• Introduction

• Understanding Causes of Obesity

• Check Your BMI

• Waist-to-Hip ratio

• Clinical Features

• Management Strategy

• Low Energy Diet

• Fight Obesity by Eating Breakfast

• FDA-Approved Medications for Treating  Obesity. 

Home > Obesity

Obesity may be defined as a condition in which there is an excess amount of body fat. It is the most common form of malnutrition in the Western world. Obesity is the net result of an excess of energy consumption over expenditure. Factors that must be considered as contributing to causation are: heredity, overeating, altered metabolism of adipose tissue, defective or decreased thermogenesis (the process by which calories are converted to heat), decreased physical activity without an appropriate reduction in food intake, and certain prescribed medications.

Excess abdominal fat is an independent predictor of disease risk. A waist circumference of over 35 inches in women signifies increased risk in those who have a BMI of 25 to 34.9

Our main energy store is fat, an energy intake greater than energy expenditure unavoidably causes an increase of adipose tissue, which is always accompanied by an increase of lean body mass, and thus an increase of body weight.
Since body energy expenditure is proportional to body weight, an increase of the latter also causes an increase of energy expenditure. The body weight will then stabilize when the energy expenditure of the weight gain will equal the increase of energy intake, the balance condition being re-established. Exactly the opposite happens if the energy intake is permanently reduced.

Level of physical activity : There are patient who reports a history of progressive lifelong weight gain with no progressive lifelong increase in food intake. Moreover, it is quite possible that the energy intake has actually remained the same, the progressive weight gain being caused by decreased energy expenditure due either to the progressive reduction of physical activity that generally accompanies weight gain 

Aging :The progressive reduction of lean body mass which inevitably occurs with aging causes increase in weight due to fall in the body's capacity to burn fat. The physiological loss of lean body mass that occurs with aging, if the energy intake remains the same, compulsorily causes the gain of a body weight which, as we know, is composed of lean and fat, and thus consumes less and must be gained in a greater amount to produce the same consumption of what was lost.

Body Composition: Individuals with equal body weight may have different energy intakes, and individuals with the same energy intake may have different body weights, and a very heavy individual may have an energy intake much smaller than that of another much lighter individual, and vice versa. In summary, certainly the energy intake determines body weight and its variations, but the size of body weight and of its variations is determined by body composition and by its variations. 

Genetic factors: Obesity tends to run in families, suggesting a genetic cause. The mechanism through which genetics might effect weight gain include reduced dietary-induced thermogenesis, lower Resting Metabolic Rate, decreased thyroid functioning, decreased lipoprotein lipase activity, lower Basal body temperatures and decreased amount of more metabolically active brown fat.  Families also share diet and lifestyle habits that may contribute to obesity. Separating these from genetic factors is often difficult. Even so, science shows that heredity is linked to obesity.

Socio-economic : In affluent countries obesity is more common in the lower socio-economic groups. In developing countries it occurs in the prosperous elite. Society too carries its pressure on individuals to either be too thin (model-like) or fat as a sign of prosperity. 

Lifestyle behaviors - such as what a woman eats. Americans tend to eat high-fat foods, and put taste and convenience ahead of nutrition. Although you cannot change your genetic makeup, you can change your eating habits.

Psychological factors may also influence eating habits. Many people eat in response to negative emotions such as boredom, sadness, or anger. Most overweight people have no more psychological problems than people of average weight. Still, up to 10 percent of people who are mildly obese and try to lose weight on their own or through commercial weight loss programs have binge eating disorder. This disorder is even more common in people who are severely obese.

During a binge eating episode, people eat large amounts of food and feel that they cannot control how much they are eating. Those with the most severe binge eating problems are also likely to have symptoms of depression and low self-esteem. These people may have more difficulty losing weight and keeping it off than people without binge eating problems. If you are upset by binge eating behavior and think you might have binge eating disorder, seek help from a health professional such as a psychiatrist, psychologist, or clinical social worker.

Endocrine factors : An endocrine influence on body fat is seen both in normal physiological situations and in pathological state. The normal fat content of young adult women is about twice that of young men and pregnancy is characterized by an increase in body fat. Obesity in women begins at puberty, during pregnancy or at menopause. Obesity frequently but not invariably, accompanies hypothyroidism, hypogonadism, hypopituitarian and Cushing's Syndrome. 

Other causes of obesity

Some illnesses can lead to obesity or a tendency to gain weight. These include depression, and certain neurological problems that can lead to overeating. Also, drugs such as steroids, oral contraceptives, phenothiazines, insulin and some antidepressants may cause appetite stimulation & consequently weight gain. A doctor can tell whether there are underlying medical conditions that are causing weight gain or making weight loss difficult

In most cases the diagnosis will be apparent from the woman's appearance but the degree of obesity should be assessed, by using the Body-Mass Index. In addition the skin-fold thickness over the triceps muscle can be measured using special spring loaded calipers. Obesity is indicated by a measurement of more than 28mm in women.    

Mechanical Disabilities associated with Obesity are listed below: 

Metabolic disorders: Non-insulin dependent diabetes mellitus, hyperlipidaemia, gall stone, hyperuricaemia, and gout are more common among the obese than in general population.  

Cardiovascular Disorders : Obesity increases the load on the heart, which enlarges with rising body weight. Cardiac output, stroke volume, and blood volume also increases. Higher Blood Pressure is often reported.

Life Expectancy : Overweight is associated with an increased rate of mortality at all ages. However the degree of mortality varies more or less in proportion to degree of obesity.

Several serious medical conditions have been linked to obesity, including type 2 diabetes, heart disease, high blood pressure, and stroke. Obesity is also linked to higher rates of certain types of cancer. Obese women are more likely than non-obese women to die from cancer of the gallbladder, breast, uterus, cervix, or ovaries.

Health care providers generally agree that the more obese a person is, the more likely he or she is to develop health problems.

Psychological and social effects

Emotional suffering may be one of the most painful parts of obesity. American society emphasizes physical appearance and often equates attractiveness with slimness, especially for women. Such messages make overweight people feel unattractive.

Many people think that obese individuals are gluttonous, lazy, or both, even though this is not true. As a result, obese women often face prejudice or discrimination in the job market, at school, and in social situations. Feelings of rejection, shame, or depression are common.

According to the guidelines, the most successful strategies for weight loss include calorie reduction, increased physical activity, high carbohydrate and fiber content in diet, palatable food choices, decreased fat consumption and behavior therapy designed to improve eating and physical activity habits. Other recommendations include:

• Engage in moderate physical activity, progressing to 30 minutes or more on most or preferably all days of the week. Choose a low impact exercise such as walking, swimming or cycling, avoid high-impact aerobics. Besides, begin at low intensity just enough to get your muscles accustomed to moving. Once regular slowly build up on duration by 5-10 min per session. Try to exercise for a longer duration rather than increasing the pace to burn fat. Don't count the scale to tell you the whole story, for muscle weigh more than fat, you may be getting fitter and thinner without corresponding loss of pound. 

• Reducing dietary fat alone--without reducing calories--will not produce weight loss. Cutting back on dietary fat can help reduce calories and is heart-healthy. Foods high in fat and sugar such as cakes, puddings, cream, chips, pies, mayonnaise and butter need not be banned, but should not become a part of your daily diet. Instead eat more vegetables, fruits, wholegrain, and pulses which are filling nutritious but not fattening. 

• Resistance training has been found to significantly increase the Resting Metabolic Rate (RMR) and Fat-Free Mass (FFM) in sedentary elderly women. Therefore a personalised Strength Training Programis essential component of a weightloss program.

• The initial goal of treatment should be to reduce body weight by about 10 percent from baseline, an amount that reduces obesity-related risk factors. With success, and if warranted, further weight loss can be attempted. 

• A reasonable time line for a 10 percent reduction in body weight is six months of treatment, with a weight loss of 1 to 2 pounds per week. 

• Weight-maintenance should be a priority after the first 6 months of weight-loss therapy. 

• Physicians should have their patients try lifestyle therapy for at least 6 months before embarking on physician-prescribed drug therapy. Weight loss drugs approved by the FDA for long-term use may be tried as part of a comprehensive weight loss program that includes dietary therapy and physical activity in carefully selected patients (BMI >30 without additional risk factors, BMI >27 with two or more risk factors) who have been unable to lose weight or maintain weight loss with conventional non-drug therapies. Drug therapy may also be used during the weight maintenance phase of treatment. However, drug safety and effectiveness beyond one year of total treatment have not been established. 

• Weight loss surgery is an option for carefully selected patients with clinically severe obesity -- BMI of > 40 or BMI of >35 with coexisting conditions when less invasive methods have failed and the patient is at high risk for obesity-associated illness. Lifelong medical surveillance after surgery is a necessity.  

• Overweight and obese patients who do not wish to lose weight, or are otherwise not candidates for weight loss treatment, should be counseled on strategies to avoid further weight gain. 

• Age alone should not preclude weight loss treatment in older adults. A careful evaluation of potential risks and benefits in the individual patient should guide management. 
  According to NHANES III, the trend in the prevalence of overweight and obesity is upward. The guidelines note that from 1960 to 1994, the prevalence of obesity in adults (BMI >30) increased from nearly 13 percent to 22.5 percent of the U.S. population, with most of the increase occurring in the 1990s. 
  
  The guidelines have been reviewed by 115 health experts at major medical and professional societies. They have been endorsed by the coordinating committees of the National Cholesterol Education Program and the National High Blood Pressure Education Program, the North American Association for the Study of Obesity, the NIDDK Task force on the Prevention and Treatment of Obesity, and the American Heart Association.

• SAMPLE MENUS /1200 CALORIES
  This reducing diet is suitable for non pregnant women. The amount of weight you'll loose depends on the difference between your previous calories intake and the diet.

• SAMPLE MENUS /1800 CALORIES
  This menu is suitable for many mature women. each days menu illustrates four principles of low fat eating.

  1. select lower fat milk products

  2. Select lean, lower fat meat: Removes skin from poultry and trim excess fat from meat.

  3. Use low fat food preparation methods.

  4. Reduce the amounts of fats added at the table.

Drug therapy : This is no substitute for a dietary regime.

• Amphetamine-like drugs with similar anorectic properties may be given for short period say about a month to help attain short-term goals. They should not be taken by patients with hypertension & coronary heart disease. 

• Orlistat, which acts on the intestinal tract to prevent the absorption of about 30 % of ingested fat.

One thing all these drugs have in common is while they facilitate 10 % loss in body weight, the weight rapidly returns once the drugs are discontinued.

 

FDA-Approved Medications for Treating Obesity:

Weight-loss medications may be recommended for patients who are at increased medical risk because of their obesity. Most research-based and professional associations recommend lifestyle therapy for at least six months before embarking on a weight-loss plan using physician-prescribed drug therapy. Even then, it must be used only as part of a comprehensive weight loss program that includes dietary therapy and physical activity. Currently available prescription medications include:

* Phentermine (Adipex, Fastin, Ionamin, Oby-trim)

* Diethylpropion (Tenuate, Tenuate dospan, Tepanil)

* Mazindol (Sanorex, Mazanor)

* Phendimetrazine (Adipost, Bontril, Plegine, Prelu-2, X-Trozine)

* Benzphetamine (Didrex)

* Sibutramine (Meridia)

* Orlistat (Xenical)

Most of these appetite-suppressants have been approved for short-term use, meaning a few weeks or months. Sibutramine and orlistat are the only weight-loss medications approved for longer-term use in significantly obese patients, although the safety and effectiveness have not been established for use beyond one year. Most of these drugs decrease appetite by affecting levels of the brain neurotransmitters catecholamine, serotonin and/or noradrenaline -- brain chemicals that affect mood and appetite. Orlistat (Xenical) does not act directly on the central nervous system but inhibits an enzyme essential to fat digestion. In general, these medications are modestly effective, leading to an average weight loss of five to 22 pounds above that expected with non-drug obesity treatments.

If you are, may be or could become pregnant or are nursing, be sure to tell your healthcare professional. The effects of most of these drugs have not been tested on unborn babies; however, medications similar to some of the short-term appetite-suppressants have been shown to cause birth defects when taken in high doses. Also, diethylpropion and benzphetamine pass into breast milk.

You also will need to tell your health care professional about any existing medical problems before taking these medications, especially thyroid problems, anxiety disorders, epilepsy or other seizure disorders, diabetes, heart disease, high blood pressure, arteriosclerosis, or glaucoma. Also, your healthcare professional needs to be aware of any other medications you are taking or have taken within the last 14 days, especially monoamine oxidase inhibitors (MAOIs) such as isocarboxazid (Marplan), tranylcypromine (Parnate), or phenelzine (Nardil). Mention any existing or previous problems with alcohol or drug abuse as well. Side effects of anti-obesity drugs can range from mild to serious and should be discussed in detail with your health care professional before making a decision to use these medications.

Surgical treatment : For clinically severe obesity, surgery may be an element of treatment. Many people, some physicians included, wrongly believe that obese people merely need to stop eating so much and they will lose weight. In reality, severe obesity is a potentially deadly disease that sometimes requires a treatment as dramatic as surgery.

There are two types of obesity surgery — restrictive and combined restrictive/mal-absorptive. Different ways of performing each surgery have been developed. Each type of surgery has its own risks and side effects. Your physician can help you decide which is best for you.

Wiring the jaws together to prevent eating has been used to treat those who have found it impossible to adhere to low-energy diet. These can help patients to achieve remarkable weightloss, but most patients regain weight when the procedure is reversed. Another major surgery involves the reduction in size of the stomach for example by stapling which can be undone. Small intestine bypass aimed at inducing mal-absorption, has been undertaken in some centers for treatment of severe "morbid" obesity but complications can be severe and sometimes fatal. Surgery should be considered only for those with gross, intractable obesity. To know more about the various surgical procedures log on to http://www.medscape.com.

NOTE: Successful weightloss does not depend on operation, drugs, injections, fad diets or other manipulation undertaken by the therapist, rather it depends on the ability of the patient to manage the disorder herself and to persist indefinitely with some restrictions on dietary freedom.

For more easy to understand guidelines:

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