With your participation, your health provider can help you to choose the best ways of treating your obesity, according to your overall health condition and particular needs and goals. Obesity What Is Obesity? Obesity is the presence of excessive body fat (adipose tissue) under the skin above the muscles and around the internal organs. The most useful measure of “excess” in this context is the body mass index (BMI), which represents your weight in relation to the range of weights that characterizes healthy people of your height in the wider population. Obesity is defined as having a body mass index that exceeds 30. Overweight, a less extreme condition, corresponds to a BMI of 25-30. Obesity increases a person's risk of illness and death from heart disease, stroke, diabetes hypertension, high cholesterol, kidney failure, and gallbladder disease. Obesity may increase your risk of some types of cancer, as well as of osteoarthritis, depression, and sleep apnea. According to the National Health and Nutrition Examination Survey (NHANES) 2007– 2008, about one-third of adults in the United States are obese and an additional third are overweight. The prevalence of obesity in the United States has grown in the past 30 years. Of particular concern is the fact that obesity is a growing problem among children. What Causes Obesity? The direct cause of most cases of obesity and overweight is an imbalance between the levels of energy that you take in as food and the energy that your body spends in exercise, daily activity, and basic self-maintenance (breathing, maintaining normal body 2016 © Persivia Proprietary Page 1 of 7 Patient Education Obesity temperature, and other basic processes). The indirect causes of this imbalance usually include the following contributors: Unhealthy eating habits An inactive lifestyle Emotional factors Smoking Age Lack of sleep Pregnancy Genes and family history Other health problems Unhealthy eating habits have become more widespread and extreme in recent decades, in great part because market forces have projected an unrealistic representation of food in relation to our real needs and capacities. In the United States restaurant portions have become oversized and food companies have placed advertisements in almost every venue. Of particular concern is the practice of targeting children in advertising high-calorie, high-fat snacks and sugary drinks. The next contributor to obesity in the United States and the developed world is an inactive lifestyle. Many Americans are not very physically active, in part because they spend a great deal of time sitting in front of computer or television screens. A daily pattern entailing more than two hours a day of television viewing time has been linked to overweight and obesity. Other reasons for inactivity include relying on cars instead of walking, making less physical effort at work and at home, and being deprived of physical education classes in children’s schools. Emotions contribute to obesity when people turn to food to solve emotional problems, eating when they are bored, angry, or anxious. Over time, overeating leads to weight gain and may cause overweight or obesity. Many people gain weight as they quit smoking, in part because nicotine raises the rate at which the body burns calories. 2016 © Persivia Proprietary Page 2 of 7 Patient Education Obesity Age often contributes to weight gain because people lose muscle mass with age. Muscle loss can slow down the rate at which your body burns calories. Women are exposed to an additional age-related contributor with menopause. Inadequate sleep can contribute to weight gain because hormones that are released during sleep control appetite and the body's use of energy. Finally, medical conditions such as underactive thyroid can contribute to obesity, as can some antidepressant medications, corticosteroids, and seizure medicines. Who Is at Risk of Obesity? Overweight and obesity affect Americans of all ages, sexes, and racial/ethnic groups. However, higher levels of these conditions affect certain ethnic groups: Women are at higher risk of obesity than men African Americans are at heightened risk of overweight and obesity (78 percent of all African-American women are affected) Hispanic Americans are at higher risks of overweight and obesity Race does not itself contribute to overweight or obesity but the two attributes change together when observed among many cases over time. In that sense, being a member of one of these racial minorities in the United States is a correlated risk of overweight and obesity. The following conditions are risk factors of obesity because they contribute to the condition: Smoking Age Loss of muscle mass Lack of sleep (failure over time to get at least seven hours of sleep per night) Pregnancy Genes and family history Other health problems such as hypothyroidism 2016 © Persivia Proprietary Page 3 of 7 Patient Education Obesity What Are Signs and Symptoms? The changes that can culminate in obesity take place over time; for this reason, early symptoms may be subtle. However, the following changes can indicate the need to consider weight management: The need for a larger size in your clothing Increased values on a scale when you weigh yourself A higher- than-normal body mass index A higher-than -normal waist circumference How Is Obesity Diagnosed? A diagnosis of obesity follows a determination that your body mass index is over 30, meaning that your weight is significantly above the upper limit of the range of weights that characterizes healthy people of your height in the general population. BMI Significance 18.5–24.9 Normal weight 25.0–29.9 Overweight 30.0–39.9 Obese 40.0 and above Extreme obesity One limitation of the BMI entails unusual levels of muscle mass. A BMI reading may mischaracterize an athlete or a person with a large muscle mass as overweight. Conversely, a BMI reading may misrepresent as normal the body mass of an elderly person who has lost muscle. The BMI must be modified as a tool in evaluating children who are still growing and who grow in unique patterns. For this reason, the body mass of a child or an adolescent is qualified in the BMI-for-age percentile measurement, which compares the body mass of a particular young person with that of others of the 2016 © Persivia Proprietary Page 4 of 7 Patient Education Obesity same height, weight, and age. In spite of these limitations, the BMI is reliable and accurate in evaluating most adults. What Are Common Treatments? With your participation, your healthcare provider can help you to choose the best ways of treating your obesity, according to your overall health condition and particular needs and goals. He or she is likely to recommend modifying your patterns of eating and physical activity. In addition, you may be advised to watch for “triggers” that prompt you to eat impulsively. Dietary Modification A healthy eating plan gives your body the nutrients that it needs for good health but not the extra caloric nutrients that cause you to gain weight. Besides being caloriecontrolled, a healthy eating plan minimizes foods that are high in calories and low in nutrients. For this reason, a healthy eating plan is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar. The following types of food contribute to a healthy diet: Vegetables (fresh, frozen, dried, or canned without added salt) Fruits (fresh, frozen, dried, or canned without added sugar) Fat-free and low-fat milk and milk products (low-fat yogurt, cheese, and milk) Lean meat, fish, poultry, cooked beans, and peas Whole-grain foods (whole-wheat bread, oatmeal, and brown rice) Other grain foods (pasta, cereal, bagels, bread, tortillas, couscous, and crackers) Canola and olive oils and soft margarines made from these oils, are heart healthy. However, you should use them in small amounts because they are high in calories. Exercise Your doctor is likely to recommend increasing your exercise. A widely used recommendation calls for at least 30 minutes of moderate exercise, such as continuous brisk walking, at least five days per week. Behavioral and Environmental Treatments 2016 © Persivia Proprietary Page 5 of 7 Patient Education Obesity Behavioral and environmental treatments may include teaching you techniques to manage stress, as well as referrals for any needed counseling to help with emotional issues. Medications Medications can be useful in a weight-loss program but your doctor is not likely to prescribe them unless you have not succeeded in losing weight after six months of dieting and exercise. Medication is only a part of a multi-faceted program that centers on diet management, exercise, and emotional self-management. Orlistat (Xenical®) is now the only FDA-approved weight-loss medicine. Orlistat reduces the body’s absorption of fats, fat calories, and certain vitamins (A, D, E, and K). Because Orlistat reduces the body’s absorption of vitamins, you should not take it without also taking a vitamin supplement. The FDA also approves an over-the-counter weight-loss aid, Alli®. Alli contains Orlistat but delivers it at a lower dose than when it is prescribed. Talk with your doctor before starting Alli, especially if you are taking blood-thinning medicines or being treated for diabetes or thyroid disease. As adjuncts to your weight-management program, your doctor may also prescribe medicines to treat depression and anxiety. Surgery In severe cases, surgical procedures can reduce the size of the stomach, thereby limiting the number of calories that the intestines absorb. However, as with medications surgery is only a part of a multi-faceted program that centers on diet management, exercise, and emotional self-management. Two common weight-loss surgeries include banded gastroplasty and Roux-en-Y gastric bypass. For banded gastroplasty, a band or staples are used to create a small pouch at the top of your stomach. This surgery limits the amount of food and liquids the stomach can hold. Both these procedures can be risky unless you are in good overall health. Both have significant side effects and require lifelong medical follow-up. Consider all options carefully with your doctor before deciding on weight-loss surgery. 2016 © Persivia Proprietary Page 6 of 7 Patient Education Obesity Can Obesity Be Prevented? The mainstays of obesity prevention are healthy eating habits and maintaining an active lifestyle. Should I Call My Doctor? If you are extremely obese (that is, have a BMI of 40 or above), keep in close touch with your doctor because you are at risk of heart attack, stroke, and other medical problems. Communicate closely with your doctor if you are obese and have any of these additional conditions: Heart disease Diabetes High blood pressure For More Information For more information, refer to the following medical resources: https://www.cdc.gov/obesity/ http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthylifestyles/obesity/obesity-patient-resources.page? http://www.nhlbi.nih.gov/health/health-topics/topics/ms/ http://win.niddk.nih.gov/publications/understanding.htm#Healthrisks http://www.nlm.nih.gov/medlineplus/obesity.html The content in this document is neither intended nor recommended as a substitute for seeking professional medical advice, diagnosis or treatment. It is recommended that you seek the advice of your physician or other qualified healthcare professional regarding any medical questions related to the topics contained within this document, your health or conditions. 2016 © Persivia Proprietary Page 7 of 7