Overview, Causes, & Risk Factors
Obesity is measured using body mass index, or BMI. BMI is determined by dividing a person's weight in kilograms by a person's height in meters squared. A person whose BMI is 25.0 to 29.9 kg/m2 is considered overweight. A BMI of 30 to 39.9 kg/m2 indicates obesity. A BMI of 40 kg/m2 or more indicates extreme obesity.
behavioral
cultural
genetic
metabolic
physiological
social
What is going on in the body?
Food is made up of calories, or units of energy. Physical activity and normal body metabolism burn calories. When a person takes in more calories than the body uses, the extra calories are stored as fat. These fat cells enlarge or decrease in size depending on the balance of energy in the body. When fat cells build up or accumulate, it causes obesity.What are the causes and risks of the condition?
Obesity is a complex condition. It is caused by an interaction among a number of factors. These varied factors fit into these categories:Symptoms & Signs
What are the signs and symptoms of the condition?
Someone who is obese has accumulations of body fat. Other symptoms may be seen if the fat affects other body systems. For example, an obese person may have swelling in the legs because the heart has to work harder.Diagnosis & Tests
How is the condition diagnosed?
Diagnosis of obesity begins with a medical history and physical exam. The National Institute of Health, or NIH, recommends that healthcare providers follow these steps:Waist circumference
The amount of fat around the abdomen is very important in assessing disease risk. An individual's risk for certain disorders increases when waist circumference is larger than normal. These disorders include the following:
A waist measurement of more than 40 inches, or 102 cm, in men and more than 35 inches, or 88 cm, in women is above normal. Combined with overweight or obesity, a high waist circumference can raise the person's disease risks from high to extremely high.
Comorbidities
Some disorders place a person at high absolute risk for death if they are combined with obesity. An obese person with one or more of these factors should be treated aggressively. These factors include:
Other comorbidities increase an obese person's risk of death but are not life-threatening. These factors, which should be treated, include:
A third set of comorbidities also increases an obese person's risk of death if they are combined. Three or more of these factors increase a person's high absolute risk:
Treatment algorithm
The treatment algorithm developed by NIH helps the provider decide if treatment for obesity is appropriate. It takes into account the person's BMI, waist circumference, and comorbidities.
Readiness and motivation
The healthcare provider will also ask questions to see if the person is ready and motivated to lose weight. These questions deal with the following issues:
Prevention & Expectations
What can be done to prevent the condition?
Staying at normal body weight by eating healthfully and keeping physically active can prevent obesity.What are the long-term effects of the condition?
Obesity puts a person at risk for other health problems, including:Obesity can even lead to an early death. As obesity increases, the risk for these problems also increases.
What are the risks to others?
Obesity is not contagious. It poses no risk to others.Treatment & Monitoring
What are the treatments for the condition?
NIH recommends weight loss treatment for people who have one or more of the following conditions:The first weight loss goal should be a 10% weight loss over a 6-month period. The rate of weight loss should be 1 to 2 pounds a week. Faster weight loss does not improve the long-term results. After the first 6 months, additional weight management goals can be discussed with the healthcare provider. Sometimes more weight loss is needed. Others may be ready to maintain their weight loss.
No one treatment works for everyone. The healthcare provider should follow these guidelines in planning treatment:
A successful weight management plan will include the following components:
The plan may also include medicines or surgery.
Dietary therapy
Dietary therapy is works best when it meets the needs of the individual. NIH recommends the following general dietary guidelines.
Physical activity
To begin treatment of obesity, NIH recommends moderate levels of physical activity 30 to 45 minutes a day, 3 to 5 days a week. The activity should be started slowly and gradually increased in intensity. Some moderate physical activities are as follows:
Behavior therapy
Behavior therapy provides ways to overcome barriers to dietary therapy or physical activity. A good behavior therapy plan has the following characteristics:
Medicine and surgery
The Food and Drug Administration, or FDA, has approved only two medications for long-term use for weight loss. They are orlistat, or Xenical, and sibutramine, or Meridia. These medicines may be prescribed for people with a BMI of 27 to 29.9 with comorbidities. NIH also includes them as a consideration for people with a BMI of 30 or higher.
Surgery, which changes the way food is absorbed, is sometimes used to treat obesity. NIH includes surgery as an option for people with a BMI or 30 or higher and comorbidities.
Tools
NIH provides sample tools to aid in weight management. These include the following:
Contraindications
NIH states that these groups of people should be excluded from weight loss treatment:
NIH also recommends that certain individuals be referred to specialists for weight loss as needed. These include people with a history of eating disorders, such as anorexia nervosa or bulimia. People who are currently abusing drugs should also be referred to a specialist.
What are the side effects of the treatments?
Losing weight is not risk-free. Diets that are not carefully planned increase the risk of vitamin deficiencies. Rapid weight loss can cause nausea, tiredness, weakness, hair loss, and low blood pressure. Dieting can also lead to emotional changes and binge eating. Medicines may cause increased blood pressure and heart rate, decreased absorption of fat soluble vitamins, and loose stools. Surgery for weight loss has all the risk of any major surgery. Nutrient deficiencies can also occur if parts of the digestive system are bypassed.What happens after treatment for the condition?
After the person has reached the weight loss goal, weight maintenance needs to be lifelong. The person should have regular treatment to continue with these measures:The ongoing therapy can be given in a number of ways. Some options recommended by NIH include:
Weight loss in an obese person can have the following effects:
While these effects are beneficial, they may also signal a need for a change in medicines. For example, the person may need lower doses of a medicine to lower blood pressure. Other people may need different medicines or be able to stop medicine completely for elevated blood glucose levels.
How is the condition monitored?
After successful treatment for obesity, the person can check his or her weight regularly. The individual will also have regular visits with the healthcare provider. NIH recommends an appointment at 6 months and again one year after the start of the weight management plan. The healthcare provider will look at the person's weight, BMI, and waist circumference during these visits. Any new or worsening symptoms should be reported to the provider.Attribution
Author:Dr. Karen Wolfe, MBBS, MA
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:07/31/01
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:07/03/01
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:07/31/01
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:07/03/01
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