Obesity

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KEY POINTS

• Obesity is having too much body fat.
• Obesity increases your risk for many illnesses and health problems.
• Obesity may be treated with diet, exercise, counseling, and sometimes medicine.

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What is obesity?

Obesity is having too much body fat. People who are obese weigh more than is healthy for their body type. Obesity increases your risk of health problems and major illness, such as:

• Arthritis
• Breathing problems such as apnea (stopping breathing during sleep)
• Diabetes
• Gallbladder disease
• Gout
• High blood pressure
• High cholesterol
• Liver disease
• Some types of cancer
• Stroke

Obesity also increases your risk of heart disease because it causes changes in the structure and function of the heart. The more you weigh, the more blood you have flowing through your body. Your heart has to work harder to pump the extra blood. Over time, your heart may not be able to keep up with the extra load. You may then have heart failure.

What is the cause?

There are several things that can cause obesity.

• Eating more food than your body uses. You get energy (calories) from the food you eat. Eating more calories than your body uses means that the extra energy is stored as fat.
• Not getting enough exercise. Watching television, working or playing on the computer for hours every day, and not exercising regularly contribute to weight gain. People who are obese may burn fewer calories than people who are not obese because it is harder to move about and be physically active.
• Metabolism. This is the rate at which you use energy, or calories, for basic processes such as eating, sleeping, or walking. Obese people may have a slower metabolism than people who are not obese.
• Family history. The genes you inherit from your parents can affect your weight. Children of obese parents are 10 times more likely to become obese than children whose parents are not obese. Unhealthy family eating habits may also be a reason several members of a family are obese.
• Emotions. Depression, anger, anxiety, and stress are emotional problems that can lead to weight gain. It may also be true that being overweight can cause emotional problems.
• Hormone imbalances. Having an underactive thyroid gland can lead to weight gain and can make losing weight difficult. Menopause may also cause women to gain weight.
• Medicines. Some medicines such as birth control pills or medicines to treat depression can cause weight gain.

What are the symptoms?

Weight gain is the first sign that you may be at risk for obesity. You may notice that your clothing is getting too tight. As you gain weight, you may have symptoms caused by obesity. Symptoms may include:

• Shortness of breath when you are active
• Trouble sleeping, including sleep apnea. If you have sleep apnea, you stop breathing for a short time during sleep. These problems can make you tired during the day, and you may snack to help stay awake. Sleep apnea can be a life-threatening problem.
• Pain in the joints and muscles, especially the back, knees, and ankles
• Rashes and sometimes infections that develop where the skin rubs together and traps moisture, especially on the abdomen and groin
• Irregular periods or no periods in women

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. He or she will ask about your medical history, eating habits, and exercise habits. You may have blood tests to check for hormone problems.

For most adults, your waist size and body mass index (BMI) are good ways to tell whether you are overweight.

Your provider will measure your waist at the point below your ribcage but above your navel. Your waist size is a measure of your belly fat. Your health risks increase as your BMI and waist size get larger. A waist size more than 40 inches for men or 35 inches for women puts you at risk for type 2 diabetes, heart disease, and stroke.

BMI is determined by looking up your height and weight on a BMI chart. A BMI of at least 25 indicates overweight. A BMI of 30 or more means that you are obese. Note that the BMI score may not be an accurate way to measure body fat if you are athletic or have a muscular build. It may underestimate body fat in older persons and others who have lost muscle mass. Your provider will use a different chart if you are pregnant. The chart can also be used as a guide for normal weight gain during pregnancy.

Your healthcare provider can tell you if you have an increased risk of health problems because of your weight. Your provider can also help you find a weight-loss program that works for you.

How is it treated?

Treatment for obesity will include lifestyle changes. Dietitians and healthcare providers can help you design a safe, healthy, effective weight loss program.

Healthy diet

In general, a healthy eating plan for weight loss is one that:

• Includes a lot of fruits, vegetables, whole grains, and beans
• Includes fat-free or low-fat milk products, including soy or almond milk
• Includes lean meats, poultry, fish, eggs or egg whites, nuts, seeds, and soy foods
• Is low in saturated fats, trans fats, cholesterol, salt, and added sugars

Most weight loss diets suggest 1200 to 1500 calories a day for women and 1500 to 1800 calories a day for men. However, your calorie needs may be different. They depend on your activity level and current weight. Do not fast or follow fad diets. If you get too few calories a day, your body will slow down your metabolism and stop you from losing weight. Ask your healthcare provider how many calories you need a day.

It is helpful to drink a lot of water (4 to 8 glasses a day). If you drink a glass of water before each meal, it helps you feel full faster.

Your diet should allow you to lose 1 to 2 pounds a week. If you lose more than that each week, you start to lose muscle rather than fat.

Exercise

Exercise is a very important part of a successful weight-loss program. Once you reach a lower weight, exercise may help you stay at that weight.

A healthy goal for all adults is to exercise for 30 minutes a day for 5 days a week (or 2 hours and 30 minutes or more each week), in addition to your regular activities. You don't need to do 30 minutes of activity all at once. You can do shorter periods, at least 10 minutes each time. As part of your weight loss program, you may need to do more physical activity. Some people will need to do up to 5 hours of physical activity a week to help them lose weight.

Almost any activity that involves mild to moderate exertion is good. You may choose to walk, jog, swim, cycle, or do aerobics. Walking is a great way for almost everyone to get more exercise. Using a pedometer can be fun and motivating. A pedometer is a device that attaches to your clothing and tracks how many steps you take in a day. A good goal is to work up to 10,000 steps a day (5 miles). If your provider agrees, try increasing your steps each week by 500 a day until you reach 10,000 steps a day.

Strength training will make your muscles stronger and able to work longer without getting tired. Strength training, or weight training, means doing exercises that build muscle strength. To build muscle you can lift free weights, use weight machines, use resistance bands, or use your own bodyweight, such as doing push-ups, pull-ups, or sit-ups. Muscle mass burns more calories than fat so as your muscle increases, you burn calories.

Ask your healthcare provider what kinds and amounts of exercise might be right for you.

Emotions

Some people eat as a way to cope with emotional problems and stress. If you have trouble with stress, depression, or anxiety, your healthcare provider may refer you to a counselor. Learning how to cope with emotional problems can help you to be successful with a weight-loss program.

Medicines

If hormone imbalances are contributing to excess weight, your provider may prescribe medicine to treat the imbalance.

There are prescription medicines to help you lose weight. Most people lose between 5 and 10 pounds by taking these medicines. Along with taking the medicine, you must also make lifestyle changes, such as exercising and eating a healthy diet. These medicines can have side effects (such as increased blood pressure). Often the weight is gained back when the medicine is stopped, unless healthy lifestyle changes have been made.

Claims have been made that certain herbal and dietary products help you lose weight. Many of these claims are not true. Some supplements can have serious side effects. Talk to your healthcare provider before using them.

How can I take care of myself?

To help yourself, follow these guidelines:

• Eat healthy, well-balanced meals that reduce the calories in your diet enough for you to lose 1 to 2 pounds a week and reach and maintain a healthy weight. If you are used to eating big portions, try to eat smaller portions of the higher calorie foods and add more vegetables and fruits. Stick to your diet and don't get discouraged.
• Cut back on the empty-calorie foods such as sugary drinks and potato chips. Or avoid them altogether.
• Keep a daily diary. Write down everything you eat and drink. Make notes about the changes you are making in food and physical activity. You can also write down your weight to see how your changes have helped. It can make you feel proud to see how far you have come in changing your habits. And writing these things down can help you keep on track.
• Ask your healthcare provider if you should take a multivitamin. Taking a multivitamin and mineral supplement can help you meet your nutritional needs, especially if you are following a diet that contains less than 1,500 calories.
• Avoid alcohol. Alcoholic beverages add calories and may increase hunger.
• Do some form of strength training, using gym equipment or your own body weight, 2 or more days a week. Keep a daily record of your exercise. Find a friend to exercise with you.
• It’s hard to be active when you spend a lot of time in front of a screen (TV, computer, DVD, smartphone, video games). Try to keep screen time to 2 hours or less per day, not including what you need to do for school or work.
• Learn to use relaxation techniques such as deep breathing and yoga to help you deal with stress.
• Get support. Support from other people can help motivate you. Your main support group can be your family and friends. Look for weight-loss support groups in your community. Or find an exercise partner.
• Keep your appointments with your healthcare provider, dietitian, or therapist. They can guide you and help keep you motivated.