obesity

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Obesity

 

Definition

Obesity is an abnormal accumulation of body fat, usually 20% or more over an individual's ideal body weight. Obesity is associated with increased risk of illness, disability, and death.
The branch of medicine that deals with the study and treatment of obesity is known as bariatrics. As obesity has become a major health problem in the United States, bariatrics has become a separate medical and surgical specialty.

Description

Obesity traditionally has been defined as a weight at least 20% above the weight corresponding to the lowest death rate for individuals of a specific height, gender, and age (ideal weight). Twenty to forty percent over ideal weight is considered mildly obese; 40-100% over ideal weight is considered moderately obese; and 100% over ideal weight is considered severely, or morbidly, obese. More recent guidelines for obesity use a measurement called BMI (body mass index) which is the individual's weight multiplied by 703 and then divided by twice the height in inches. BMI of 25.9-29 is considered overweight; BMI over 30 is considered obese. Measurements and comparisons of waist and hip circumference can also provide some information regarding risk factors associated with weight. The higher the ratio, the greater the chance for weight-associated complications. Calipers can be used to measure skin-fold thickness to determine whether tissue is muscle (lean) or adipose tissue (fat).
Much concern has been generated about the increasing incidence of obesity among Americans. Some studies have noted an increase from 12% to 18% occurring between 1991 and 1998. Other studies have actually estimated that a full 50% of all Americans are overweight. The World Health Organization terms obesity a worldwide epidemic, and the diseases which can occur due to obesity are becoming increasingly prevalent.
Excessive weight can result in many serious, potentially life-threatening health problems, including hypertension, Type II diabetes mellitus (non-insulin dependent diabetes), increased risk for coronary disease, increased unexplained heart attack, hyperlipidemia, infertility, and a higher prevalence of colon, prostate, endometrial, and, possibly, breast cancer. Approximately 300,000 deaths a year are attributed to obesity, prompting leaders in public health, such as former Surgeon General C. Everett Koop, M.D., to label obesity "the second leading cause of preventable deaths in the United States."

Causes and symptoms

The mechanism for excessive weight gain is clear—more calories are consumed than the body burns, and the excess calories are stored as fat (adipose) tissue. However, the exact cause is not as clear and likely arises from a complex combination of factors. Genetic factors significantly influence how the body regulates the appetite and the rate at which it turns food into energy (metabolic rate). Studies of adoptees confirm this relationship—the majority of adoptees followed a pattern of weight gain that more closely resembled that of their birth parents than their adoptive parents. A genetic predisposition to weight gain, however, does not automatically mean that a person will be obese. Eating habits and patterns of physical activity also play a significant role in the amount of weight a person gains. Recent studies have indicated that the amount of fat in a person's diet may have a greater impact on weight than the number of calories it contains. 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 are immediately stored in fat cells, which add to the body's weight and girth as they expand and multiply. A sedentary lifestyle, particularly prevalent in affluent societies, such as in the United States, can contribute to weight gain. Psychological factors, such as depression and low self-esteem may, in some cases, also play a role in weight gain.
Height And Weight Goals
Men
Height Small Frame Medium Frame Large Frame
5′2″ 5′3″ 5′4″ 128-134 lbs. 130-136 132-138 131-141 lbs. 133-143 135-145 138-150 lbs. 140-153 142-153
5′5″ 5′6″ 5′7″ 134-140 136-142 138-145 137-148 139-151 142-154 144-160 146-164 149-168
5′8″ 5′9″ 5′10″ 140-148 142-151 144-154 145-157 148-160 151-163 152-172 155-176 158-180
5′11″ 6′0″ 6′1″ 146-157 159-160 152-164 154-166 157-170 160-174 161-184 164-188 168-192
6′2″ 6′3″ 6′4″ 155-168 158-172 162-176 164-178 167-182 171-187 172-197 176-202 181-207
Women
Height Small Frame Medium Frame Large Frame
4′10″ 4′11″ 5′0″ 102-111 lbs. 103-113 104-115 109-121 lbs. 111-123 113-126 118-131 lbs. 120-134 112-137
5′1″ 5′2″ 5′3″ 106-118 108-121 111-124 115-129 118-132 121-135 125-140 128-143 131-147
5′4″ 5′5″ 5′6″ 114-127 117-130 120-133 124-141 127-141 130-144 137-151 137-155 140-159
5′7″ 5′8″ 5′9″ 123-136 126-139 129-142 133-147 136-150 139-153 143-163 146-167 149-170
5′10″ 5′11″ 6′0″ 132-145 135-148 138-151 142-156 145-159 148-162 152-176 155-176 158-179
At what stage of life a person becomes obese can affect his or her ability to lose weight. In childhood, excess calories are converted into new fat cells (hyperplastic obesity), while excess calories consumed in adulthood only serve to expand existing fat cells (hypertrophic obesity). Since dieting and exercise can only reduce the size of fat cells, not eliminate them, persons who were obese as children can have great difficulty losing weight, since they may have up to five times as many fat cells as someone who became overweight as an adult.
Obesity can also be a side effect of certain disorders and conditions, including:
  • Cushing's syndrome, a disorder involving the excessive release of the hormone cortisol
  • hypothyroidism, a condition caused by an underactive thyroid gland
  • neurologic disturbances, such as damage to the hypothalamus, a structure located deep within the brain that helps regulate appetite
  • consumption of such drugs as steroids, antipsychotic medications, or antidepressants
The major symptoms of obesity are excessive weight gain and the presence of large amounts of fatty tissue. Obesity can also give rise to several secondary conditions, including:
  • arthritis and other orthopedic problems, such as lower back pain
  • hernias
  • heartburn
  • adult-onset asthma
  • gum disease
  • high cholesterol levels
  • gallstones
  • high blood pressure
  • menstrual irregularities or cessation of menstruation (amenorhhea)
  • decreased fertility, and pregnancy complications
  • shortness of breath that can be incapacitating
  • sleep apnea and sleeping disorders
  • skin disorders arising from the bacterial breakdown of sweat and cellular material in thick folds of skin or from increased friction between folds
  • emotional and social problems

Diagnosis

Diagnosis of obesity is made by observation and by comparing the patient's weight to ideal weight charts. Many doctors and obesity researchers refer to the body mass index (BMI), which uses a height-weight relationship to calculate an individual's ideal weight and personal risk of developing obesity-related health problems. Physicians may also obtain direct measurements of an individual's body fat content by using calipers to measure skin-fold thickness at the back of the upper arm and other sites. The most accurate means of measuring body fat content involves immersing a person in water and measuring relative displacement; however, this method is very impractical and is usually only used in scientific studies requiring very specific assessments. Women whose body fat exceeds 30% and men whose body fat exceeds 25% are generally considered obese.
Doctors may also note how a person carries excess weight on his or her body. Studies have shown that this factor may indicate whether or not an individual has a predisposition to develop certain diseases or conditions that may accompany obesity. "Apple-shaped" individuals 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 pounds settle primarily in their hips and thighs.

Treatment

Treatment of obesity depends primarily on how overweight a person is and his or her overall health. However, to be successful, any treatment must affect life-long behavioral changes rather than short-term weight loss. "Yo-yo" dieting, in which weight is repeatedly lost and regained, has been shown to increase a person's likelihood of developing fatal health problems than if the weight had been lost gradually or not lost at all. Behavior-focused treatment should concentrate on:
  • What and how much a person eats. This aspect may involve keeping a food diary and developing a better understanding of the nutritional value and fat content of foods. It may also involve changing grocery-shopping habits (e.g., buying only what is on a prepared list and only going on a certain day), timing of meals (to prevent feelings of hunger, a person may plan frequent, small meals), and actually slowing down the rate at which a person eats.
  • How a person responds to food. This may involve understanding what psychological issues underlie a person's eating habits. For example, one person may binge eat when under stress, while another may always use food as a reward. In recognizing these psychological triggers, an individual can develop alternate coping mechanisms that do not focus on food.
  • How they spend their time. Making activity and exercise an integrated part of everyday life is a key to achieving and maintaining weight loss. Starting slowly and building endurance keeps individuals from becoming discouraged. Varying routines and trying new activities also keeps interest high.
For most individuals who are mildly obese, these behavior modifications entail life-style changes they can make independently while being supervised by a family physician. Other mildly obese persons may seek the help of a commercial weight-loss program (e.g., Weight Watchers). The effectiveness of these programs is difficult to assess, since programs vary widely, drop-out rates are high, and few employ members of the medical community. However, programs that emphasize realistic goals, gradual progress, sensible eating, and exercise can be very helpful and 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.
For individuals who are moderately obese, medically supervised behavior modification and weight loss are required. While doctors will put most moderately obese patients on a balanced, low-calorie diet (1200-1500 calories a day), they may recommend that certain individuals follow a very-low-calorie liquid protein diet (400-700 calories) for as long as three months. This therapy, however, should not be confused with commercial liquid protein diets or commercial weight-loss shakes and drinks. Doctors tailor these diets to specific patients, monitor patients carefully, and use them for only a short period of time. In addition to reducing the amount and type of calories consumed by the patient, doctors will recommend professional therapists or psychiatrists who can help the individual effectively change his or her behavior in regard to eating.
For individuals who are severely obese, dietary changes and behavior modification may be accompanied by surgery to reduce or bypass portions of the stomach or small intestine. Although obesity surgery is less risky as of 2003 because of recent innovations in equipment and surgical technique, it is still performed only on patients for whom other strategies have failed and whose obesity seriously threatens their health. Other surgical procedures are not recommended, including liposuction, a purely cosmetic procedure in which a suction device is used to remove fat from beneath the skin, and jaw wiring, which can damage gums and teeth and cause painful muscle spasms.
Appetite-suppressant drugs are sometimes prescribed to aid in weight loss. These drugs work by increasing levels of serotonin or catecholamine, which are brain chemicals that control feelings of fullness. Appetite suppressants, though, are not considered truly effective, since most of the weight lost while taking them is usually regained after stopping them. Also, suppressants containing amphetamines can be
Body/mass index can be calculated by locating your height and weight on the chart and drawing a diagonal line between the two. Where the line crosses over the third bar is the approximate BMI.
Body/mass index can be calculated by locating your height and weight on the chart and drawing a diagonal line between the two. Where the line crosses over the third bar is the approximate BMI.
(Illustration by Argosy Inc.)
potentially abused by patients. While most of the immediate side-effects of these drugs are harmless, the long-term effects of these drugs, in many cases, are unknown. Two drugs, dexfenfluramine hydrochloride (Redux) and fenfluramine (Pondimin) as well as a combination fenfluramine-phentermine (Fen/Phen) drug, were taken off the market 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.
Other weight-loss medications available with a doctor's prescription include:
  • diethylpropion (Tenuate, Tenuate dospan)
  • mazindol (Mazanor, Sanorex)
  • phendimetrazine (Bontril, Plegine, Prelu-2, X-Trozine)
  • phentermine (Adipex-P, Fastin, Ionamin, Oby-trim)
Phenylpropanolamine (Acutrim, Dextarim) is the only nonprescription weight-loss drug approved by the FDA These over-the-counter diet aids can boost weight loss by 5%. Combined with diet and exercise and used only with a doctor's approval, prescription anti-obesity medications enable some patients to lose 10% more weight than they otherwise would. Most patients regain lost weight after discontinuing use of either prescription medications or nonprescription weight-loss products.
Prescription medications or over-the-counter weight-loss products can cause:
  • constipation
  • dry mouth
  • headache
  • irritability
  • nausea
  • nervousness
  • sweating
None of them should be used by patients taking monoamine oxidase inhibitors (MAO inhibitors).
Doctors sometimes prescribe fluoxetine (Prozac), an antidepressant that can increase weight loss by about 10%. Weight loss may be temporary and side effects of this medication include diarrhea, fatigue, insomnia, nausea, and thirst. Weight-loss drugs currently being developed or tested include ones that can prevent fat absorption or digestion; reduce the desire for food and prompt the body to burn calories more quickly; and regulate the activity of substances that control eating habits and stimulate overeating.

Alternative treatment

The Chinese herb ephedra (Ephedra sinica), combined with caffeine, exercise, and a low-fat diet in physician-supervised weight-loss programs, can cause at least a temporary increase in weight loss. However, the large doses of ephedra required to achieve the desired result can also cause:
  • anxiety
  • heart arrhythmias
  • heart attack
  • high blood pressure
  • insomnia
  • irritability
  • nervousness
  • seizures
  • strokes
  • death
Ephedra should not be used by anyone with a history of diabetes, heart disease, or thyroid problems. In fact, an article that appeared in the Journal of the American Medical Association in early 2003 advised against the use of ephedra.
Diuretic herbs, which increase urine production, can cause short-term weight loss but cannot help patients achieve lasting weight control. The body responds to heightened urine output by increasing thirst to replace lost fluids, and patients who use diuretics for an extended period of time eventually start retaining water again anyway. In moderate doses, psyllium, a mucilaginous herb available in bulk-forming laxatives like Metamucil, absorbs fluid and makes patients feel as if they have eaten enough. Red peppers and mustard help patients lose weight more quickly by accelerating the metabolic rate. They also make people more thirsty, so they crave water instead of food. Walnuts contain serotonin, the brain chemical that tells the body it has eaten enough. Dandelion (Taraxacum officinale) can raise metabolism and counter a desire for sugary foods.
Acupressure and acupuncture can also suppress food cravings. Visualization and meditation can create and reinforce a positive self-image that enhances the patient's determination to lose weight. By improving physical strength, mental concentration, and emotional serenity, yoga can provide the same benefits. Also, patients who play soft, slow music during meals often find that they eat less food but enjoy it more.
Getting the correct ratios of protein, carbohydrates, and good-quality fats can help in weight loss via enhancement of the metabolism. Support groups that are informed about healthy, nutritious, and balanced diets can offer an individual the support he or she needs to maintain this type of eating regimen.

Prognosis

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%. Repeatedly losing and regaining weight (yo yo dieting) encourages the body to store fat and may increase a patient's risk of developing heart disease. The primary factor in achieving and maintaining weight loss is a life-long commitment to regular exercise and sensible eating habits.

Prevention

Obesity experts suggest that a key to preventing excess weight gain is monitoring fat consumption rather than counting calories, and the National Cholesterol Education Program maintains that only 30% of calories should be derived from fat. Only one-third of those calories should be contained in saturated fats (the kind of fat found in high concentrations in meat, poultry, and dairy products). Because most people eat more than they think they do, keeping a detailed food diary is a useful way to assess eating habits. Eating three balanced, moderate-portion meals a day—with the main meal at mid-day—is a more effective way to prevent obesity than fasting or crash diets. 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. Finally, encouraging healthful habits in children is a key to preventing childhood obesity and the health problems that follow in adulthood.

New directions in obesity treatment

The rapid rise in the incidence of obesity in the United States since 1990 has prompted researchers to look for new treatments. One approach involves the application of antidiabetes drugs to the treatment of obesity. Metformin (Glucophage), a drug that was approved by the Food and Dug Administration (FDA) in 1994 for the treatment of type 2 diabetes, shows promise in treating obesity associated with insulin resistance.
Another field of obesity research is the study of hormones, particularly leptin, which is produced by fat cells in the body, and ghrelin, which is secreted by cells in the lining of the stomach. Both hormones are known to affect appetite and the body's energy balance. Leptin is also related to reproductive function, while ghrelin stimulates the pituitary gland to release growth hormone. Further studies of these two hormones may lead to the development of new medications to control appetite and food intake.

Key terms

Adipose tissue — Fat tissue.
Appetite suppressant — Drug that decreases feelings of hunger. Most work by increasing levels of serotonin or catecholamine, chemicals in the brain that control appetite.
Bariatrics — The branch of medicine that deals with the prevention and treatment of obesity and related disorders.
Ghrelin — A recently discovered peptide hormone secreted by cells in the lining of the stomach. Ghrelin is important in appetite regulation and maintaining the body's energy balance.
Hyperlipidemia — Abnormally high levels of lipids in blood plasma.
Hyperplastic obesity — Excessive weight gain in childhood, characterized by the creation of new fat cells.
Hypertension — High blood pressure.
Hypertrophic obesity — Excessive weight gain in adulthood, characterized by expansion of already existing fat cells.
Ideal weight — Weight corresponding to the lowest death rate for individuals of a specific height, gender, and age.
Leptin — A protein hormone that affects feeding behavior and hunger in humans. At present it is thought that obesity in humans may result in part from insensitivity to leptin.
A third approach to obesity treatment involves research into the social factors that encourage or reinforce weight gain in humans. Researchers are looking at such issues as the advertising and marketing of food products; media stereotypes of obesity; the development of eating disorders in adolescents and adults; and similar questions.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Nutritional Disorders: Obesity." Section 1, Chapter 5. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
Flancbaum, Louis, MD, with Erica Manfred and Deborah Biskin. The Doctor's Guide to Weight Loss Surgery. West Hurley, NY: Fredonia Communications, 2001.
Pi-Sunyer, F. Xavier. "Obesity." In Cecil Textbook of Medicine, edited by Russel L. Cecil, et al. Philadelphia, PA: W. B. Saunders Company, 2000.

Periodicals

Aronne, L. J., and K. R. Segal. "Weight Gain in the Treatment of Mood Disorders." Journal of Clinical Psychiatry 64, Supplement 8 (2003): 22-29.
Bell, S. J., and G. K. Goodrick. "A Functional Food Product for the Management of Weight." Critical Reviews in Food Science and Nutrition 42 (March 2002): 163-178.
Brudnak, M. A. "Weight-Loss Drugs and Supplements: Are There Safer Alternatives?" Medical Hypotheses 58 (January 2002): 28-33.
Colquitt, J., A. Clegg, M. Sidhu, and P. Royle. "Surgery for Morbid Obesity." Cochrane Database Systems Review 2003: CD003641.
Espelund, U., T. K. Hansen, H. Orskov, and J. Frystyk. "Assessment of Ghrelin." APMIS Supplementum 109 (2003): 140-145.
Hundal, R. S., and S. E. Inzucchi. "Metformin: New Understandings, New Uses." Drugs 63 (2003): 1879-1894.
Pirozzo, S., C. Summerbell, C. Cameron, and P. Glasziou. "Advice on Low-Fat Diets for Obesity (Cochrane Review)." Cochrane Database Systems Review 2002: CD003640.
Schurgin, S., and R. D. Siegel. "Pharmacotherapy of Obesity: An Update." Nutrition in Clinical Care 6 (January-April 2003): 27-37.
Shekelle, P. G., M. L. Hardy, S. C. Morton, et al. "Efficacy and Safety of Ephedra and Ephedrine for Weight Loss and Athletic Performance: A Meta-Analysis." Journal of the American Medical Association 289 (March 26, 2003): 1537-1545.
Tataranni, P. A. "Treatment of Obesity: Should We Target the Individual or Society?" Current Pharmaceutical Design 9 (2003): 1151-1163.
Veniant, M. M., and C. P. LeBel. "Leptin: From Animals to Humans." Current Pharmaceutical Design 9 (2003): 811-818.

Organizations

American Dietetic Association. (800) 877-1600. www.eatright.org..
American Obesity Association (AOA). 1250 24th Street NW, Suite 300, Washington, DC 20037. (202) 776-7711 or (800) 98-OBESE. www.obesity.org.
American Society for Bariatric Surgery. 7328 West University Avenue, Suite F, Gainesville, FL 32607. (352) 331-4900. www.asbs.org.
American Society of Bariatric Physicians. 5453 East Evans Place, Denver, CO 80222-5234. (303) 770-2526. www.asbp.org.
HCF Nutrition Research Foundation, Inc. P.O. Box 22124, Lexington, KY 40522. (606) 276-3119.
National Institute of Diabetes and Digestive and Kidney Diseases. 31 Center Drive, USC2560, Building 31, Room 9A-04, Bethesda, MD 20892-2560. (301) 496-3583. 〈www.niddk.nih/gov〉.
National Obesity Research Foundation. Temple University, Weiss Hall 867, Philadelphia, PA 19122.
Weight-Control Information Network. 1 Win Way, Bethesda, MD 20896-3665. (301) 951-1120. 〈www.navigator.tufts.edu/special/win.html〉.

o·be·si·ty

(ō-bē'si-tē), [MIM*601665]
An excess of subcutaneous fat in proportion to lean body mass. Excess fat accumulation is associated with increase in the size (hypertrophy) as well as the number (hyperplasia) of adipose tissue cells. Obesity is variously defined in terms of absolute weight, weight:height ratio, distribution of subcutaneous fat, and societal and esthetic norms. Measures of weight in proportion to height include relative weight (RW, body weight divided by median desirable weight for a person of the same height and medium frame according to actuarial tables), body mass index (BMI, kg/m2) and ponderal index (kg/m3). These do not differentiate between excess adiposity and increased lean body mass. In contrast, subscapular and triceps skinfold measurements and determination of the waist:hip ratio help define the regional deposition of fat and differentiate the more medically significant central obesity from peripheral obesity in adults. No single cause can explain all cases of obesity. Ultimately it results from an imbalance between energy intake and energy expenditure. Although faulty eating habits related to failure of normal satiety feedback mechanisms may be responsible for some cases, many obese people neither consume more calories nor eat different proportions of foodstuffs than nonobese persons. Contrary to popular belief, obesity is not caused by disorders of pituitary, thyroid, or adrenal gland metabolism. However, it is often associated with hyperinsulinism and relative insulin resistance. Studies of obese twins strongly suggest the presence of genetic influences on resting metabolic rate, feeding behavior, changes in energy expenditures in response to overfeeding, lipoprotein lipase activity, and basal rate of lipolysis. Environmental factors associated with obesity include socioeconomic status, race, region of residence, season, urban living, and being part of a smaller family. The prevalence of obesity is greater when weight is measured during winter rather than summer. Obesity is much more common in the southeastern U.S., although the northeastern and midwestern states also have high rates, a phenomenon independent of race, population density, and season.
Synonym(s): adiposity (1) , corpulence, corpulency
[L. obesus, pp. of obedo, to eat up, + -ity]

Obesity is a major public health problem and the leading nutritional disorder in the U.S. It is responsible for more than 280,000 deaths annually in this country. A widely accepted definition of obesity is body weight that is 20% or more in excess of ideal weight:height ratio according to actuarial tables. By this definition, 34% of adults in the U.S. are obese. The National Institutes of Health have defined obesity as a BMI of 30 kg/m2 or more, and overweight as a BMI between 25 and 30 kg/m2. By these criteria, two thirds of adults are either overweight or obese. There is strong evidence that the prevalence of obesity is increasing in both children and adults. Increases are particularly striking among African-Americans and Mexican-Americans. More than 80% of black women over the age of 40 are overweight, and 50% are obese. Among factors blamed for the steady increase in the prevalence of obesity are unhealthful eating practices (high-fat diet, overlarge portions) and the decline in physical activity associated with use of automobiles and public transportation instead of walking, labor-saving devices including computers, and passive forms of entertainment and recreation (television, computer games). Despite efforts of public health authorities to educate the public about the dangers of obesity, it is widely viewed as a cosmetic rather than a medical problem. Obesity is an independent risk factor for hypertension, hypercholesterolemia, Type 2 diabetes mellitus, myocardial infarction, certain malignancies (cancer of the colon, rectum, and prostate in men and of the breast, cervix, endometrium, and ovary in women), obstructive sleep apnea, hypoventilation syndrome, osteoarthritis and other orthopedic disorders, infertility, lower extremity venous stasis disease, gastroesophageal reflux disease, and urinary stress incontinence. Lesser degrees of obesity can constitute a significant health hazard in the presence of diabetes mellitus, hypertension, heart disease, or their associated risk factors. Body fat distribution in central (abdominal or male pattern, with an increased waist:hip ratio) versus peripheral (gluteal or female pattern) adipose tissue depots is associated with higher risks of many of these disorders. Obese people are more liable to injury, more difficult to examine by palpation and imaging techniques, and more likely to have unsuccessful outcomes and complications from surgical operations. Not least among the adverse effects of obesity are social stigmatization, poor self-image, and psychological stress. Weight reduction is associated with improvement in most of the health risks of obesity. All treatments for obesity (other than cosmetic surgical procedures in which subcutaneous fat is mechanically removed) require creation of an energy deficit by reducing caloric intake, increasing physical exercise, or both. Basic weight reduction programs involve consumption of a restricted-calorie, low-fat diet and performance of at least 30 minutes of endurance-type physical activity of at least moderate intensity on most and preferably all days of the week. Behavior modification therapy, hypnosis, anorexiant drugs (sympathomimetic agents, sibutramine), the lipase inhibitor orlistat, and surgical procedures to reduce gastric capacity or intestinal absorption of nutrients are useful in selected cases, but the emphasis should be on establishing permanent changes in lifestyle. Weight reduction is not recommended during pregnancy or in patients with osteoporosis, cholelithiasis, severe mental illness including anorexia nervosa, or terminal illness.

obesity

/obes·i·ty/ (o-bēs´ĭ-te) an increase in body weight beyond the limitation of skeletal and physical requirements, as the result of excessive accumulation of body fat.obese´,
adult-onset obesity  that beginning in adulthood and characterized by increase in size (hypertrophy) of adipose cells with no increase in number.
lifelong obesity  that beginning in childhood and characterized by an increase both in number (hyperplasia) and in size (hypertrophy) of adipose cells.
morbid obesity  the condition of weighing two or more times the ideal weight; so called because it is associated with many serious and life-threatening disorders.

obesity

(ō-bē′sĭ-tē)
n.
The condition of being obese; increased body weight caused by excessive accumulation of fat.

obesity

[ōbē′sitē]
Etymology: L, obesitas, fatness
an abnormal increase in the proportion of fat cells, mainly in the viscera and subcutaneous tissues of the body. Obesity may be exogenous or endogenous. Hyperplastic obesity is caused by an increase in the number of fat cells in the increased adipose tissue mass. Hypertrophic obesity results from an increase in the size of the fat cells in the increased adipose tissue mass.
observations Obesity is manifested as excess body weight for height. Overweight is determined by a body mass index (BMI) of 25 to 29.9 kg/m2, and obesity is a BMI = 30 kg/m2. Body fat distribution can be assessed by waist-to-hip ratios, with a ratio of greater than 1.0 for men and greater than 0.8 for women signaling increased risk of obesity. Morbidity and mortality are increased in the obese. Complications include predisposition to diabetes mellitus, hypertension, hyperlipidemia, coronary artery disease, cerebrovascular disease, osteoarthritis, sleep apnea, and certain cancers.
interventions Treatment is aimed at weight reduction and modification of risk factors such as diabetes, hypertension, and elevated lipid levels. There are three major components in weight loss therapy: diet therapy, physical activity, and life-style and behavioral modifications. Any number of approaches have been espoused that incorporate one or all of the three components. None has proved consistently successful for losing weight and maintaining weight loss. These include pharmacological drugs that suppress appetite or limit nutrient absorption; nutritional consult and diets that limit calories, fat, and carbohydrates; behavioral counseling and support networks; and surgery, such as gastroplasty, gastric partitioning, gastric bypass, and lipectomy. Blood pressure, glucose, and lipid levels are regularly monitored, and persistent elevations are treated pharmacologically.
nursing considerations Nursing interventions are aimed at reinforcement of long-term life-style changes, including a balanced diet and regular exercise. Instruction is aimed at developing mutually agreed-on diet and exercise goals and successful management of blood pressure, lipid levels, and glucose levels.
enlarge picture
Obesity

obesity

A state of excess body fat, which is a premorbid addiction disorder, defined as 20% above an individual’s standard weight (the ideal body weight is 21 kg/m2; a person is considered obese with a body weight above 30 kg/m2).
 
Epidemiology-US
31% of adults are obese; 17% of children are obese. Mississippi is the fattest state with 34% obesity; Colorado is the thinnest state with 21% obesity. In 2000, there were 3.8 million people over 300 pounds, and 400,000 people (mostly males) over 400 pounds. Children are more likely to be obese if born to obese parent; the patterns may be established as early as 3 months of age, due to decreased energy expenditure in infants of obese mother.

Lab
Obesity mimics the lab findings of type-2 diabetes—e.g., insulin resistance; increased glucose, cholesterol and triglycerides; decreased HDL (cholesterol) and norepinephrine; and depression of the sympathetic and parasympathetic nervous systems.
 
Conditions linked to obesity
Cardiovascular disease, thromboembolism, cholecystitis, cholelithiasis, cholorectal cancer, abnormal GI transit, poor wound healing, atelectasis, hepatic steatosis and fibrosis, increased risk of vision loss. 

Management
Diet, exercise, behaviour modification. 

Pathogenesis
Increased lipid deposit in fat cells, decreased mobilisation of lipids from adipocytes, decreased lipid utilisation.

obesity

Endocrinology A state of excess body fat, which is regarded as a premorbid addiction disorder, defined as 20% above a person's standard weight; the ideal body weight is 21 kg/m2 Epidemiology 59% of Americans are clinically obese, according to a 1995 report by the Institute of Medicine, there has been a 54% ↑ in obesity and a 98% ↑ in superobesity in children 6-9 yrs of age; an obese child is often an obese adult; the patterns may
be established by 3 months of age and linked to ↓ energy expenditure in infants of obese mothers; diet-resistant obesity is characterized by an inability to lose weight despite ↓ caloric intake and ↑ exercise; a certain percentage of diet-resistant obesity is related to underreporting of actual caloric consumption and/or overreporting of physical activity, not due to low energy expenditure Etiology, 2º obesity Endocrine-hypothyroidism, Cushing syndrome, hypogonadism–Fröhlich syndrome, polycystic ovaries, pseudohypoparathyroism Pathogenesis ↑ Lipid deposit in fat cells, ↓ mobilization of lipids from adipocytes, and ↓ lipid utilization; obesity mimics lab findings of type 2 DM–insulin resistance, ↑ glucose, ↑ cholesterol,
↑ TGs, ↓ HDL-C and norepinephrine and depressed sympathetic and parasympathetic nervous systems Co-morbid conditions See Obesity-related disease Management Diet–balanced hypocaloric or individualized, exercise, behavior modification, hypnosis, bariatric surgery, OTC appetite suppressants, prescription agents–eg, orlistat. See Abdominal obesity, Adipsin, Adult obesity, Body mass index, Central obesity, Childhood obesity, Diet, Eye-mouth gap, Gastric 'balloon. ', Ideal weight, Morbid obesity, Orlistat, Secondary obesity, Superobesity, Upper body fat obesity.
Obesity, classifications of  
Age of onset, eg juvenile, mature, in pregnancy or other
Anatomic
•  Android obesity Central obesity, 'beer-gut' obesity More common in ♂, more central/truncal in distribution; carries an ↑ risk for DM
•  Gynecoid obesity More common in ♀; fat is distributed in the lower abdomen and legs and is less associated with ASHD
Primary/secondary
• Primary A component of Allström, Blount, Cohen, Carpenter, Laurence-Moon-Biedl, Prader-Willi, and other eponymic syndromes
• Secondary Acquired obesity comprises the bulk of obesity
Psychological
Type of tissue change, eg hyperplastic or hyperplastic-hypertrophic  

o·be·si·ty

(ō-bē'si-tē)
An excessive accumulation of fat in the body.
Synonym(s): adiposity (1) , corpulence, corpulency.
[L. obesus, pp. of obedo, to eat up, + -ity]

obesity

Excessive energy storage in the form of fat. This occurs when food intake exceeds the requirements for energy expenditure. Obesity is a hazard to health and longevity and increases the risk of high blood pressure (HYPERTENSION), DIABETES, various cancers, osteoarthritis, foot trouble and depression.

obesity

a condition in which body fat stores are enlarged to an extent which impairs health. Develops when food intake is in excess of energy requirements. The most common nutritional disorder worldwide, and the incidence is increasing. Defined in terms of body mass index and circumference at the waist. See also body composition, body weight, waist-to-hip ratio.

obesity,

n excessive body fat. Clinically, it means body fat percentage that is greater than 30% (in women) or 25% (in men) or a BMI of greater than 27.
Obesity and
overweight are not equivalent terms. Being overweight refers to having a disproportionate body fat level relative to a person's height.
obesity, hyperplastic,
n a type of obesity that typically develops in childhood and is characterized by the increased number of fat cells within the body. See also obesity, hypertrophic and obesity, hyperplastic-hypertrophic.
Enlarge picture
Obesity.
obesity, hyperplastic-hypertrophic,
n a type of obesity characterized by the increase in number and enlarged size of the fat cells within the body.
obesity, hypertrophic,
n a type of obesity characterized by the enlarged size of fat cells within the body. An increased distribution of weight in the waist region is a typical indicator of this type of obesity. It is associated with an increased risk of hypertension, diabetes, and other metabolic disorders.

o·be·si·ty

(ō-bē'si-tē) [MIM*601665]
Excess of subcutaneous fat in proportion to lean body mass. Excess fat accumulation is associated with increase in size (hypertrophy) as well as number (hyperplasia) of adipose tissue cells. Obesity is variously defined in terms of absolute weight, weight:height ratio, distribution of subcutaneous fat, and societal and esthetic norms. Although faulty eating habits related to failure of normal satiety feedback mechanisms may be responsible for some cases, many obese people neither consume more calories nor eat different proportions of foodstuffs than nonobese people. Contrary to popular belief, obesity is not caused by disorders of pituitary, thyroid, or suprarenal gland metabolism. However, it is often associated with hyperinsulinism and relative insulin resistance. Studies of obese twins strongly suggest the presence of genetic influences on resting metabolic rate, feeding behavior, changes in energy expenditures in response to overfeeding, lipoprotein lipase activity, and basal rate of lipolysis. Environmental factors associated with obesity include socioeconomic status, race, geographic region of residence, season, urban, or rural residence, and being a member of a smaller family. Prevalence is greater when weight is measured during winter rather than summer; is much more common in the southeastern U.S., although northeastern and midwestern states also have high rates, a phenomenon independent of race, population density, and season.
Synonym(s): adiposity (1) .
[L. obesus, pp. of obedo, to eat up, + -ity]

obesity (ōbēs´itē),

n a bodily condition marked by excessive generalized deposition and storage of fat.
n one of the symptoms characteristic of Cush-ing's syndrome; an obesity that is confined mainly to the trunk, face, and neck. Also called
buffalo obesity.
obesity, buffalo,
n See obesity, adrenocortical.

obesity

excessive accumulation of fat in the body; increase in weight beyond that considered desirable with regard to age, height and bone structure.

obesity fold pyoderma
see fold dermatitis.

Patient discussion about obesity

Q. What Are the Complications of Obesity? Why is obesity so dangerous? What are the possible complications of being obese?

A. Excessive body weight has been shown to predispose to various diseases, particularly cardiovascular diseases, diabetes mellitus type 2, sleep disturbances (sleep apnea) and osteoarthritis. Obesity is one of the major risk factors for developing a heart attack, as well as hypertension and stroke. It is also a risk factor for breast, colon, prostate cancer and other malignancies. It is known that losing weight helps to reduce the risk of suffering from these diseases.

Q. What Are the Surgical Options for Treating Obesity? I would like to find out more about the surgery that is performed on obese people for weight reduction. What surgical options are available?

A. The main two surgical approaches for obesity treatment are gastric banding and gastric bypass. Band surgery is reversible, while bowel shortening operations (bypass) are not. Here is more information about being a candidte for surgery- http://www.5min.com/Video/Weight-Loss-Surgery-To-Be-a-Surgical-Candidate-5007

Q. Is obesity a risk factor for Dementia?

A. The answer is YES. In fact, many of the risk factors for heart disease, such as high blood pressure, blood glucose levels, insulin resistance, and overweight, are also risk factors for dementia, in addition to genetic predisposition for the disease.

More discussions about obesity
References in periodicals archive ?
The differences between the two products were expected to cause variation in weight gain but no difference in mean weight gain (0.
where the residual birth weight (the birth weight not explained by gestational weight gain alone) was sampled from a normal distribution with a mean of 0 and an SD of 0.
Analysis of physical activity showed that increased television viewing correlated with weight gain (0.
Compared to the mothers who did not exceed recommended weight gain mothers with excess gestational weight gain were younger (16% vs 28%) which had a statistically significant difference.
After weaning, intake of milk calories may result in excess weight gain or, worse scenario, unhealthy obese body mass gain.
Withholding this information may also prevent people from taking potential measures to reduce the risk of weight gain.
When the researchers compared the prognostic value of weight gain in men and women, they found no significant differences.
Efforts to understand and manage treatment-associated weight gain stem from its association with medication noncompliance and discontinuation, (2) as well as clinically relevant health outcomes associated with excess weight and obesity.
It bears repeating that carbohydrate, which is a vital nutrient for distance runners, does not in and of itself cause weight gain.
Teen athletes can use the following as a guide to promote weight gain.
Women receive services during visits or contacts with staff throughout pregnancy The study focused on three risk factors and their resolution by the end of pregnancy: smoking, for which resolution was defined as self-reported smoking cessation; inadequate prenatal weight gain, for which resolution was defined as achievement of weight within the recommended range; and psychosocial problems (such as depression, domestic violence or homelessness that caused severe stress), for which resolution was defined as addressing these problems so that they no longer existed or no longer caused severe stress.
Although this increase can be relative in nature, in most reported cases of symptomatic EAH, there is body weight gain suggestive of an absolute increase in total body water (1,4,5,21,23,29,35,39,41,48,53,57).