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# What Is Obesity?

An obese person has accumulated so much body fat that it might have a negative effect on their health. If a person's bodyweight is at least 20% higher than it should be, he or she is considered obese. If your Body Mass Index (BMI) is between 25 and 29.9 you are considered overweight. If your BMI is 30 or over you are considered obese.

## What is Body Mass Index (BMI)?

The BMI is a statistical measurement derived from your height and weight. Although it is considered to be a useful way to estimate healthy body weight, it does not measure the percentage of body fat. The BMI measurement can sometimes be misleading - a muscleman may have a high BMI but have much less fat than an unfit person whose BMI is lower. However, in general, the BMI measurement can be a useful indicator for the 'average person'. To calculate your BMI, use our BMI Calculator

## Why do people become obese?

People become obese for several reasons, including:

1.

Consuming too many calories. People are eating much more than they used to. This used to be the case just in developed nations - however, the trend has spread worldwide. Despite billions of dollars being spent on public awareness campaigns that attempt to encourage people to eat healthily, the majority of us continue to overeat. In 1980 14% of the adult population of the USA was obese; by 2000 the figure reached 31% (The Obesity Society). In the USA, the consumption of calories increased from 1,542 per day for women in 1971 to 1,877 per day in 2004. The figures for men were 2,450 in 1971 and 2,618 in 2004. Most people would expect this increase in calories to consist of fat - not so! Most of the increased food consumption has consisted of carbohydrates (sugars). Increased consumption of sweetened drinks has contributed significantly to the raised carbohydrate intake of most young American adults over the last three decades. The consumption of fast-foods has tripled over the same period. Various other factors also may have contributed to America's increased calorie and carbohydrate intake: o In 1984 the Reagan administration freed up advertising on sweets and fast foods for children - regulations had previously set limits.

Agricultural policies in most of the developed world have led to much cheaper foods.

The US Farm Bill meant that the source of processed foods came from subsidized wheat, corn and rice. Corn, wheat and rice became much cheaper than fruit and vegetables. 2. Leading a sedentary lifestyle. With the arrival of televisions, computers, video games, remote controls, washing machines, dish washers and other modern convenience devices, the majority of people are leading a much more sedentary lifestyle compared to their parents and grandparents. Some decades ago shopping consisted of walking down the road to the high street where one could find the grocers, bakers, banks, etc. As large out-of-town supermarkets and shopping malls started to appear, people moved from using their feet to driving their cars to get their provisions. In some countries, such as the USA, dependence on the car has become so strong that many people will drive even if their destination is only half-a-mile away.
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Poorly balanced diets and the lack of physical exercise are key factors in the increase of obesity and other metabolic diseases in modern societies. In epidemiological studies in humans, the effect of the intake of fructose-sweetened beverages also seems to be more intense in women. (From - "New Data On Fructose-Sweetened Beverages And Hepatic Metabolism"). Although there appears to be a consensus on the negative effects of fructose-sweetened beverages there is still some debate over the effects of fructose versus high fructose corn syrup - two studies of note are: "AMA Finds High Fructose Syrup Unlikely To Be More Harmful To Health Than Other Caloric Sweeteners" and "Fructose Sweetened Drinks Increase Nonfasting Triglycerides In Obese Adults". Fructose effect on the brain may promote obesity - researchers from Yale University School of Medicine compared the effects of fructose and glucose on the brain with MRI scans and found that high fructose diets may be behind the current obesity epidemic. In an article published in JAMA (Journal of the American Medical Association), the authors said they found that regions in the brain that regulate appetite became active when people consumed glucose, but remained inactive when they ingested fructose. When those regions become active, they release hormones that produce feelings of satiety (fullness) in other words, the hormones tell you to stop eating. 5. Lower rates of smoking (smoking suppresses appetite). According to the National Institutes of Health (NIH) "Not everyone gains weight when they stop smoking. Among people who do, the average weight gain is between 6 and 8 pounds. Roughly 10 percent of people who stop smoking gain a large amount of weight 30 pounds or more." 6. Medications that make patients put on weight. According to an article in Annals of Pharmacotherapy, some medications cause weight gain. "Clinically significant weight gain is associated with some commonly prescribed medicines. There is wide interindividual variation in response and variation of the degree of weight gain within drug classes. Where possible, alternative therapy should be selected, especially for individuals predisposed to overweight and obesity." (The Annals of Pharmacotherapy: Vol. 39, No. 12, pp. 2046-2054. DOI 10.1345/aph.1G33) 7. Is obesity self-perpetuating? The longer a person is overweight, the harder it becomes for them to lose weight. Many have wondered whether obesity itself becomes a permanent state, i.e. does obesity promote obesity?. Researchers from the University of Michigan and the National Council of Science and Technology (COINCET) in Argentina, reported in the Journal of Clinical Investigation that in animal experiments, obesity seems to become a self-perpetuating state. They found that the normal body weight of mice that become obese starts going up; their bodies perception of normal weight becomes a heavier than before, regardless of whether they are made to go on diets which had made them lose weight. Senior author, Malcolm J. Low, M.D., Ph.D., said "Our model demonstrates that obesity is in part a self-perpetuating disorder and the results further emphasize the importance of early intervention in childhood to try to prevent the condition whose effects can last a lifetime. Our new animal model will be used in pinpointing the reasons why most adults find it exceedingly difficult to maintain meaningful weight loss from dieting and exercise alone."

## Treatments for obesity (source: The Mayo Clinic)

Obesity treatments have two objectives: 1. 2. To achieve a healthy weight. To maintain that healthy weight.

People who are obese are often discouraged because they think they have to lose a lot of weight before any benefits are experienced. This is not true. Any obese person who loses just five to ten per cent of their body weight will have significant improvement in health - this would mean between 12-25 pounds for an obese person who weighs 250 pounds. It is important for patients to realize that a small drop in weight is a good start and a great achievement. Experts have found that obese people who lose weight slowly and constantly, say one or two pounds each week, are more successful in keeping their weight down when they have reached their target weight. According to the Mayo Clinic, successful and permanent weight loss is best achieved as a result of increased physical activity, changing how and when you eat, and modifying your behavior. Some patients may be prescribed medication, while others might undergo weightloss surgery.

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Dietary changes
The Mayo Clinic advises obese people to reduce their total daily calorie intake and to consume more fruits, vegetables and whole grains. It is important that your diet is varied you still need to feed yourself, and should continue to enjoy the tastes of different foods. The consumption of sugar, certain refined carbohydrates and some fats should be reduced significantly. Ideally, you should work with your doctor, a dietician, and/or a well-known weight-loss program.

## Trying to lose weight quickly by crash-dieting carries the following risks:

You may develop health problems You will probably experience vitamin deficiencies You chances of failure are significantly higher People who are seriously obese may be prescribed a very low calorie liquid diet. These must be done with a health care professional.

Physical activity

## Prescription medications for losing weight

Prescription medications should really only be considered as a last resort. If the patient finds it extremely hard to shed the pounds, or if his obesity has reached such a point as to significantly undermine his health, then prescription drugs may become an option. According to the Mayo Clinic prescription medications should only be considered if:

Other strategies to lose weight have failed The patient's BMI is over 27 and he also has diabetes, hypertension, or sleep apnea.

The patient's BMI is over 30 There are two approved drugs a physician may consider, Sibutramine (Meridia in USA/Canada, Reductil in Europe and much of the world) or Orlistat (Xenical). Bear in mind that as soon as you stop taking these drugs the overweight problem generally comes back they have to be taken indefinitely. Some patients may not respond to these drugs, while others may find their beneficial effects may lessen somewhat after a few months.

## Weight loss surgery (bariatric surgery)

Weight loss surgery (WLS) is also known as Bariatric Surgery. It comes from the Greek work baros, which means weight. WLS is a development of cancer/ulcer operations that consisted of removing part of a patient's stomach or small intestine. Those cancer/ulcer patients subsequently lost weight after surgery. Doctors decided the procedure might be beneficial for morbidly obese patients. In 2008 about 220,000 bariatric operations were carried out in the USA (American Society for Bariatric Surgery). As obesity levels in America and many other parts of the world grow, so does the number of bariatric procedures. About 15 million people in the U.S. have morbid obesity; only 1% of the clinically eligible population is being treated for morbid obesity through bariatric surgery. According to the American Society for Bariatric Surgery, the average female surgery patient weighs about 300 pounds. The American Society for Bariatric and Metabolic Surgery says that Bariatric surgery can improve or resolve more than 30 obesity-related conditions, including type 2 diabetes, heart disease, sleep apnea, hypertension and high cholesterol . Basically, bariatric surgery alters your stomach or small intestine so that you are unable to consume much food in one sitting. This reduces the total number of calories you consume each day, thus helping to lose weight. There are two types of bariatric surgeries:

Restrictive procedures - These make your stomach smaller. The surgeon may use a gastric band, staples, or both. After the operation the patient cannot consume more than about one cup of food during each sitting, significantly reducing his food intake. Over time, some patients' stomachs may stretch and they are gradually able to consumer larger quantities. Researchers from Monash University in Melbourne, Australia, reported in the journal Annals of Surgery that laparoscopic adjustable gastric banding (lap banding) was found to be a successful long-term solution to obesity after carrying out a 15-year follow-up on obese patients. Malabsorptive procedures - Parts of the digestive system, especially the first part of the small intestine (duodenum) or the mid-section (jejunum), are bypassed. Doctors may also reduce the size of the stomach. This procedure is generally more effective than restrictive procedures. However, the patient has a higher risk of experiencing vitamin/mineral deficiencies because overall absorption is reduced.

## Combining two hormones into one molecule, a possible obesity treatment

Scientists from Indiana University managed to combine GLP-1, a digestive hormone, with the hormone estrogen with promising obesity treatment results in an animal experiment. They published their findings in the journal Nature Medicine (November 2012). The authors wrote "We find that combining the hormones as a single molecule dramatically enhanced their efficacy and their safety. The combination improves the ability to lower body weight and the ability to manage glucose, and it does so without showing the hallmark toxicities associated with estrogen." The scientists believe that the combination of nuclear hormones and other peptides as substances for therapeutic usage is a significant and promising opportunity for research.

## Making white cells more like brown cells

Scientists from the Perelman School of Medicine found a protein switch that determines whether precursor fat cells become white or brown fat cells.

Brown fat cells burn calories, they produce heat White fat cells store calories in the all-too-obvious deposits that plague the growing numbers of obese people They wonder whether it might be possible to reprogram white fat cells to become a little more like brown fat cells. Lead researcher, Patrick Seale, explained that brown fat cells, being the ones that produce heat in the body, are protective against obesity as well as type 2 diabetes.

## Health risks associated with obesity

Bone and cartilage degeneration (Osteoarthritis) Obesity is an important risk factor for osteoarthritis in most joints, especially at the knee joint (the most important site for osteoarthritis). Obesity confers a nine times increased risk in knee joint osteoarthritis in women. Osteoarthritis risk is also linked to obesity for other joints. A recent study indicated that obesity is a strong determinant of thumb base osteoarthritis in both sexes. Data suggest that metabolic and mechanical factors mediate the effects of obesity on joints (University of Bristol).

Coronary heart disease Obesity carries a penalty of an associated adverse cardiovascular risk profile. Largely as a consequence of this, it is associated with an excess occurrence of cardiovascular disease morbidity and mortality. (Department of Preventive Medicine, University of Tennessee) Gallbladder disease Being overweight is a significant risk factor for gallstones. In such cases, the liver overproduces cholesterol, which is then delivered into the bile causing it to become supersaturated. Some evidence suggests that specific dietary factors (saturated fats and refined sugars) are the primary culprit in these cases (University of Maryland Medical Center) High blood pressure (Hypertension) There are multiple reasons why obesity causes hypertension, but it seems that excess adipose (fat) tissue secretes substances that are acted on by the kidneys, resulting in hypertension. Moreover, with obesity there are generally higher amounts of insulin produced. Excess insulin elevates blood pressure. (Weight.com) High total cholesterol, high levels of triglycerides (Dyslipidemia) The primary dyslipidemia related to obesity is characterized by increased triglycerides, decreased HDL levels, and abnormal LDL composition. (Howard BV, Ruotolo G, Robbins DC.) Respiratory problems Obesity can also cause respiratory problems. Breathing is difficult as the lungs are decreased in size and the chest wall becomes very heavy and difficult to lift. (Medical College of Wisconsin) Several cancers In 2002, approximately 41,000 new cases of cancer in the USA were thought to be due to obesity. In other words, about 3.2% of all new cancers are linked to obesity (Polednak AP. Trends in incidence rates for obesity-associated cancers in the U.S. Cancer Detection and Prevention 2003; 27(6):415-421) Sleep apnea Obesity has been found to be linked to sleep apnea. Also, weight reduction has been associated with comparable reductions in the severity of sleep apnea. (NHLBI) Stroke Rising obesity rates have been linked to more strokes among women aged 35 to 54. (Medical News Today - "Stroke Increase And Obesity Linked Among Middle-Aged Women") Type 2 diabetes One of the strongest risk factors for type 2 diabetes is obesity, and this is also one of the most modifiable as it can be partially controlled through diet and exercise. (Medical News Today - "Researchers Verify Link Between Type 2 Diabetes And Diet" )