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Obesity



Related terms
Background
Treatment
Author information
Bibliography
Causes

Related Terms
  • Adolescent obesity, bariatric surgery, BMI, body mass index, body weight, childhood obesity, diet, endocrine disease, exercise, gastric bypass, liposuction, metabolism, morbid obesity, morbidly obese, obesity in the elderly, overeating, super obesity.

Background
  • Obesity occurs when an individual has an increased amount of body fat. It is usually defined as being 20-30% above the normal body weight for someone of the same age, gender, and height.
  • Morbid obesity is usually defined as being 50-100% above the normal body weight for someone of the same age, gender, and height.
  • Many factors, including an individual's age, gender, and height, are considered to determine if he/she is overweight. People increase in weight until they are fully grown. On average, females tend to gain about 16 pounds of body weight from age 25-54. In contrast, males tend to gain about 10 pounds of body weight from age 25-45. By around age 55, both men and women start to decline in weight. Females naturally have more body fat and less muscles mass than men. It is also normal for taller individuals to weigh more than shorter individuals.
  • Obesity is typically considered a long-term condition that often persists for many years. Researchers believe that many factors, including poor diet, overeating, pregnancy, medications, medical conditions, genetics, gender, and age, may contribute to a person becoming obese.
  • Obesity can have serious long-term effects on health. Individuals who are overweight have an increased risk of developing many life-threatening illnesses including heart disease, high blood pressure, stroke, obesity, diabetes, osteoporosis, and cancer. According to the American Heart Association, obesity was associated with nearly 112,000 deaths in 2005.
  • In the United States, obesity is considered an epidemic. More than half of all Americans are considered overweight, and about 20% of children are overweight. In 2005, 140 million Americans were considered overweight or obese, according to the American Heart Association. Nearly 33% of Americans are considered obese, and these numbers continue to grow.

Treatment
  • General: Most doctors believe that overweight individuals should try to lose weight gradually. This reduces the risk of nutritional deficiencies and increases the likelihood of long-term success. Individuals who are overweight should aim to lose about one-half to two pounds per week. The safest and most effective way to lose weight is to reduce the amount of calories in the diet and increase physical activity. Individuals should eat sensible portions of foods that are well-balanced.
  • In serious cases when obesity is causing life-threatening conditions or when all other options have failed, surgical weight-loss procedures (called bariatric surgeries) may be considered. However, individuals must meet specific criteria in order to qualify for weight-loss surgery. In addition, bariatric surgeries, like all surgeries, have potential health risks. Patients should discuss the potential risks and benefits with their healthcare providers before making any decisions about medical treatments.
  • Exercise programs: Patients who are overweight or obese are encouraged to exercise. Research shows that regular exercise can help individuals live longer, healthier lives. Exercise can help prevent illnesses, such as heart disease, stroke, diabetes, and cancer.
  • In general, overweight patients should participate in 45-60 minutes of moderate exercise (e.g. brisk walking or jogging) each day in order to prevent becoming obese. Patients who were formerly obese are encouraged to participate in 60-90 minutes of moderate exercise each day along with a healthy, well-balanced diet, in order to prevent gaining the weight back.
  • Not everyone is able to perform intense types of exercise, such as tennis or running. The American Academy of Family Physicians recommends that individuals who are pregnant or have bone disease or nerve injuries participate in low-impact forms of exercise, such as walking or swimming. Individuals who are overweight or obese may have serious health conditions that limit the type or amount of exercise they can perform. Therefore, patients should talk to their healthcare providers before starting a new exercise plan, especially if they are pregnant, elderly, or have a critical illness or injury. A healthcare provider can work with a patient to design an individualized and safe exercise program.
  • Healthy diet: In addition to regular exercise, a healthy diet is also important. Individuals should eat well-balanced meals that are sensible portions. The U.S. government issued a revised food pyramid in 2005 to help Americans choose healthier eating habits. The new, updated food pyramid provides 12 different models based on daily calorie needs, ranging from the 1,000-calorie diets for toddlers to 3,200-calorie diets for teenage boys.
  • Overall, doctors suggest drinking six to eight glasses of water a day and lots of raw fruits and vegetables, especially green leafy vegetables. Some individuals may find it helpful to eat frequent small meals throughout the day to keep the body's energy and metabolism increased. Foods and drinks that contain a lot of sugar and little or no nutritional value should be consumed in moderation. This means individuals should limit their intakes of foods and drinks, such as coffee, alcohol, soft drinks, fruits juices that are high in sugar, processed foods, white sugar, white flour, red meat, and animal fats.
  • A healthcare provider may recommend a nutritionist to help plan meals that are appropriate for the patient. A nutritionist can help teach the patient what foods are considered healthy and what are not. It is important for the patient to understand the negative impact that poor eating habits have on the body.
  • Many experts recommend making gradual changes in the diet. This has been shown to help prevent or minimize food cravings. Individuals who slowly change their diets may be more likely to adopt these eating habits as part of their long-term lifestyle.
  • Appetite suppressants: Appetite suppressants are medications, herbs, or supplements that decrease appetite or make the individual feel full.
  • Some doctors prescribe appetite suppressant medications to help treat obese individuals. Most individuals who take these medications initially lose between five and 22 pounds. Weight loss is usually greatest during the first few weeks or months of treatment. After about six months, the patient's weight usually levels off. However, most people gain the weight back once they stop taking the medications.
  • Appetite suppressants can be taken short term (few weeks to a few months) or long term (one year or more), depending on the specific medication prescribed. Diethylpropion (Tenuate®), a short term medication, may increase blood pressure. Phentermine (Fastin®), another short-term medication, has been taken off the market due to increased risk for heart valve disease.
  • There are also many appetite suppressants that are available over-the-counter. These products can be purchased at health food stores, local pharmacies, or nutrition stores. For instance, an herb called hoodia may cause individuals to feel full. As a result, patients may eat less food. However, no studies have been performed in humans to determine if hoodia is safe and effective in humans.
  • Dietrine Carb Blocker with Phase 2® is also available over-the-counter. This product is made with an ingredient from white kidney beans that may prevent the body from storing sugar as fat in the body.
  • While some side effects of U.S. Food and Drug Administration (FDA) approved medications are mild, and may usually go away as treatment is continued, some side effects may be severe and long-lasting. Symptoms may include sleeplessness and/or nervousness. There have also been reports of serious and deadly reactions to appetite suppressants, including primary pulmonary hypertension. Several previously approved drugs, such as phentermine (Fastin®), have caused heart valve disease in patients, and are no longer available.
  • Other medications: Orlistat (Xenical®) is a lipase inhibitor, which reduces the amount of fat the body can absorb, and is used as long-term medication. About 30% of the fat from foods is excreted instead of being absorbed. Alli® is a reduced-strength form of orlistat (Xenical®) currently available, thus it also functions in weight loss by decreasing fat absorption. Sibutramine (Meridia®), also a long-term medication, aids in weight-loss by blocking the re-uptake of the neurotransmitters serotonin and norepinephrine. These long-term medications may be taken for several months or years. Some individuals may need to take them their entire lives.
  • Gastric bypass surgery: Gastric bypass surgery, which uses bands or staples to create food intake restriction, is the most common weight loss surgery. The bands or staples are surgically placed near the top of the stomach to section off a small portion that is often called a stomach pouch. A small outlet, about the size of a pencil eraser, is left at the bottom of the stomach pouch. Since the outlet is small, food stays in the pouch longer and the patient also feels full for a longer time. Next, a section of the small intestine is attached to the pouch. This allows food to bypass part of the intestine, resulting in fewer calories being absorbed.
  • This surgery is often performed in those who have a BMI ?40 (extremely obese) or in patients that have BMIs that are 35-39.9 along with weight-related health problems such as diabetes or high blood pressure.
  • Surgical candidates go through an extensive screening process. Not everyone who meets the criteria for the surgery is psychologically or medically ready for the surgical procedure. A team of professionals, including a physician, dietitian, psychologist, and surgeon, evaluate whether the surgery is appropriate. Following surgery, physical, nutritional and metabolic counseling are given to prevent nutritional deficiencies. Lifelong use of nutritional supplements such as multivitamins, vitamin B12, vitamin D, and calcium is recommended.
  • Over two years, gastric bypass surgery patients have been shown to lose two-thirds of excess weight. The improvements observed in type 2 diabetes, high blood pressure, and high blood cholesterol may significantly decrease the risk of heart disease in individuals who have undergone gastric bypass surgery compared to those treated through other means. Gastric bypass surgery has also shown to improve mobility and quality of life for people who are severely overweight.
  • However, individuals who continue to overeat after undergoing the surgery may stretch out the pouch. As a result, the stomach may become as large as it was prior to surgery, and the patient may gain back weight.
  • There is a risk of death during gastric bypass surgery. The risk varies depending on age, general health, and other medical conditions.
  • If the contents of the stomach leaks out of one of the staple lines, the patient will receive antibiotics to prevent an infection. Most cases heal with time. Sometimes, the leak can be serious enough to require emergency surgery.
  • Excess weight places extra stress on the chest cavity and lungs. As a result, there is a higher risk of developing pneumonia during post-operative recovery when the patient is lying down.
  • Narrowing of the opening between the stomach and small intestine has occurred. This rare complication may require either an outpatient procedure to pass a tube through the mouth to widen the narrowed opening or corrective surgery.
  • Gastric bypass can also cause dumping syndrome, a condition where stomach contents move too quickly through the small intestine causing nausea, vomiting, diarrhea, dizziness, and sweating.
  • Other common complications include dehydration, gallstones, bleeding stomach ulcers, hernia at the incision site, and intolerance to certain foods.
  • Liposuction: Liposuction is the most frequent cosmetic operation in the United States in which fat tissue is removed. Relatively small amounts of total body fat can be removed safely. However, little weight is lost. Unless the patient makes lifestyle changes, that include regular exercise and a healthy diet, the weight will return. Therefore, liposuction is categorized as a cosmetic surgery rather than a weight loss surgery.
  • Adjustable gastric banding: A surgical procedure called gastric banding may also be performed. This surgery is designed to make the patient feel full quicker so he/she will eat less and lose weight. During the procedure, the surgeon uses an inflatable band to partition the stomach into two parts. The surgeon then wraps the band around the upper part of the stomach and pulls it tight, like a belt, creating a tiny channel between the two pouches. The band keeps the opening from expanding and is designed to stay in place indefinitely. However, it can be adjusted or surgically removed if necessary. Most surgeons perform this operation using a laparoscope.
  • Biliopancreatic diversion: During a surgical procedure, called biliopancreatic diversion, a portion of the stomach is removed. The remaining pouch is connected directly to the small intestine, but completely bypasses the small intestine, where most nutrient absorption takes place. This weight-loss surgery offers sustained weight loss, but it presents a greater risk of malnutrition and vitamin deficiencies that requires close monitoring.
  • Some patients may require vitamin and/or nutritional supplements after the surgery. Other possible complications include infection, blood clot in the lung (called pulmonary embolism), as well as stomach contents leaking into the abdominal cavity.
  • Vertical banded gastroplasty: This operation divides the stomach into two parts, limiting space for food and forcing the patient to eat less. There is no bypass. Using a surgical stapler, the surgeon divides the stomach into upper and lower sections. The upper pouch is small and empties into the lower pouch, the rest of the stomach. Surgeons use this procedure less frequently than gastric bypass partly because it does not lead to adequate long-term weight loss.
  • Jaw wiring: Jaw wiring is another option, although it is used infrequently. This is a form of food intake restriction for temporary use in patients who do not have breathing problems. During the procedure, the patient's jaw is wired shut. While the jaw is wired, the patient is only able to consume liquid nutrition through a straw. The wires are typically removed every four to six weeks to allow the patient to exercise the jaw. Treatment may last anywhere from three to six months. Individuals regularly rinse their mouths with mouthwash and use antiseptic wipes on the front of their teeth. When the wires are removed, the patient can brush his/her teeth.
  • It is recommended that individuals carry wire cutters with them at all times in case of an emergency such as the need to vomit. In general, breathing is not inhibited while the jaw is wired. However, activities that cause deep breathing, such as aerobic exercise, should be avoided.
  • Although jaw wiring can be effective for short-term weight loss, weight regain occurs soon after the wires are removed. Therefore, it is not considered a conventional weight-loss procedure.
  • Antidepressants: Depression is commonly associated with obesity. Antidepressants may be prescribed to treat depression in some patients. Drugs called selective serotonin reuptake inhibitors (SSRIs) are the most common type of antidepressants used. Commonly prescribed SSRIs include fluoxetine (Prozac®), fluvoxamine (Luvox®), sertraline (Zoloft®), and paroxetine (Paxil®). Less commonly prescribed antidepressants include clomipramine (Anafranil®), mirtazapine (Remeron®), amitriptyline (Elavil®), and bupropion (Wellbutrin®). Side effects may include nausea, nervousness, insomnia, diarrhea, rash, agitation, or problems with sexual arousal or orgasm.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Society for Metabolic and Bariatric Surgery.
  2. Assimakopoulos K, Panayiotopoulos S, Iconomou G, et al. Assessing sexual function in obese women preparing for bariatric surgery. Obes Surg. 2006 Aug;16(8):1087-91.
  3. Centers for Disease Control and Prevention (CDC). .
  4. Gordon-Larsen P. Obesity-related knowledge, attitudes, and behaviors in obese and non-obese urban Philadelphia female adolescents. Obes Res. 2001 Feb;9(2):112-8.
  5. Kolotkin RL, Binks M, Crosby RD, et al. Obesity and sexual quality of life. Obesity (Silver Spring). 2006 Mar;14(3):472-9.
  6. Kolotkin RL, Head S, Hamilton M, et al. Assessing Impact of Weight on Quality of Life. Obes Res. 1995 Jan;3(1):49-56.
  7. National Heart, Lung, and Blood Institute. .
  8. Natural Standard: The Authority on Integrative Medicine. .
  9. Nguyen-Michel ST, Unger JB, Spruijt-Metz D. Dietary correlates of emotional eating in adolescence. Appetite. 2007 Mar 19; [Epub ahead of print.]
  10. No authors listed. A critique of low-carbohydrate ketogenic weight reduction regimens. A review of Dr. Atkins' diet revolution. JAMA 6-4-1973;224(10):1415-1419.
  11. Oliver G, Wardle J, Gibson EL. Stress and food choice: a laboratory study. Psychosom Med. 2000 Nov-Dec;62(6):853-65.
  12. U.S. Food and Drug Administration (FDA). .
  13. Viner RM, Haines MM, Taylor SJ, et al. Body mass, weight control behaviours, weight perception and emotional well being in a multiethnic sample of early adolescents. Int J Obes (Lond). 2006 Oct;30(10):1514-21. Epub 2006 May 23.
  14. Wilson LF. Adolescents' attitudes about obesity and what they want in obesity prevention programs. J Sch Nurs. 2007 Aug;23(4):229-38.

Causes
  • General: There are many potential causes of obesity. Some patients may be obese for multiple reasons.
  • Poor diet: Individuals who regularly consume foods that are high in calories and saturated fats have an increased risk of becoming obese. Examples of foods and beverages that may lead to obesity include fast food, fried food, sodas, candy, and desserts.
  • To maintain a healthy weight, an individual's intake of calories should be about equal to the calories used or burned during the day. If an individual eats more calories than are burned, the body stores the extra calories as fat. That is why someone who leads a sedentary, or inactive, lifestyle would most likely gain weight if they ate the same amount of food as someone who goes running every day.
  • Overeating: Consistently eating too much food also increases the risk of becoming obese. Individuals who regularly eat extra-large portions of food, eat until they are full, or eat many times throughout the day are more likely to become obese.
  • Inactivity: Individuals who do not exercise regularly are more likely to become obese. Physical activity is needed to burn the calories that are consumed in the diet. If these calories are not burned, they will be stored as fat in the body. Most experts recommend at least 30 minutes of moderate exercise three or more times per week to help maintain a healthy weight.
  • Pregnancy: During pregnancy, the female's body weight increases, not only because she is carrying a baby, but also because the mother's body needs to support the growing fetus. The average weight gain after pregnancy is typically 25-35 pounds. Researchers believe that this weight gain may contribute to the development of obesity.
  • Medications: Some medications, including corticosteroids and tricyclic antidepressants, may cause weight gain as a side effect.
  • Medical conditions: Although it is uncommon, sometimes obesity is caused by medical conditions. For instance, if the thyroid does not produce enough thyroid hormone, the metabolism slows down and it may lead to mild weight gain and difficulty losing extra weight.
  • In addition, some long-term conditions, such as emphysema or arthritis, may limit an individual's ability to exercise. As a result, individuals may become overweight or obese.
  • Stress: Stress may also contribute to obesity. When an individual becomes stressed, it signals the adrenal glands to release a hormone called cortisol. Research suggests that increase in cortisol levels may lead to increased fat around the midsection.
  • In addition, recent research suggests that there is a connection between high levels of stress and the desire to eat. It has been proposed that comfort foods, specifically those that are high in fats and sugars, may help reduce the body's response to stress and limit the amount of cortisol that is released. However, individuals who frequently indulge in these foods typically develop excess abdominal fat, which has been associated with an increased risk of heart disease and stroke.
  • Genetics: Genetics may also contribute to obesity. For instance, a patient's genetics may affect how much fat is stored and where it is distributed in the body. Genetics may also affect how quickly the body is able to convert food into energy and how efficiently the body is able to burn calories during physical activity. Although genetics can increase an individual's risk of becoming obese, it is not the only factor for the condition. In other words, individuals who are genetically predisposed to become obese will not always become obese, especially if they make the right lifestyle choices.
  • Gender: Women are more likely to become obese than men. This is because women naturally have more body fat and less muscle mass than men. In addition, women burn fewer calories at rest than men do. As a result, women are more likely experience an increase in body fat than males.
  • Age: Age may also contribute to obesity. Muscle mass tends to decrease with age, which decreases the body's metabolism, or rate at which the body is able to process fats. In addition, most patients become less active as they age. All of these changes lead to a decrease in the amount of calories that body needs. If individuals do not decrease the amount of calories they consume, they will start to gain weight.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.



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