The coming months of holidays and festivities inevitably result in many of us abandoning our healthy diets and exercise regimes. While this may be tempting, it is important to remind ourselves of the value of a healthy lifestyle and the prevention of obesity. The prevalence of overweight and obesity in the United States makes obesity a leading public health problem. The United States has the highest rates of obesity in the developed world. From 1980 to 2002, obesity doubled in adults and overweight prevalence tripled in children and adolescents. From 2003-2004, “children and adolescents aged 2 to 19 years, 17.1% were overweight and 32.2% of adults aged 20 years or older were obese.” The prevalence in the United States continues to rise. While we are all aware that obesity goes hand in hand with being extremely overweight, many of us are not aware of how it is diagnosed, what factors contribute to it, what its consequences are and how it can be prevented or reversed.
Obesity – The Facts
Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and mammals, is increased to a point where it is a risk factor for certain health conditions or increased mortality. Excessive body weight has been shown to correlate with various diseases, particularly cardiovascular disease, diabetes mellitus type 2, sleep apnea, and osteoarthritis. Obesity is both an individual clinical condition and is increasingly viewed as a serious public health problem. In the clinical setting, obesity is typically evaluated by measuring BMI (body mass index), waist circumference, and evaluating the presence of risk factors.
Factors that have been suggested to contribute to the development of obesity include:
- Genetic factors and some genetic disorders)
- Underlying illness (e.g. hypothyroidism)
- Certain medications (e.g., atypical antipsychotics)
- Sedentary lifestyle
- A high glycemic diet (i.e., a diet that consists of meals that give high postprandial blood sugar)
- Weight cycling, caused by repeated attempts to lose weight by dieting
- Eating disorders (such as binge eating disorder)
- Stressful mentality
- Insufficient sleep
- Smoking cessation
Depending on the level of obesity, the American College of Physicians make the following recommendations:
- People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss.
- If these goals are not achieved, pharmacotherapy can be offered. The patient needs to be informed of the possibility of side-effects and the unavailability of long-term safety and efficacy data.
- Drug therapy may consist of sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. For more severe cases of obesity, stronger drugs such as amphetamine and methamphetamine may be used on a selective basis. Evidence is not sufficient to recommend sertraline, topiramate, or zonisamide.
- In patients with BMI > 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for bariatric surgery may be indicated. The patient needs to be aware of the potential complications.
- Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications.
Before a simple case of overweight gets to the later stages of obesity, it is important to take preventative measures in the form of diet and exercise. Therefore, you should consult your healthcare provider at your earliest convenience in order to obtain a tailored diet and exercise regime.