OBESITY & WEIGHT LOSS

One in three or 58 million American adults aged 20 through 74 are overweight.

According to data from the Third National Health and Nutrition Examination Survey (NHANES III), the number of overweight Americans increased from 25 to 33 percent between 1980 and 1991.

The survey also shows that minority populations, specifically minority women, are disproportionately affected: approximately 50% percent of African American and Mexican American women are overweight.

By a similar definition, more than one in five children and adolescents aged 6 through 17 are also overweight. Even using a more rigorous definition recommended for youths, 11 percent of children and adolescents are overweight, up from approximately 5 percent in the 1960s and 70s. Overweight and obesity is a known risk factor for diabetes, heart disease, high blood pressure, gallbladder disease, arthritis, breathing problems, and some forms of cancer.

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Overweight is the excess amount of body weight that includes muscle, bone, fat, and water. Obesity is the excess accumulation of body fat. One can be overweight without being obese: a body builder who has a lot of muscle, for example. However, for practical purposes, most people who are overweight are also obese.

Doctors and scientists generally agree that men with more than 25 percent body fat and women with more than 30 percent body fat are obese. However, it is difficult to measure body fat precisely. The most accepted method has been to weigh a person underwater. But underwater weighing is a procedure limited to laboratories with special equipment.

Two simpler methods for measuring body fat are skinfold thickness measurements and bioelectrical impedance analysis (BIA). Skinfold thicknesses are measures of the thickness of skin and subcutaneous (lying under the skin) fat at targeted sites of a person's body such as the triceps (the back of the upper arm). Measurements of skinfold thickness depend on the skill of the examiner, and may vary widely when measured by different examiners.

BIA sends a harmless amount of an electrical current through the body, which estimates total body water. Generally, a higher percent body water indicates a larger amount of muscle and lean tissue. Mathematical equations can translate the percent body water measure into an indirect estimate of body fat and lean body mass. BIA may not be accurate in severely obese individuals, and is not useful for tracking short-term changes in body fat brought about by diet or exercise.

In addition to skinfold thickness measures and BIA, doctors also use weight-for-height tables and body mass index measures (BMI) to determine if a person is at a desirable body weight. Doctors and obesity researchers prefer BMI to other measurements. Body mass index is found by dividing a person's weight in kilograms by height in meters squared. When a man's BMI is over 27.8, or woman's exceeds 27.3, that person is considered overweight. The degree of obesity associated with a particular BMI ranges from mild obesity at a BMI near 27, moderate obesity at 30, severe obesity at 35, to very severe obesity at 40 or greater. ¹ An estimated 41 percent of the population has a BMI greater than 25. ¹ Like weight-for-height tables, BMI does not measure body fat. While limited, these measures nevertheless help doctors, patients, and the public assess a person's desirable body weight.

Non-insulin-dependent diabetes mellitus (NIDDM)

Nearly 80 percent of patients with NIDDM are obese. ⁹ Much of the estimated $11.3 billion dollars spent each year to diagnose, treat, and manage NIDDM, including treatment for diabetic ketoacidosis, diabetic coma, diabetic eye disease, and diabetic kidney disease, stems from obesity. ⁹

Gallbladder disease

The incidence of symptomatic gallstones soars as a person's body mass index (BMI) goes beyond 29. ¹⁰ Nearly $2.4 billion dollars or 30 percent of the total amount spent annually on gallbladder disease and gallbladder surgery are related to obesity. ¹⁰

Heart disease

Nearly 70 percent of the diagnosed cases of cardiovascular disease are related to obesity.

Obesity

Obesity accounts for $22.2 billion, or 19 percent, of the total cost of heart disease. ¹⁰

High blood pressure

Obesity more than doubles one's chances of developing high blood pressure, which affects approximately 26 percent of obese American men and women. The annual cost of obesity-related high blood pressure is close to $1.5 billion dollars. ¹⁰

Breast and colon cancer

Almost half of breast cancer cases are diagnosed among obese women; an estimated 42 percent of colon cancer cases are diagnosed among obese individuals. Obesity-related breast cancer and colon cancer account for 2.5 percent of the total costs of cancer, or $1.9 billion dollars, annually. ¹⁰

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Indirect costs:

Americans spend an additional $33 billion dollars annually on weight-reduction products and services, including diet foods, products, and programs. ¹⁰

Obesity In Children And Teens

The problem of childhood obesity in the United States has grown considerably in recent years. Between 16 and 33 percent of children and adolescents are obese.  Obesity is among the easiest medical conditions to recognize but most difficult to treat.  Unhealthy weight gain due to poor diet and lack of exercise is responsible for over 300,000 deaths each year.  The annual cost to society for obesity is estimated at nearly $100 billion.  Overweight children are much more likely to become overweight adults unless they adopt and maintain healthier patterns of eating and exercise.

What is obesity?
A few extra pounds do not suggest obesity.  However they may indicate a tendency to gain weight easily and a need for changes in diet and/or exercise.  Generally, a child is not considered obese until the weight is at least 10 percent higher than what is recommended for the height and body type.  Obesity most commonly begins in childhood between the ages of 5 and 6, and during adolescence.  Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult. 

What causes obesity?
The causes of obesity are complex and include genetic, biological, behavioral and cultural factors.  Basically, obesity occurs when a person eats more calories than the body burns up.  If one parent is obese, there is a 50 percent chance that the children will also be obese.  However, when both parents are obese, the children have an 80 percent chance of being obese.  Although certain medical disorders can cause obesity, less than 1 percent of all obesity is caused by physical problems.  Obesity in childhood and adolescence can be related to:

• poor eating habits
• overeating or binging
• lack of exercise (i.e., couch potato kids)
• family history of obesity
• medical illnesses (endocrine, neurological problems)
• medications (steroids, some psychiatric medications)
• stressful life events or changes (separations, divorce, moves, deaths, abuse)
• family and peer problems
• low self-esteem
• depression or other emotional problems

What are risks and complications of obesity?
There are many risks and complications with obesity.  Physical consequences include:

• increased risk of heart disease
• high blood pressure
• diabetes
• breathing problems
• trouble sleeping

Child and adolescent obesity is also associated with increased risk of emotional problems.  Teens with weight problems tend to have much lower self-esteem and be less popular with their peers.  Depression, anxiety, and obsessive compulsive disorder can also occur.

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How can obesity be managed and treated?
Obese children need a thorough medical evaluation by a pediatrician or family physician  to consider the possibility of a physical cause.  In the absence of a physical disorder, the only way to lose weight is to reduce the number of calories being eaten and to increase the child's or adolescent's level of physical activity.  Lasting weight loss can only occur when there is self-motivation.  Since obesity often affects more than one family member, making healthy eating and regular exercise a family activity can improve the chances of successful weight control for the child or adolescent. 

Ways to manage obesity in children and adolescents include:

• start a weight-management program
• change eating habits (eat slowly, develop a routine)
• plan meals and make better food selections (eat less fatty foods, avoid junk and fast foods)
• control portions and consume less calories
• increase physical activity (especially walking) and have a more active lifestyle
• know what your child eats at school
• eat meals as a family instead of while watching television or at the computer
• do not use food as a reward
• limit snacking
• attend a support group (e.g., Weight Watchers, Overeaters Anonymous)

Obesity frequently becomes a lifelong issue.  The reason most obese adolescents gain back their lost pounds is that after they have reached their goal, they go back to their old habits of eating and exercising.  An obese adolescent must therefore learn to eat and enjoy healthy foods in moderate amounts and to exercise regularly to maintain the desired weight.  Parents of an obese child can improve their child's self esteem by emphasizing the child's strengths and positive qualities rather than just focusing on their weight problem.

When a child or adolescent with obesity also has emotional problems, a child and adolescent psychiatrist can work with the child's family physician to develop a comprehensive treatment plan.  Such a plan would include reasonable weight loss goals, dietary and physical activity management, behavior modification, and family involvement.

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