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Resource Description: 
The Obesity Association provides is one of the web's most comprehensive sources of information on obesity and overweight.
Increase your understanding of adult obesity by referencing information from the National Institute of Diabetes and Digestive and Kidney Diseases, the primary National Institutes of Health organization for research on obesity.
The Centers for Disease Control provides an in-depth examination of overweight and obesity.
The National Heart, Lung, and Blood Institute offers an easy-to-use calculator to help you determine your Body Mass Index (BMI).
Learn more about the link between obesity and Insulin Resistance Syndrome at the American Association of Clinical Endocrinologists' website.
The American Heart Association offers a concise "Eating Plan for Healthy Americans".
It's easy to determine how many calories you burn doing your favorite exercise or activity with the online calorie calculator from BMI calculator USA.
Visit the American Academy of Family Physicians site for an information-rich section entitled, "Working with Your Doctor to Overcome Overweight and Obesity".
Episode number: 
108
Transcript: 
Obesity (transcript)

When do you overeat?  LCD's (little chocolate donuts) for breakfast? Fast food for lunch? Ice cream before bedtime?  In this episode of Second Opinion, we'll learn about the interaction of genes and the environment, and learn to eat sensibly, exercise regularly, and manage stress. The result? A healthy lifestyle in which weight loss is simply a natural by-product.

If you weigh more than you should, you are definitely not alone. According to the Centers for Disease Control, overweight and obesity are serious health problems that have increased at an epidemic rate over the past two decades. And many healthcare professionals feel the situation may get worse before it gets better.

According to one key study approximately 127 million adults in the U.S. are overweight, including 60 million people who are obese and 9 million who are severely obese. However, the problem does not end there. Even among children and teens ages 6 to 19, almost 9 million are overweight, a number that has tripled since 1980. And studies show that many overweight children and adolescents grow up to be overweight or obese adults.

Your body weight can literally be a matter of life or death. Every year, about 280,000 women and men die prematurely from causes linked to obesity. People who are obese are at greater risk of developing serious medical conditions which can contribute to ill health and early death. It has also been established that the more obese you are, the greater your risk. Among the more serious problems linked to obesity are type 2 diabetes, heart disease, high blood pressure, osteoarthritis, and even certain types of cancer.

Overeating and lack of exercise are the primary causes of overweight and obesity, especially when the two are combined. But there are many factors that may contribute to the problem. These include:

  • Diet. Regular consumption of fast foods, soft drinks, candy, desserts, and other high-fat or sugary foods that are high in calories contribute to weight gain.
  • Inactivity. People who get little or no exercise burn fewer calories than they take in, and are more likely to gain weight.
  • Genes. If one or both of your parents are obese, you have an increased chance of being overweight yourself. But your genetic makeup does not guarantee that you will be obese.
  • Gender. Men burn up to 20% more calories than women do, and they generally have an easier time staying at a healthy weight.
  • Psychological factors. Some people eat more than they should to cope with stress, problems, and emotional distress.
  • Age. As you get older, your muscle mass decreases and fat accounts for a greater percentage of your weight. In addition, your metabolism slows and you tend to be less active, so your body needs fewer calories to function. But if you don't reduce the number of calories you take in, you will probably put on weight.
  • Pregnancy. After each pregnancy, a woman's weight increases by an average of four to six pounds.
  • Cigarette smoking. When you quit smoking cigarettes, your metabolism slows because you are no longer getting nicotine, so you burn fewer calories. Additionally, food begins to taste and smell better, and you may gain weight because you eat more.
  • Medications. Tricyclic antidepressants, corticosteroids, and some other medicines can influence weight gain.
  • Medical issues. Low thyroid function, excess hormone production by the adrenal glands (Cushing's syndrome), and other medical problems directly account for only a small percentage of obesity cases. However, medical problems that lead to decreased activity can easily result in weight gain.

The good news is that losing even small amounts of weight can lower your blood pressure and reduce your risk of heart disease, stroke, diabetes, and other medical problems. While there are many safe and effective ways to lose weight, many people are drawn to slickly marketed fad diets and "miracle cures" that may do more harm than good. The best way to approach weight loss is with the help of your doctor.

 

Quick Facts

You need to burn 3,500 calories to lose a pound of body weight.

You know your height and weight. You also should know your blood pressure, cholesterol level, and Body Mass Index (BMI).

Dieting, exercising, and creating healthy options for dealing with stress take time. Consider that time an investment in good health.

In children, obesity may be related to depression, behavioral problems, and genetics.

Unlike alcohol, tobacco, and other habits, you cannot decide to give up on food. It is better to modify your eating habits early - before a heart attack, diabetes, or other diagnosis forces the lesson upon you.

When you have had enough to eat, fat cells release the hormone, leptin , to curb you appetite. If there is a problem with your production of leptin, fat cells are unable to "tell you" that you are full. Research into the leptin-obesity link is underway.

It is estimated that up to 10% of mildly obese people who repeatedly try to lose have binge eating disorders in which they eat large quantities of food with no sense of self-control. Those with severe binge eating problems are also likely to have symptoms of depression and low self-esteem. They find it more difficult to lose weight and keep it off than those without binge eating problems. This disorder is more common in people who are severely obese.

A large amount of abdominal fat indicates a higher risk of having high blood pressure, hyperlipidemia, diabetes, stroke, heart attack, and heart and blood vessel disease. Weight and its distribution on the body should be considered along with gender, amount of exercise, age, blood pressure, and smoking habits when assessing the risk of heart disease, stroke, blood vessel disease and metabolic syndrome.

Ask Your Doctor

Lisa Sanders, MD
Yale Internal Medicine
Author, "The Perfect Fit Diet"

This list of questions is a good starting point for discussion with your doctor; however, it is not a comprehensive list.

  1. What is my BMI?
  2. What are the health risks associated with being obese?
  3. What about being overweight -- What are the risks there?
  4. As you get older it seems like it becomes easier to gain weight and harder to lose it. Why? Are there ways to prevent this slow age-related weight gain?
  5. Does obesity run in families? What can I do to make sure that my kids don't have this problem?
  6. What is Metabolic Syndrome? How can I tell if I have it?
  7. Does Metabolic Syndrome run in families?
  8. What is the best way for me to lose weight?
  9. Are low carbohydrate diets, like the Atkins diet or the South Beach diet, effective methods for weight loss? What about the low fat diet?
  10. Do I have to exercise? Is any type of exercise best? How much exercise is necessary?

Key Point 1

Obesity is the interaction of genes and environment.

Genes are one of several factors that influence your weight. Our ancestors stored energy as fat, enabling them to survive during lean times. But your ancestors and genes are not always to blame for extra weight. Many people who have the obesity gene are not obese. Your environment and lifestyle choices have the greatest influence on how much you weigh.

Everyone is Different

Obesity and overweight occur when there is an energy imbalance caused when you take in more calories or energy than you expend. In almost all cases, the cause may simply be eating too much and exercising too little. Two people can follow the same diet and exercise routine, and one may be overweight while the other maintains a healthy weight. There are many reason why this is true, including:

  • Environment has a major influence on obesity. We live in a fast-paced culture where high-fat, high-sugar diets, and limited exercise are the norm and technology contributes to physical inactivity. In our fast-food culture, we have many conveniences that keep us from being physically active.
  • Psychological and behavioral factors influence weight gain. When stressed, bored, or angry, some people cope by eating. This creates an association between an emotion and food. Depression and stress, the leading causes of eating disorders, can lead to obesity.
  • Fat storage is regulated by complex biological systems that involve input and feedback from fatty tissues, the brain, and endocrine glands (pancreas and thyroid). Even a small imbalance over a long period of time can affect metabolism and predispose to overweight and obesity.
  • Men have more lean body mass (muscle) and less fat than women. Since lean body mass uses more energy than fat, men burn up to 20% more calories than women.  Women are more susceptible to gaining weight than men if they eat the same quantity of food as men.
  • Some people are genetically predisposed to gain weight. They have a chronic imbalance that favors energy input over energy output. If you tend to retain weight, preventing weight gain may be the best approach to maintaining a normal weight.
  • Some illnesses can lead to weight gain or obesity. These include hypothyroidism, Cushing's syndrome , depression, and some neurological problems. Medications such as steroids and some antidepressants may also are related to weight gain. Your doctor can tell you whether you have underlying medical conditions that are making it difficult for you to lose weight.
  • For women, the balance of female sex hormones during adolescence, pregnancy, and menopause influences body fat levels.
  • Women, on average, exercise less than men, and drop out of exercise programs sooner than men, contributing to weight problems.

Understanding the specific factors that contribute to obesity is an important step toward maintaining a normal body weight.

    

Key Point 2

Modest weight reduction improves your health and well-being.

The goal of modest weight reduction is improved health. Even if you do not reach your ideal body weight, losing small amounts of weight can help you reduce the odds of developing medical conditions such as coronary heart disease, hypertension , arthritis, type 2 diabetes , and others. If you already have coronary heart disease, type 2 diabetes, high cholesterol, or hypertension, losing weight helps to reduce the damage caused by these conditions.

What the Research Shows

  • Studies of obese patients with serious medical complications found that a weight loss of approximately 10% or less resulted in improved glycemic control, reduced blood pressure, and lower cholesterol levels for people with non-insulin dependent diabetes mellitus (NIDDM). Even a small amount of weight loss provides health benefits if you are obese.
  • The Diabetes Prevention Program and the Finnish Diabetes Program showed that:
    • Overweight patients who lost approximately 5% of their body weight reduced their risk for developing type 2 diabetes by 58%.
    • Any amount of intentional weight loss in women 40 to 60 years of age who had never smoked can reduce mortality by 20%. Diabetic patients who lose weight can reduce mortality by 30 to 40%.
    • Modest weight reduction has been associated with clinically significant improvements in hypertension. 
  • A modest weight reduction of five to eight pounds, or 10% of current body weight, can significantly reduce abdominal fat and improve insulin resistance, hypertension, and hyperlipidemia .

Your Doctor Can Attest to the Benefits of Modest Weight Reduction

The benefits of modest weight loss are more than just statistics found in research studies. Your doctor can tell you how losing even a small amount of weight can improve your health by:

  • Reducing diabetes and cardiovascular disease risk factors
  • Improving conditions such as joint pain associated with osteoarthritis
  • Decreasing the occurence of sleep apnea
  • Reducing blood glucose levels and lowering Hemoglobin A1C if you have type 2 diabetes
  • Improving lipid levels

An Added Benefit: More Money in Your Pocket

There is another benefit to losing weight and improving your health. It can save you money.

  • The Centers for Disease Control estimates that a 10% weight loss can reduce an overweight person's lifetime medical costs by an average of $2,200 to $5,300. 
  • The lifetime medical costs of hypertension, diabetes, heart disease, stroke, and high cholesterol among moderately obese people are estimated to be $10,000 higher than those paid by people who maintain a healthy weight.
    

Key Point 3

Healthy weight is an integration of watching what you eat, exercising, and coping with stress.

What does it take to achieve and maintain a healthy weight? Weight loss starts by taking control. To a great extent, the decisions you make every day determine your lifestyle, the quality of your life, and your weight. Even if you have a predisposition for obesity, you can watch your diet, increase your activity level, and develop healthy mechanisms for coping with stress.

Eating

When you change your diet, you start paying attention to what and how much you eat. The sensible way to lose weight and maintain a healthy weight permanently is to avoid fad diets, eat less, and balance food intake with physical activity. It is wise to consult with your physician before beginning an aggressive diet and exercise regimen.

The American Heart Association urges people to follow these guidelines for healthy, nutritionally balanced weight loss:

  • Adjust total calories to reach and maintain a healthy weight
  • Limit saturated fat to 7 to 10% or less of your total calories
  • Limit polyunsaturated fat to 10% of your total calories
  • Adjust your monounsaturated fat to 15% of your total calories
  • Adjust your total fat intake to no more than 30% of total calories if you are overweight
  • Limit your cholesterol intake to less than 300 milligrams per day
  • Limit your sodium intake to less than 2,400 milligrams per day (the equivalent of about one teaspoon of salt)

A healthy diet that is rich in fresh fruits, vegetables, whole grains, and low-fat dairy products stays within these guidelines and provides you with a nutritious balance of foods. An insulated snack pack filled with nutritious foods is a much better option than purchasing fast food from a vending machine. You can learn more about nutritional needs in this interactive feature from  NOVA web site on PBS.org.

How do you measure up?

Your Body Mass Index (BMI) a measurement of weight for height. The BMI formula is used to determine weight status for adults.

Use this equation to determine your Body Mass Index (BMI) OR use the BMI Table below:

 

 Weight in Pounds 
BMI =
X 703
 (Height in Inches) X (Height in Inches) 

 

Body Mass Index Table for Adults
BMI1920212223242526272829303132333435
Height
(inches)
Body Weight (pounds)
589196100105110115119124129134138143148153158162167
599499104109114119124128133138143148153158163168173
6097102107112118123128133138143148153158163168174179
61100106111116122127132137143148153158164169174180185
62104109115120126131136142147153158164169175180186191
63107113118124130135141146152158163169175180186191197
64110116122128134140145151157163169174180186192197204
65114120126132138144150156162168174180186192198204210
66118124130136142148155161167173179186192198204210216
67121127134140146153159166172178185191198204211217223
68125131138144151158164171177184190197203210216223230
69128135142149155162169176182189196203209216223230236
70132139146153160167174181188195202209216222229236243
71136143150157165172179186193200208215222229236243250
72140147154162169177184191199206213221228235242250258
73144151159166174182189197204212219227235242250257265
74148155163171179186194202210218225233241249256264272
75152160168176184192200208216224232240248256264272279
76156164172180189197205213221230238246254263271279287

* Source: National Heart, Blood, and Lung Institute

Where do you fit in?

 

BMIWeight Status
Below 18.5Underweight
18.5 - 24.9Normal
25.0 - 29.9Overweight
30.0 and aboveObese

Exercising

When you are tempted to indulge in your favorite dessert, consider what it will take to burn it off. This Get Moving! Calculator can help you make a healthy choice.

There are many activities - from light to moderate to high levels - that you can use to stay active, burn calories, and improve your overall health. Whether you walk, bicycle, lift weights, play a favorite sport, or run up and down the stairs, the important thing is to keep moving. Increased physical activity can help you lose and maintain weight and reduce your risk of developing many of the illnesses associated with obesity. The more time you spend on an activity, the better; working longer yields better results than working harder. And remember that balancing your caloric intake and caloric expenditure makes all the difference when it comes to weight reduction.

Coping

Eating your problems away often results in another problem: weight gain. Finding healthy ways to cope with stress, disappointment, and other emotions can help you avoid putting on extra pounds. And you can extend your coping strategy to your diet plan by following these guidelines:

  • Set short-term goals that help you get incrementally closer to the ultimate goal.
  • Find ways - other than food - to reward yourself for achieving smaller goals.
  • Monitor your progress by observing and recording some aspect of your behavior. For weight control, this could include tracking your:
    • Calorie intake
    • Servings of fruits and vegetables
    • Exercise sessions
    • Weight
    • Body Mass Index
  • Be aware of and then change the social or environmental cues that trigger excess eating. For example, if you binge on junk food every day at 3:00 p.m., substitute nutritious foods for high fat, sugary items. Or you can make 3:00 p.m. exercise time rather than binge time.  
  • Give your brain sufficient time to realize that you are full. It takes 15 or more minutes for the message to come through.

Seeking Help

Healthcare providers are available to help you reach your goals. Just as they have helped others take control, conquer the battle of the bulge, and lead healthier lives, they can help you meet your challenges. By sharing information with them about your eating habits and physical activity level, you can help them develop and monitor a diet and exercise plan that makes sense for you. There is no time like the present to take control of your eating, exercising, and coping behaviors and to seek help.

Medline Plus

Medline Description: 

Conduct an off-site search for Obesity information from MedlinePlus.  These up-to-date search results are based on search terms specific to Second Opinion Key Points.

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