. Please do not recommend that any of your patients take any form the following list: Phen-fen, Redux, Ephedra (MaHuang), amphetamines, Phenylpropanolamine (PPA). Ask patients if they are taking over the counter, health food or TV supplements or other weight control products. They will tell you they are if they are asked about other products, but will often not volunteer the information.The use of medications to treat overweight and obesity has met with mixed results, and should be used with caution. Drugs such as Sibutramine (Meridia and Orlistat (Xenical) are available for use.
Bariatric Surgery

Bariatric Surgery can be recommended for morbidly obese patients with a BMI greater than 40 kg/m2. There are 2 types of bariatric surgery: malabsorptive and restrictive. Both types of surgery are restricted to certain qualifying patients, and should be carefully explored by patients with their physicians prior to taking this life-altering step. For more information of Bariatric Surgery, please click here.