• Overweight in Adults

    (Obesity; Morbid Obesity)

    Definition

    Being overweight or obese means your weight is above an ideal weight range. Excess weight creates an increase in the risk of serious diseases like heart disease, certain cancers, and diabetes. One tool used to estimate weight range is called the body mass index (BMI). This scale determines weight ranges based on height. BMI levels in adults include:
    • Ideal weight range: 18.5-24.9
    • Overweight: 25.0-29.9
    • Obese: 30.0 or above
    • Morbid obesity: 40

    Causes

    Overweight is caused by taking in more calories than we use. Calories are taken in through food. All activity in our bodies is fueled by calories. This includes physical activity and basic body functions. Excess weight gain occurs when this relationship is not kept in balance. If this imbalance happens regularly it will lead to obesity.
    Factors that can influence obesity include:

    Risk Factors

    Risk factors include:
    • Advancing age
    • Working varied shifts
    • Decreased activity
    • Sedentary lifestyle—Getting too little exercise and spending too much time in front of a television or computer
    • Imbalance of excess calories versus decreased activity
    • High level of fast food intake
    • High alcohol consumption
    • Eating until full and eating quickly
    • Eating large portions of food
    • Not getting enough sleep

    Symptoms

    Symptoms include:
    • Increased weight
    • Thickness around the midsection
    • Obvious areas of fat deposits

    Complications of Obesity

    Obesity has been linked to health problems and quality of life issues such as:

    Diagnosis

    Obesity is diagnosed by visual exam and body measurements using:
    • Height and weight tables
    • Body mass index
    • Measuring body folds with a caliper
    • Measuring waist circumference
    • Measuring waist-to-hip ratio
    • Water-displacement tests
    Your doctor may order blood tests to eliminate the possibility of other medical conditions.

    Treatment

    Obesity is difficult to treat. Things that affect treatment are:
    • Cultural factors
    • Personal habits
    • Lifestyle
    • Genetics
    There are many different approaches to treating obesity. You are more likely to successfully lose weight and keep it off by using a combination of strategies, like eating healthy, exercise, counseling, and/or medication. Talk to your doctor or ask for a referral to a dietician. They can help you develop a plan that is best for you. Plans for weight loss may include:

    Diet

    Your doctor may recommend that you:
    • Reduce carbohydrate and fat intake.
    • Spread your calorie intake throughout the day rather than getting it all in a few large meals
    Calorie Intake
    The key to weight loss is reducing the total number of calories that you eat. Following a specific kind of diet, like a low-carb diet, is not necessary. It is much more important to choose a low calorie diet that you can stick with for the long haul. A dietitian can help you with your total calorie intake goal. This is based on your:
    • Current weight
    • Weight loss goals
    Portion size (or serving's size) also plays an important role. Using special portion control plates may help you succeed.
    Food Diary
    Keep track of everything you eat and drink.

    Exercise

    Ask your doctor about an exercise program. Even moderate-intensity exercise, like brisk walking, can help you lose weight.
    Add bits of activity through your day. Take stairs instead of elevators. Park a little further away. Limit the amount of time you spend watching television and using the computer.

    Behavior Therapy

    Behavior therapy may help you understand:
    • When you tend to overeat
    • Why you tend to overeat
    • How to combat overeating habits
    When combined with diet and exercise, therapy can help you with your weight reduction.

    Weight Loss Programs

    Weight loss programs do seem to work for some people. Some studies also suggest that a partner or group may help you improve your eating habits and fitness.

    Medications

    Weight loss medicines, like orlistat (Xenical), may be prescribed. Orlistat interferes with the absorption of fat from the intestines. There are other medications available that may help with weight loss, but potential side effects need to be weighed carefully with potential benefits.
    Medicines alone are not a viable option for losing weight and keeping it off. Some have serious side effects. There are also risks associated with over-the-counter and herbal products. Talk to your doctor before taking any of these.

    Bariatric Surgery

    Bariatric surgery makes the stomach smaller. In some cases, it will also rearrange the digestive tract. The smaller stomach can only hold a tiny portion of food at a time. Examples of procedures include:
    These procedures may be a good option for people who are severely obese who are having trouble losing weight by other means.
    Gastric Bypass
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Prevention

    Preventing obesity can be difficult. There are many factors influence your weight. General recommendations include:
    • Talk to your doctor or a dietician about an appropriate number of calories to eat per day.
    • Follow an appropriate exercise program.
    • Limit the amount of time you spend doing sedentary activities. This includes watching TV or using the computer.
    • Talk to your doctor or an exercise professional about working activity into your daily life.
    • Ask a dietitian for help planning a diet that will help you maintain a healthy weight or lose weight if necessary.
    • Learn to eat smaller portions of food. Most Americans eat portions that are too large.

    RESOURCES

    American Dietetic Association http://www.eatright.org/

    The Obesity Society http://www.obesity.org/

    CANADIAN RESOURCES

    Canada's Food GuideHealth Canada http://www.hc-sc.gc.ca/

    Dietitians of Canada http://www.dietitians.ca/

    References

    Cecil R, Goldman L, Bennett J. Cecil Textbook of Medicine . 21st ed. Philadelphia, PA: WB Saunders Co; 2000.

    Dietary guidelines for Americans. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.health.gov/dietaryguidelines/dga2005/document/default.htm . Accessed August 28, 2012.

    Goldman L, Ausiello D, eds. Cecil Textbook of Internal Medicine . 23rd ed. Philadelphia, PA: Saunders, 2008.

    Goroll AH, Mulley AG, Mulley AG Jr. Primary Care Medicine . 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.

    Kronenberg HM, Melmed S, Polonsy KS, Larsen PR. Williams Textbook of Endocrinology . 11th ed. Philadelphia, PA: Saunders Elsevier; 2008.

    Obesity in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 16, 2012. Accessed August 28, 2012.

    Obesity, bias, and stigmatization. The Obesity Society website. Available at: http://www.obesity.org/information/weight%5Fbias.asp . Accessed June 8, 2008.

    Thompson WG, Cook DA, Clark MM, Bardia A, Levine JA. Treatment of obesity. Mayo Clin Proc . 2007;82:93-101.

    Weight loss medication for obesity in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 18, 2012. Accessed August 28, 2012.

    8/21/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Pedersen SD, Kang J, Kline GA. Portion control plate for weight loss in obese patients with type 2 diabetes mellitus: a controlled clinical trial. Arch Intern Med . 2007;167:1277-1283.

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    1/15/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol . 2010;171(2):135-54.

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    2/19/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : O'Brien PE, Sawyer SM, Laurie C, et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA. 2010;303(6):519-526.

    10/15/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : US Food and Drug Administration. Meridia (sibutramine): market withdrawal due to risk of serious cardiovascular events. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm228830.htm . Published October 8, 2010. Accessed October 15, 2010.

    12/17/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : US Food and Drug Administration. FDA: Tainted products marketed as dietary supplements potentially dangerous. US Food and Drug Administration website. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm236967.htm . Updated December 15, 2010. Accessed December 17, 2010.

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