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Obesity

Definition


Disease: Obesity Obesity
Category: Endocrine and metabolic diseases

Disease Definition:

Obesity means having an inordinate amount of body fat. Obesity is not only a cosmetic concern because it also increases the risk of diseases and health problems like high blood pressure and diabetes.
In order to determine whether a person is obese or not, doctors usually use a pattern called the body mass index (BMI) based on the person’s height and weight. Adults with a BMI of over 30 are considered obese. When a person has a BMI of 40 or more, extreme obesity also known as severe obesity or morbid obesity occurs. A person is likely to have serious health problems, especially with morbid obesity. 

 

A person is considered to be underweight in case his/her body mass index is below 18.5.
People will be considered to have normal weight in case their body mass index is between 18.5 and 24.9.
People whose BMI is between 25.0 and 29.9 are considered to be overweight, while those who have a BMI of 30.0 and higher are considered obese.

 

Obesity is becoming an increasing health problem. Luckily, the health problems related to obesity can be improved or prevented even with modest weight loss.
 

Work Group:


Symptoms, Causes

Symptoms:

Obesity may cause some symptoms such as:

 

  • Snoring
  • Sleep apnea
  • Difficulty sleeping
  • Excessive sweating
  • Always feeling hot
  • Pain in the back or joints
  • Depression
  • Daytime fatigue or sleepiness
  • Rashes or infection in folds of the skin
  • Feeling out of breath with minor exertion

 

While sometimes prescription medications or weight-loss surgery might be alternatives, but weight loss is often possible through dietary changes, behavior changes and increased physical activity. When someone is having symptoms related to the ones mentioned above, he/she might discuss these problems with a doctor or health care provider and find out their weight-loss alternatives.
 

Causes:

When people gain more calories than they can burn through normal daily activities or exercise, obesity occurs, despite the fact that there are genetic and hormonal influences on body weight. These extra calories are stored in the body as fat. Obesity is usually the result of a combination of causes and contributing factors, such as:

Unhealthy diet and eating habits:

Eating fast food, skipping breakfast, having a diet that’s high in calories, eating most of the calories at night, eating oversized portions and consuming high-calorie drinks all lead to gaining weight.

Inactivity:

A person leading an inactive life can easily take in more calories each day than they burn off trough normal daily activities or exercise. When a person is inactive, he/she doesn’t burn many calories. And watching too much television is one of the biggest contributors to weight gain and a sedentary lifestyle. The bad news is that today most adults spend most of their day sitting, whether at work, home or during leisure activities.

Lack of sleep:

Changes in hormones can be the result of getting less than seven hours of sleep a night, increasing a person’s appetite. The person might also crave for foods that are high in calories and carbohydrates leading to weight gain.

Pregnancy:

A woman’s weight necessarily increases throughout pregnancy. Some women get difficulty losing those gained weights after giving birth. This weight gain might lead to the growth of obesity in women.

Medical problems:

Obesity could occasionally be traced to a medical cause, like polycystic ovary syndrome, Prader-Willi syndrome, Cushing’s syndrome and other diseases and conditions. Some medical problems, like arthritis, can contribute to reduced activity that might cause weight gain. Neither low thyroid function nor low metabolism is likely to result in obesity.

Certain medications:

Some drugs might contribute to weight gain when it is not repaired through diet or activity. Antidepressants, antipsychotic medications, anti-seizure medications, steroids, beta blockers and diabetes medications are some examples.

 

Factors that might increase a person’s risk of obesity are:

Age:

Obesity could take place at any age, even in young children. Though as the person grows older hormonal changes and a less active lifestyle increase the risk of obesity. Additionally, the amount of muscle in the body seems to get reduced with age and this lower muscle mass contributes to a reduction in metabolism. These changes also decrease calorie requisites and could make it more difficult to keep off extra weight. When the person doesn’t reduce their caloric intake as they age, they’ll possibly gain weight.

Genetics:

The person’s genes might affect the amount of stored body fat and where that fat is distributed. Genetics might also play a role in how efficiently the body changes food into energy and how the body burns calories throughout exercise.

Social and economic issues:

Some social and economic issues might be traced to obesity. For instance, a person might lack access to safe areas to exercise, might lack the financial means to buy fresh fruits and vegetables or foods that aren’t processed and packaged, or might not have been taught healthy ways of cooking. Someone is more likely to get obese when having obese friends or relatives, for some studies show that the person’s social networks influence their weight.

Family history:

Since family members seem to have similar eating, lifestyle and activity habits, obesity seems to run in families, practically not just because of genetics. The risk of being an obese is higher when someone’s one or both of the parents are obese.

Quitting smoking:

Quitting smoking is usually related to weight gain. It could contribute to a weight gain of as much as several pounds a week for several months that could occasionally lead to obesity for some people.

 

Having one or more of the risk factors mentioned above doesn’t mean being destined to become obese. A person can neutralize most risk factors through diet, behavior changes and physical activity and exercise.
 

Complications

Complications:

A person is more likely to grow a number of possibly serious health problems when they’re obese, such as:

 

  • Gallbladder disease
  • Depression
  • Heart disease
  • Stroke
  • High blood pressure
  • Blood (fat) lipid abnormalities
  • Metabolic syndrome
  • Osteoarthritis
  • Skin problems, such as impaired wound healing and intertrigo
  • Sleep apnea
  • Cancer, including cancer of the uterus, cervix, breast, prostate, rectum and ovaries
  • Nonalcoholic fatty liver disease
  • Type 2 diabetes
  • Gynecological problems, such as irregular periods and infertility

 

Quality of life:

In case of being an obese, a person’s overall quality of life might be lower, the person might not be able to get around or be able to perform common daily activities as well as he/she wishes. They might avoid public places, might even encounter discrimination and have trouble participating in family activities.

 

Other factors affecting the person’s quality of life include the following:

 

  • Sexual problems
  • Depression
  • Disability
  • Social isolation
  • Shame
  • Physical discomfort
     

Treatments:

Obesity treatment aims at achieving and maintaining a healthier weight to decrease the person’s risk of serious health problems and raise the quality of life. Working with a team of health professionals might be required such as nutritionist, dietitian, therapist or an obesity specialist to help the person understand and make changes in their eating and activity habits. The person can determine a healthy goal weight and how to achieve it. The person’s primary goal might be losing 5 to 10 % of their body weight within six months. With just minor weight loss though, 5 to 15% of the person’s total weight makes him/her feel better seeing improvements in their health. For instance, if the person weighs 200 pounds (91 kilograms) and is obese by BMI standards, they would need to lose only about 10 to 30 pounds (4.5 to 13.6 kilograms) to start seeing benefits.

 

SPECIFIC TREATMENT METHODS:

There are several ways for treating obesity and reaching a healthier weight. The treatment techniques that are right for a person depend on their level of obesity, overall health, and willingness to participate in their weight-loss plan. As a way to make changes that could be stuck with for a lifetime, the person might think of their treatment plan to keep the weight off.

 

Treatment methods include:

 

  • Exercise and activity
  • Behavior change
  • Dietary changes
  • Weight-loss surgery
  • Prescription weight-loss medications

 

Dietary changes, lifestyle changes, increased activity and change of behavior are ways to achieve a healthy weight. In more serious cases, prescription medications or weight-loss surgery is commonly used in addition to lifestyle changes.

 

DIETARY CHANGES:

In order to overcome obesity, A person needs TO decrease their daily calorie intake and start eating healthier. The safest way to lose weight and the best way to keep it off permanently is by losing weight slowly and steadily, 1 or 2 pounds (1/2 to 1 kilogram) a week. There are various dietary strategies to be chosen from, all of which could lower the calorie intake. A person should avoid drastic and unrealistic diet changes, like crash diets, because they’re unlikely to help keep excess weight off for a long term.
Dietary ways to overcome obesity include:

Reducing calorie intake:

Decrement of numerous consumed calories is the key to weight loss. The person, together with health care providers, could go over his/her typical eating and drinking habits to see how many calories he/she normally consumes and where they could be cut back. The patient might be eating larger portions than they’re expecting to, or they might realize that their diet contains many fast foods, sweets or sugary drinks. The person could decide with the doctor how many calories he/she is required to take in every day to achieve weight loss, however, 1,000 to 1,600 calories a day is a typical amount. 

Feeling full on less:

The concept of energy density could help in satisfying hunger with fewer calories. All foods have a certain number of calories within a given amount (volume). Foods that are high in energy density include desserts, candies and processed foods. A large number of calories are found in even small amounts of those foods. In contrast, other foods have low energy density such as fruits and vegetables. These foods provide a larger portion size with fewer calories. By eating larger portions of foods that have fewer calories, the person squelches hunger pangs, takes in fewer calories and feels better about their meal that leads to a satisfying overall feeling.

Adopting a healthy eating plan:

Eating more plant-based foods such as fruits, vegetables and whole grains, sticking with low-fat dairy products, emphasizing plant sources of protein, as it is the case with beans, lentils and soy, choosing lean meats, trying to include seafood twice a week, and making certain fats coming from healthier sources, like nuts and olive, canola and nut oils can make a person’s diet healthier.

If medically recommended, following a very low calorie liquid diet:

These mainly liquid diets are intended to provide rapid weight loss over the short term. They provide only about 600 to 800 calories a day. In the case of having to lose weight hurriedly before a medical procedure or in case a person has got serious health problems, a very low calorie diet might be recommended. However, a person shouldn’t try this on his/her own.  A close monitoring is required by the person’s health care providers to prevent complications from occurring. Taking vitamins or nutritional supplements might also be required. While the person might be able to lose weight rapidly on a very low calorie diet, they’re also likely to gain it back rapidly once they stop the diet. Making changes in the person’s overall diet, activity level and behavior is important in order to avoid gaining the lost weight back after a very low calorie diet.

Meal replacements:

This type of diet could help lose weight in a short term, and might be a good alternative if they help in controlling portion size, limiting calories and encouraging healthy eating. Meal replacements plans recommend that the person replaces one or two meals with low-calorie shakes or meal bars, and eat instead healthy snacks and a healthy, balanced third meal that’s low in fat and calories. Though the person should know that these diets won’t teach him/her how to change their overall lifestyle. That’s why these diets might work for some people, while others may find it difficult to maintain their weight loss over a long term.

 

BEWARE OF QUICK FIXES:

Fad diets promising quick and easy weight loss might seem tempting. Yet, there are no magic foods or rapid fixes. Exceptional diets such as low-carbohydrate diets might produce weight loss in a short time, but the long-term outcomes don’t seem to be any better than other diets. Additionally, losing weight on a crash diet might likely result in regaining the lost weights as soon as the diet stops. The person should adopt healthy eating habits that he/she can maintain over time in order to keep off the lost weights.

 

INCREASED ACTIVITY:

An important part of obesity treatment is increased physical activity or exercise. Most people who could keep their weight loss for over a year get regular exercise, even simply walking. Burning more calories for weight loss is the aim of activity and exercise, though exercise offers several other health benefits as well. How many calories the person burns depends on the frequency, intensity and duration of their activity.

 

To boost a person’s activity level he/she could:

Increase the daily activity:

Although regular aerobic exercise is the most efficient way to burn calories and throw away extra weight, but any extra movement also helps burn calories. Making mere changes during the day could sum up to big gains. Parking farther from store entrances, doing more household tasks, gardening, getting up and moving around at regular time intervals and wearing a pedometer to track how many steps the person actually took over the course of a day can also help. 

Exercise:

Regular aerobic exercise such as cycling, walking, swimming or climbing stairs is one of the best ways to lose body fat. People who are overweight or obese are recommended to get at least 150 minutes a week of moderate-intensity physical activity to lose a small amount of weight or to stop further weight gain. But the person might need to get as much as 250 to 300 minutes of exercise a week in order to achieve a substantial weight loss. As the person’s endurance and fitness improve, they’ll need to gradually increase the amount they exercise. The person might need to break their exercise up into many sessions during the day, doing just five or six minutes at a time, to be able to achieve their own exercise goal. The person shouldn’t set up their aims unrealistically high, or they might give up. The doctor could help drawing an exercise plan that’s suitable for the person taking into consideration their specific condition and abilities. Taking into consideration the person’s specific condition and abilities, the doctor can come up with a suitable exercise plan.

 

BEHAVIOR CHANGES:

A person has to change their behavior and attitudes toward food and exercise to be able to lose weight and maintain weight loss. The person might get help from a behavioral modification program to change their lifestyle. Examining the persons present habits to determine which factors or situations might have led to his/her obesity are included in behavior modification programs. Exploring the person’s present eating and exercise habits gives them a place to start when changing their behaviors. Once the person understands which habits are weakening their weight-loss efforts, they could take steps to create a new, healthier lifestyle.
There are several ways to help the person change unhealthy thoughts and behavior. Behavior modification, occasionally known as behavior therapy, could include the followings:

Counseling:

Therapy could help the person understand why they overeat and it could also help them learn healthy ways to cope with anxiety. The person might also learn how to monitor their diet and activity, understand eating triggers and cope with food cravings. Therapy or treatments with trained mental health or other professionals could help the person address emotional and behavioral issues associated with eating. Counseling might be done by telephone, e-mail or internet-based programs in case traveling seems to be hard. Cognitive behavioral therapy is a kind of therapy that is often used for weight loss. Individual and group therapy are the two types of this therapy. 

Support groups:

The person could find company and understanding in support groups where others share similar challenges with obesity. The person might check for local hospitals or commercial weight-loss programs for support groups in their area.

 

PRESCRIPTION WEIGHT LOSS MEDICATIONS:

A healthy diet and regular exercise is the best way to weight loss. But in certain cases, prescription weight-loss medication might be an alternative. Acknowledging that these medications are meant to be used along with diet, exercise and behavior changes, not instead of them is important. Medication is not likely to work if the person doesn’t make these other changes in their life.
The doctor might recommend a weight-loss medication in case other methods of weight loss haven’t worked, or if the person’s body mass index (BMI) is greater than 27 and they also have medical complications of obesity, like diabetes, sleep apnea or high blood pressure. The Food and Drug Administration (FDA) approved two prescription medications for a long-term weight loss. These medications work in various ways and have varied side effects.

Sibutramine:

Average weight loss is about 5 to 10 % of the person’s starting body weight after taking the medication for one year. This medication changes the person’s brain chemistry, making them feel replete more rapidly and decreasing their hunger. Increased blood pressure, rapid heartbeat, dry mouth, insomnia, constipation and headache may be some of the side effects of this medication.

Orlistat:

This medication prevents the digestion and absorption of fat in the person’s stomach and intestines. Unabsorbed fat is ruled out in the stool. Average weight loss with orlistat is also about 5 to 10 % of the person’s primal body weight after one year of taking the medication. Side effects related to orlistat include oily and frequent bowel movements, bowel urgency and flatulence with discharge. As the person decreases the amount fat in their diet, they’d be minimizing the side effects. To stop nutritional deficiencies, the person should take a multivitamin with orlistat simultaneously, because orlistat prevents absorption of some nutrients. This medication has been approved by the FDA for use in adults, adolescents and children. The FDA has also approved a reduced-strength version of orlistat to be sold over the counter, without a prescription. This medication works similarly with prescription-strength orlistat and is meant only to add on a healthy diet and regular exercise instead of replacing them.

 

Close medical monitoring is needed while taking these medications. Also, that these medications don’t work for everyone should be kept in mind. And if they do work, after six months of use, their effects seem to level off. The person might need to take weight-loss medication for the rest of their life. In case the person stops taking these medications, he/she is likely to gain back much or all of the weight they lost.

 

SURGERY:

Sometimes, weight-loss surgery, also called bariatric surgery, may be an alternative. Weight-loss surgery provides the best chance of losing the most weight, but it could have serious risks. Weight-loss surgery restricts the amount of food a person is able to comfortably eat or subdues the absorption of food and calories, or both. Weight-loss surgery for obesity may be considered if:

 

  • The person has extreme obesity, with a body mass index (BMI) of 40 or higher
  • Their BMI is 35 to 39.9, and they also have a  serious weight-associated health problem, like diabetes or high blood pressure
  • The person’s committed to making the lifestyle changes that are necessary for surgery to work

 

Weight-loss surgery could help a person lose as much as 50 % of their extra body weight. Most of those who undergo weight-loss surgery stay off the weight at the 5-year mark. But weight-loss surgery isn’t a miracle obesity cure because it doesn’t have any guarantees whether the person will lose all of their extra weight or will keep it off long term. Weight-loss achievement after gastric bypass surgery depends on the person’s commitment to make lifelong changes in their eating and exercise habits. There are various kinds of weight-loss surgery; some kinds are constrictive, resulting in weight loss by restricting how much the person’s stomach could hold, while others are malabsorptive, and work by blocking the person’s body from absorbing calories and nutrients. Others are a combination of these two kinds. More common weight-loss surgeries include:

Gastric bypass surgery:

Since this surgery has shown relatively good long-term results, it became the favored weight-loss surgery. It combines both restriction and malabsorption to develop weight loss. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a small pocket at the top of the stomach and then cuts the small intestine a short distance below the main stomach and connects it to the new pocket. Bypassing most of their stomach, food and liquid flow directly from the pocket into this part of the intestine.

Laparoscopic adjustable gastric banding (LAGB):

In this constraining-type of operation, the stomach is divided into two pouches with an inflatable band. Pulling the band tight like a belt, the surgeon creates a tiny channel between the two pouches. The band prevents the opening from flourishing, and is generally planned to remain in place permanently. LAGB is becoming popular for generally causing slow, steady weight loss, in addition to the ability to adjust the band when needed. Yet, this won’t work without the person changing their behavior, as is the case with other operations.

Biliopancreatic diversion with duodenal switch:

This type of surgery is commonly used for people who have a body mass index of 50 or more. In this malabsorption-type operation, most of the person’s stomach is surgically removed. This weight-loss surgery offers affirmed weight loss, and a close monitoring is required for health problems because it poses a greater risk of malnutrition and vitamin deficiencies.

 

WEIGHT-LOSS SURGERY COMPLICATIONS:

There’s a great risk of many serious health problems associated with surgery or the person’s reduced food intake, such as:

 

  • Infection
  • Pneumonia
  • Blood clots
  • Hernia
  • Nausea
  • Nutritional Deficiencies
  • Diarrhea
  • Gallstones
  • Vomiting

 

HOW TO PREVENT WEIGHT REGAIN AFTER OBESITY TREATMENT:

Regaining the lost weight is common no matter what type of obesity treatments a person has tried. Still, this doesn’t mean that the person’s efforts of losing weight were all in vain. Getting regular physical activity is one of the best ways to keep off from regaining the weight the person has lost. The person might try keeping track of their physical activity in case it helps them stay motivated and on course. The person could talk to their doctor after losing weight and gaining better health, about what additional activities they might be able to do and, if allowed, how to increase their activity and exercise.

 

The person might always have to remain watchful and attentive about their weight. The best way to lose weight and maintain for a long term is combining a healthier diet and more activity. In case the person takes weight-loss medications, they’ll potentially gain back their weight the moment they stop taking them. The person might even gain back weight after weight-loss surgery if he/she goes on to overeat or eat foods laden with fat and calories.

 

The person should take their weight loss and weight maintenance one day at a time and surround themselves with supportive resources to help ascertain their success. A person should also try finding a healthier way of living that they can stick with.
 

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