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Obesity: Facts and definitions

Many of us don't want to know the facts about our health but it can be a matter of life and death! Please remember that the primary concern of overweight and obesity is one of health and not appearance.
  • The first thing we want to learn about our selves is: am I obese or morbidly obese?
  • Then we will look into what causes our obesity?

Am I obese?
Obesity Map

The Centers for Disease Control and Prevention estimates that 64.5 percent of adults and 15 percent of children in the United States are overweight. According to a recent RAND Corp. study, the number of extremely obese American adults - those who are at least 100 pounds overweight - has quadrupled since the 1980s to about 4 million, or about one in every 50 adults.

This prevalence has nearly tripled for adolescents in the past 2 decades. These increases in overweight and obesity cut across all ages, racial and ethnic groups, and both genders. As a result, 300,000 deaths each year in the United States are associated with obesity which is preventable through weight loss surgery (stomach stapling [gastric bypass surgery], lap band [adjustable gastric banding]) and non surgical weight loss methods (nutrition, diet, exercise). So this is a very important question! Lets understand what obesity is.
  • Obesity is defined as being 20% or more over ideal weight (BMI >25). Ideal weight is the weight associated with the longest life. Ideal weight tables show the ideal weight as it relates to gender and height. A rule of thumb often used by physicians to calculate ideal weight is to allow 100 lbs. for the first 5 feet of a woman's height and 5 lbs. For each inch over 5 feet. For men it is 106 lbs. For the first 5 feet and 6 lbs. For each inch thereafter.

Example: A 5 foot 6 inch woman should therefore weight 130 lbs.

  • Morbid obesity is a much more severe form of obesity. A person who is 100 or more pounds overweight or twice the ideal body weight and has a BMI of 40 or a BMI of 35 with multiple co-morbidities is morbidly obese. Morbid obesity affects an estimated 9 million Americans. Morbid obesity is a common condition that can have profoundly negative health and social consequences. It is considered a serious disease and has been linked to shortened life expectancy. Most morbidly obese patients are candidates for the various forms of weight loss surgery (restrictive - lap band, Roux-en-Y Gastric Bypass surgery, Gastroplasty, or Malobsorbtive - biliopancreatic diversion, Duodenal Switch). According to C. Everett Koop, M.D. former Surgeon General of the United States, obesity is the second leading cause of preventable death in America! And more and more insurance companies are realizing that weight loss surgery is not a cosmetically motivated treatment but instead a life saving weight loss surgery treatment making weight loss treatments such as stomach stapling (gastric bypass surgery) or the lap band financially affordable to those in need.

OK, so how do I determine if I am obese and at risk?
According to the National Heart Lung and Blood Institute guidelines, assessment of overweight involves using three key measures:
  • Body mass index (BMI)
  • Waist circumference, and
  • Risk factors for diseases and conditions associated with obesity.
The BMI is a measure of your weight relative to your height and waist circumference measures abdominal fat. Combining your BMI and your waist circumference with information about your additional risk factors yields your risk for developing obesity-associated diseases and determines whether your a candidate for weight loss surgeries such as gastric bypass surgery, the lap band or other weight loss procedures. So your BMI is a good number to start with in identifying your risk due to your weight.

Lets find out your BMI.

Body Mass Index (BMI):
BMI is a reliable indicator of total body fat, which is related to the risk of disease and death. The BMI score is valid for both men and women but it does have some limits. The limits are:
  • BMI may overestimate body fat in athletes and others who have a muscular build or those who are exceptionally tall.
  • BMI may underestimate body fat in older persons and others who have lost muscle mass.

Use the BMI calculator below to estimate your total body fat.
Weight:


Height:



Your BMI is:


Waist to Height Ratio:
In a recent study presented in the Journal of Clinical Endocrinology Metabolism, the WHtR was the strongest predictor of cardiovascular risk and mortality. On the other hand, BMI was not always positively associated with cardiovascular risk. The results of this study discourage the use of BMI as a measure of health risk and encourage the use of WHtR.

BMI provides a guide to the relationship between a person's height and weight. However, having a high BMI is not always a telltale sign that one will be at greater risk for disease. For instance, many thin people who have low or normal BMI's still have heart attacks or die from strokes and many people who have high BMI's are in good cardiovascular shape, as the study cited in the Journal of Clinical Endocrinology Metabolism indicated.

BMI does not take into account an individual's frame, gender, or the amount of muscle mass versus fat mass. For example, two people can have the same BMI, even if one is much more muscular and carrying far less abdominal fat than the other; this is because BMI does not account for differences in fat distribution.

The WHtR is calculated by dividing waist size (not body weight, as is done in BMI calculations) by height, and takes gender into account. As an example, a male with a 32-inch waist who is 5'10" (70 inches) would divide 32 by 70, to get a WHtR of 45.7 percent. The WHtR is thought to give a more accurate assessment of health since the most dangerous place to carry weight is in the abdomen. Fat in the abdomen, which is associated with a larger waist, is metabolically active and produces various hormones that can cause harmful effects, such as type-2 diabetes, elevated blood pressure, and altered lipid (blood fat) levels.

Many athletes, both male and female, who often have a higher percentage of muscle and a lower percentage of body fat, have relatively high BMIs but their WHtRs are within a healthy range. This also holds true for women who have a "pear" rather than an "apple" shape.

The following chart helps you determine if your WHtR falls in a healthy range (these ratios are percentages):

WOMEN
• Ratio less than 35: Abnormally Slim to Underweight
• Ratio 35 to 42: Extremely Slim
• Ratio 42 to 46: Slender and Healthy
• Ratio 46 to 49: Healthy and Attractive
• Ratio 49 to 54: Overweight
• Ratio 54 to 58: Seriously Overweight
• Ratio over 58: Highly Obese.

MEN
• Ratio less than 35: Abnormally Slim to Underweight
• Ratio 35 to 43: Extremely slim
• Ratio 43 to 46: Slender and Healthy
• Ratio 46 to 53: Healthy, Normal, Attractive Weight
• Ratio 53 to 58: Overweight
• Ratio 58 to 63: Extremely Overweight/Obese
• Ratio over 63: Highly Obese

Other Risk Factors
Besides being overweight or obese, there are additional risk factors to consider.
  • High blood pressure (hypertension)
  • High LDL-cholesterol ("bad" cholesterol)
  • Low HDL-cholesterol ("good" cholesterol)
  • High triglycerides
  • High blood glucose (sugar)
  • Family history of premature heart disease
  • Physical inactivity
  • Cigarette smoking

Assessment
For people who are considered obese (BMI greater than or equal to 30) or those who are overweight (BMI of 25 to 29.9) and have two or more risk factors, the guidelines recommend the need for weight loss. Even a small weight loss (just 10 percent of your current weight) will help to lower your risk of developing diseases associated with obesity. Weight loss surgery treatment such as the adjustable lap band may be available to you. Patients who are overweight, but do not have a high waist measurement, and have less than 2 risk factors may need to prevent further weight gain rather than lose weight.

Talk to your practitioner to see if you are at an increased risk and if you should lose weight or consider weight loss surgery. Your doctor will evaluate your BMI, waist measurement, and others risk factors for heart disease. People who are overweight or obese have a greater chance of developing high blood pressure, high blood cholesterol or other lipid disorders, type 2 diabetes, heart disease, stroke, and certain cancers, and even a small weight loss (just 10 percent of your current weight) will help to lower your risk of developing those diseases. And there are a variety of weight loss surgery options available such as the less invasive lap band. Other surgeries include stomach stapling or gastric bypass surgery which can be done laparoscopically.

What Caused My Obesity?
Overweight and obesity are a result of an energy imbalance over a long period of time. The cause of the energy imbalance for each individual may be due to a combination of several factors. But generally, our behavior is out of sink with our bodies biological, and our life's environmental factors which together are all responsible for causing us to be overweight and obese. Many other factors also contribute to obesity and because of this; obesity is a complex health issue to address. We will focus on these three main factors: behavioral, biological and environmental.

Behavioral: Am I partially responsible!
The choices a person makes in eating and physical activity contributes to overweight and obesity. Weight gain is a result of consuming extra calories, decreasing the amount of calories your body uses (through physical activity) or both. Personal choices concerning calorie consumption and physical activity can lead to an energy imbalance. A difference of one 12-oz. soda (150 calories) or 30 minutes of brisk walking most days can add or subtract approximately 10 pounds to your weight each year. To maintain your weight, your intake of calories must equal your energy output. To lose weight, you must use more energy than you take in. The Surgeon General says "Make fitness a priority…COMMIT TO IT." Physical exercise is a great way to burn those calories off our bodies and maintain our energy balance. Note: Consult with your health care provider before starting a vigorous exercise program if you have ever had heart trouble or high blood pressure or suffer from chest pains, dizziness or fainting, arthritis, or if you are over age 40 (men) or 50 (women).

Biological: How do genes affect obesity?
Science shows that genetics plays a role in obesity. However genes do not always predict future health. It all depends on what other factors are in play. Genes and behavior usually both play hand in hand for those of us who are overweight.

Bottom Line: For people who are genetically predisposed to gain weight, preventing obesity is the best course. Predisposed persons may require individualized interventions (including weight loss surgery) and greater support to be successful in maintaining a healthy weight.

It is time to stop blaming yourself. Many obesity researchers believe that people who struggle with their weight are pushing against thousands of years of evolution that has selected for storing energy as fat in times of plenty for use in times of scarcity. Genes are not destiny; in fact obesity can be prevented or can be managed in many cases with a combination of diet, physical activity, and medication. Genetic predisposition will usually mean that fighting obesity will be a struggle and require a lifelong commitment to achieve better health as will any decision to under go weight loss surgery. Treatments such as the Lap Band, Gastric Stimulator, stomach stapling, and gastric bypass surgery all require life long commitments to living healthy. To learn more about genetics and obesity visit A Public Health Perspective web site at the Centers for Disease Control and Prevention.


Environment: How does my environment influence my behavior?
People may make decisions based on their environment or community. For example, a person may choose not to walk to the store or work because of a lack of sidewalks. Communities, homes, and workplaces each shape health decisions. With fewer options for physical activity and healthy eating, it becomes more difficult for people to make good choices. These are all choices, sometimes very small choices that add up over time to make a big difference in our health.

Other Factors Diseases and Drugs
Some illnesses may lead to obesity or weight gain. These may include Cushing's disease or polycystic ovary syndrome. Drugs such as steroids and some antidepressants may also cause weight gain. A doctor is the best source to tell you whether illnesses, medications, or psychological factors are contributing to weight gain or making weight loss hard.

In Review:
Body weight is the result of our behavior combined with our genes (predisposition to gain weight) and our environment (opportunities for physical activity and healthy eating). These are the greatest areas for prevention and treatment actions prior to under going weight loss surgery.

With a better understanding of our self (BMI, risk factors, waist circumference) and the potential reasons for our obesity, we can focus on our path to success (which may include weight loss surgery treatment such as the adjustable lap band or stomach stapling). And like the many factors that contribute to obesity, we will have to change many factors while on our path and knowing our self is the first step towards taking your life back from obesity.