Obesity is defined as weight at least 20% above a person's "ideal": Twenty-40% over ideal weight is considered mildly obese, 40-100% over ideal weight isconsidered moderately obese, and more than 100% over ideal weight is severely(morbidly) obese. According to some estimates, about one fourth of the U.S.population can be considered obese, 4 million of whom are morbidly obese.

Excessive weight can result in many serious and potentially deadly health problems, including high blood pressure, diabetes, infertility and increased risk for heart disease and heart attack.

In common terms, "obese" means "very overweight" and often carries negative connotations. But in weight-control medicine, "obese" is a non-judgmental termthat simply means a certain body mass index.

Body mass index (BMI) has been the medical standard for obesity measurement since the early 1980s, when government researchers developed it to take heightinto account in weight measurement. In BMI terms, the "overweight" range is26 to 27.3 for women and 26 to 27.8 for men. Most experts believe that "obesity" begins at BMIs above 27.3 for women and 27.87 for men. All authorities agree that anyone with a BMI over 30 is obese.

According to these guidelines, a woman who is 5' 0" and weighs 155 has a BMIof 30.14, and is obese. Someone who is 5' 4" and weighs 155 has a BMI of 26.6, and is overweight, but not obese. A person who is 5' 11" and weighs 155 isin the healthy BMI range.

The physical explanation for weight gain is simple: more calories are consumed than burned, and the body stores the excess calories as fat. However, the exact reasons why some people become obese while others do not is not clear.

Genetic factors influence how the body regulates appetite and the rate at which it turns food into energy (metabolic rate), but a genetic tendency to gainweight does not automatically mean that a person will be obese. Eating habits and patterns of physical activity also are important. While there is a genetic component to weight, but no one is destined to be obese. If weight has been a major problem in a family, the obese person may not be able to become asthin as he or she would like, but losing weight is possible.

Recent studies have shown that the amount of fat in a person's diet may be more important than the number of calories. Carbohydrates like cereals, breads,fruits, and vegetables and protein (fish, lean meat, turkey breast, skim milk) are converted to fuel almost as soon as they are consumed. Most fat calories, however, are immediately stored in fat cells, which add to the body's weight and girth as they expand and multiply.

Obesity can also be a side-effect of certain disorders and conditions, including an underactive thyroid gland or damage to the part of the brain that helps regulate appetite. Certain medicines, such as steroids and antidepressants,also may cause weight gain.

Obesity is recognized by the National Institutes of Health as a disease in itself, and the medical problems caused by obesity are serious and often life-threatening. In fact, obesity isn't just a cosmetic problem -- it's a health hazard. Someone who is 40% overweight is twice as likely to die prematurely asan average-weight person after 10 to 30 years of being obese. Obesity has been linked to:

  • diabetes
  • heart disease
  • high blood pressure
  • stroke
  • infertility
  • snoring
  • menstrual irregularities
  • higher rates of certain types of cancer
  • gallbladderdisease and gallstones
  • osteoarthritis
  • gout
  • breathingproblems (including sleep apnea)

The location of fat on a person's body is one clue to the risk of developingcertain obesity-related conditions. "Apple-shaped" people who store most of their weight around the waist and abdomen are at greater risk for cancer, heart disease, stroke, and diabetes than "pear-shaped" people whose extra poundssettle primarily in their hips and thighs.

Almost all of these problems are relieved by permanent significant weight loss. But for many obese people, health concerns are less important than the emotional suffering they face at the hands of thinner people. American society places great emphasis on physical appearance, and equates attractiveness withslimness, especially in women. Many Americans assume that obese people are gluttonous, lazy, stupid and self-indulgent, and because of these attitudes, obese people face daily prejudice and discrimination at work, at school, whilejob-hunting, and in social situations. Feelings of rejection, shame, and depression are common.

While it is unacceptable to discriminate against people on the basis of race,religion, gender, sexual persuasion, or ethnic group, many Americans still discriminate against the obese. Overweight people find it more difficult to get and keep a job; almost half those who are 100 pounds or more overweight areunemployed. For those who do have jobs, obese workers are often overlooked because they don't present a corporate or professional "image." Heavy people are discriminated against by their insurance carriers when the insurer refusesto provide therapy that will help relieve obesity, ignoring current scientific literature on how surgery can prevent, diminish, and often cure diseases and conditions associated with obesity. Frequently, heavy patients are discriminated against by their doctors, who tell them that their medical problems will disappear if they just stop eating.

The types of disabilities experienced by obese people are not widely acknowledged by society. It is very common for heavy people to be discriminated against in social situations, where they are often treated as non-persons. Most people think that obesity is the result of slothful living, poor personal eating and exercise habits, and lack of intelligence and self-control.

Successful treatment of obesity must involve life-long behavioral changes rather than short-term weight loss. Weight-loss programs that emphasize realistic goals, gradual progress, sensible eating, and exercise can be very helpfuland are recommended by many doctors. Programs that promise instant weight loss or feature severely restricted diets are not effective and, in some cases,can be dangerous. Studies have shown that yo-yo dieting, in which weight is repeatedly lost and regained, increases a person's likelihood of developing fatal health problems more than losing weight gradually or not losing it at all.

There are many diet myths and food fads, but if it sounds too good to be true, it probably is. None of the following dietary myths are true:

  • You can lose weight with special wraps, lotions and pills
  • Special vitaminscan erase cellulite
  • Special foods can make you young
  • Starchyfoods are particularly fattening
  • Potatoes are dietary no-nos
  • Cottage cheese and grapefruit have magical weight-loss properties

Most weight-loss diets don't work because they're poorly designed and they don't help people keep the weight off. In fact, any diet that emphasizes limiting calories for a set period of time, or that focuses on crash dieting, willfail. The person may lose weight temporarily but as soon as the diet stops, the pounds return. To lose weight and keep it off, an obese person must changeeating habits permanently and get more exercise.

An obese person who wants to lose weight shouldn't focus on dieting, becausedieting means deprivation, and no one chooses to remain deprived for long. Losing weight by dieting alone will weaken muscles, lower energy levels and increase fatigue. Dropping pounds too quickly can lessen muscle mass, which canbe harmful. The best plan is to try to lose about a pound a week so that theloss won't harm the body. This loss should be linked to an exercise program to burn fat, build muscle and increase cardiovascular fitness.

The success rate for dieting is approximately three to five percent. There are a wide variety of weight-loss programs available. "Do it yourself programs"include individual efforts and groups of like-minded people such as Overeaters Anonymous and TOPS (Take Off Pounds Sensibly).

"Non-clinical programs" are commercial franchises that offer program materials that may or may not be produced with guidance from health care providers. These programs rely heavily on "counselors" (who are typically not health careproviders) to provide services to clients.

Clinical programs are provided by a licensed professional who may or may nothave had the specialized training to treat obese patients. Clinical programsinclude such services as nutrition, medical care, behavior therapy, exerciseand psychological counseling, and may use very-low-calorie diets, medications, and surgery. The medication and surgery clinical programs offer help to overweight individuals who haven't been able to lose weight with other approaches.

For people who are severely obese, diet and lifestyle changes may be accompanied by surgery to reduce or bypass portions of the stomach or small intestine. Because such surgery can be risky, it is done only after other weight-lossstrategies have failed, and only on patients whose obesity seriously threatens their health. Patients who have had some variety of stomach bypass or stapling maintain a weight loss of at least 60% at the end of five years. However,weight loss after surgery isn't guaranteed and depends on how effectively the patient follows the recommended program.

Other surgical procedures, such as liposuction and jaw wiring, are not recommended for obese patients.

Appetite-suppressant drugs are sometimes prescribed to help people lose weight. These drugs work by increasing levels brain chemicals that control feelings of fullness and satisfaction. However, most of the weight lost while takingappetite suppressants is usually regained after stopping them. Also, suppressants containing amphetamines can be abused by patients. Two weight-loss drugs, dexfenfluramine hydrochloride (Redux) and fenfluramine (Pondimin) as wellas a combination fenfluramine-phentermine (Fen/Phen) drug, were taken off themarket when they were shown to cause potentially fatal heart defects. In November 1997, the United States Food and Drug Administration (FDA) approved a new weight-loss drug, sibutramine, (Meridia). Available only with a doctor's prescription, Meridia can significantly elevate blood pressure and cause dry mouth, headache, constipation, and insomnia. This medication should not be used by patients with a history of congestive heart failure, heart disease, stroke, or uncontrolled high blood pressure.

The Chinese herb ephedra (Ephedra sinica), combined with caffeine, exercise, and a low-fat diet in doctor-supervised weight-loss programs, is an alternative approach that can cause at least a temporary weight loss. However,the large doses of ephedra required to achieve the desired result can also cause serious medical problems including high blood pressure, heart attack, seizures, stroke, and death. Ephedra should not be used by anyone with a historyof diabetes, heart disease, or thyroid problems. Diuretic herbs, which increase urine production, can cause short-term weight loss but cannot help patients achieve lasting weight control.

Acupressure and acupuncture can also suppress food cravings. Visualization and meditation can create and reinforce a positive self-image that enhances thepatient's determination to lose weight. By improving physical strength, mental concentration, and emotional serenity, yoga can provide the same benefits.

The best approach to achieving and maintaining weight loss is a life-long commitment to regular exercise and sensible eating habits. As many as 85% of dieters who do not exercise on a regular basis regain their lost weight within two years. In five years, the figure rises to 90%. Exercise increases the metabolic rate by creating muscle, which burns more calories than fat. When regular exercise is combined with regular, healthful meals, calories continue to burn at an accelerated rate for several hours. Obese people need to aim for permanent lifestyle changes of healthier eating, regular physical activity, anda better outlook toward food, because without a long-term commitment, body weight will slowly increase.

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