Obesity and Overweight

Obesity - a chronic condition

2009-01-23T05:36:00.000-08:00

Obesity is a chronic condition resulting from an energy imbalance in which energy intake exceeds energy expenditure with the net result of weight gain. The health consequences of overweight and obesity are serious and may predispose an affected individual to other conditions such as coronary heart disease, hypertension, cancer and osteoarthritis.

In recent years, the prevalence of obesity has risen to epidemic levels, primarily, although not exclusively, in developed countries. Of particular concern is the increase in overweight and obesity amongst children and adolescents, which may have severe long-term health repercussions for a whole generation. Although there is a strong genetic component, the predominant cause of obesity is excess calorific intake and insufficient energy expenditure, as a result of the over-consumption of energy-dense, micronutrient-poor foods and a more sedentary lifestyle.

Modest weight loss has been shown to confer significant medical benefits in the obese, and therefore a treatment programme should initially focus on the management of weight through dietary intervention and lifestyle changes. Of primary importance is the education of individuals as to the nutritional benefits of foods high in fibre and low in fat and the value of a structured eating regimen.

Pharmacological management of obesity is advocated if dietary restriction proves ineffective, although any weight loss is commonly reversed following cessation of treatment. The financial and social implications of obesity, for both the individual and the healthcare provider, are immense, with figures set to rise unless the problem is addressed.

Identification and treatment of extreme obesity

2008-12-27T02:03:00.000-08:00

The prevalence of obesity in the United States and worldwide is high and increasing.

According to the Behavioral Risk Factor Surveillance System (BRFSS), rates of obesity, defined as a body mass index (BMI) >30 kg/m2, have increased continually and dramatically since 1990.

By 2003-2004, the National Health and Nutrition Examination Study (NHANES) found that rates of obesity in the US adult men and 33.2% for women.2,3 Because of this high prevalence and the serious health risks associated with obesity, the increase in this condition constitutes an epidemic that presents a serious and growing public health problem.

The prevalence of severe obesity is also increasing. Severe obesity is defined. The related term
“extreme obesity” is also defined as BMI.

Also referred to as “morbid obesity,” this term has fallen out of use among most non surgeon clinicians. Additionally, many patients consider the term “morbid obesity” to be insensitive and hurtful. According to Obesity, the official journal of NAASO, the Obesity Society, many journals discourage the use of the term, and practitioners should carefully select terminology when dealing with patients.

However, it continues to appear in the literature, is used as a legacy term by some organizations, and is found in ICD-9 codes. 2003-2004, 2.8% of US men and 6.9% of US women. This represents a population of approximately 14 million severely obese individuals: 4 million men and 10 million women. In 1999-2002, clinically severe obesity was approximately twice as common among women as among men and was particularly high among black women.

Severe obesity has a substantially greater clinical impact than obesity in general, with higher rates of morbidity and mortality and decreased quality of life. Mortality rates increase with BMI, with all-cause mortality among severely obese women equal to 116. 65 deaths per 10,000 person-years, approximately 1.4 times higher than among obese women and almost twice as high as mortality among women of healthy weight.

More information in upcoming post...

Myths and Facts about Obesity!!!

2008-12-16T05:36:00.000-08:00

Obesity Kills 400,000 Americans a Year
You Can’t Be Overweight and Healthy
Obesity Is a DiseaseOvereating Is the Primary Cause of Obesity
Soda Causes Childhood Obesity
64 Percent of Americans Are Overweight or Obese
Obesity Costs the U.S. Economy $117 Billion Annually

Obesity Kills 400,000 Americans a Year

“The data linking overweight and death, as well as the data showing the beneficial effects of weight loss, are limited, fragmentary, and often ambiguous. Most of the evidence is either indirect or derived from observational epidemiologic studies, many of which have serious methodological flaws.”
— Editorial, The New England Journal of Medicine, 1998

“Of all our convictions about health, the belief that obesity itself is a killer has no rival when it comes to the gap between conventional wisdom and scientific evidence ... [T]he heath risks of moderate obesity have been greatly overstated.”
— Glenn Gaesser, Ph.D., Professor of Exercise Physiology, University of Virginia, 1997

“The major studies of obesity and mortality fail to show that overall obesity leads to greater risk.”— Reubin Andres, M.D., National Institutes of Health, 1980

“Studies concluding that obesity is harmful are embraced, despite potential flaws. Studies concluding that obesity is [not harmful] are rejected or simply ignored, regardless of merit.”
— Journal of Obesity and Weight Regulation, 1987

“Expert panels from the NIH have claimed that obesity is second only to cigarettes as a preventable cause of death, and kills 400,000 people a year. If so, then major increases in the incidence of adult obesity should have a negative impact on life expectancy. The opposite is true, as death rates have fallen. The greatest improvements are in cardiovascular disease deaths, which are most strongly linked to obesity.”
— Paul Ernsberger, Professor of Medicine, Pharmacology and Neuroscience, Case Western Reserve University, 2004

“Someone needs to say the emperor has no clothes ... [the conventional wisdom on obesity] is cultural bias, not science.”
— C. Wayne Callaway, M.D., Professor of Medicine, George Washington University, 1998

Obesity Kills 400,000 Americans a Year

“Some of the most respected epidemiological studies of the relationship between weight and mortality have been conducted by Ancel Keys, who coordinated 16 separate long-term prospective studies in seven different countries. Keys concluded: ‘In none of the areas of this study was overweight or obesity a major risk factor for death or the incidence of coronary disease.’”
— Journal of Obesity and Weight Regulation, 1987

“The major problem with this ‘obesity kills’ statistic is the lack of compelling evidence to substantiate it.”
— Harvard Health Policy Review, 2003

“Evidence that it is more dangerous to be thin than fat is either ignored or minimized in analyses that shape public policy toward weight loss ... What evidence exists for an association between obesity and mortality or morbidity, is usually found not to apply to those with mild to moderate obesity.”
— Clinical Psychology Review, 1991

“The authors made no attempt to determine whether other factors, such as physical inactivity, low fitness levels, poor diet, risky weight loss practices, weight fluctuation, use of weight loss drugs, less than adequate access to health care, etc. could have explained some or all of the excess mortality in large people.”
— Glenn Gaesser, Ph.D., Professor of Exercise Physiology, University of Virginia, 2004

“[M]ost epidemiological studies reveal that aside from the extremes, BMI is not that strong a predictor of death rates.”
— QUEST, 2004

“Obesity, in and of itself, isn’t nearly as big of a risk as much of the science would indicate.”
— Wayne Miller, Ph.D., Professor of Exercise Science, George Washington University, 2004

“Perhaps the most glaring absurdity about the 400,000 deaths due to obesity study resides in the pronouncement that ‘all excess mortality in obese people is due to their obesity.’ This is as preposterous as claiming that differences in mortality rates between blacks and whites are solely a result of the color of their skin!”
— Jon Robison, Ph.D., Professor of Exercise and Nutrition Michigan State University, 2004

“I have been very skeptical of the oft-touted number of 300,000 deathscaused annually by obesity because of the possibility of double counting.The figure of 400,000 may well suffer from the same flaw.”
— Jerome Kassirer, M.D., former Editor in Chief of The New England Journalof Medicine and author of the forthcoming book On the Take: How Medicine’sComplicity With Big Business Can Endanger Your Health, 2004

“The establishment clings to the belief that weight causes disease anddeath just as people once insisted that the world was flat.”
— Dr. Susan Wooley, Professor Emerita, The University of Cincinnati, 1998

Reduce Weight to Keep Troubles Away

2008-11-29T04:30:00.000-08:00

Obesity and Overweight

2008-11-14T04:09:00.000-08:00

Obesity is now recognized as the most prevalent metabolic disease world-wide, reaching epidemic proportions in both developed and developing countries and affecting not only adults but also children and adolescents. The WHO has already declared obesity a global epidemic that constitutes one of the biggest current health problems. In the European region, obesity also presents an unprecedented and underestimated public health challenge, with its prevalence rising rapidly and expected to include 150 million adults and 15 million children by 2010.

Overweight and obesity are responsible for about 80% of cases of type 2 diabetes, 35% of ischaemic heart disease and 55% of hypertensive disease among adults in Europe. They together cause more than 1 million deaths and 12 million lifeyears of ill health each year. It is estimated that one in 13 annual deaths in the EU is likely to be related to excess weight.

The consequent economic implications and the burden on national health costs are quite substantial. Despite steady progress in the management of obesity, its prevalence continues to rise, stressing the necessity for prevention and intervention strategies not only at the individual but also at the communities and the population as a whole.

These European guidelines on the management of obesity in adults were developed to address the need for evidence-based recommendations for the management of obesity at the individual level and to establish a basis for a more uniform approach in obesity management across Europe. Our aim is to provide physicians, health-care policy makers and health-care carriers with essential elements of good clinical practice in the management of obesity. The working group of the European Obesity Management Task Force of the European Association for the Study of Obesity (EASO), which performed this task, was composed of experts, representing key disciplines in comprehensive obesity management and reflecting European geographical and ethnic diversity. The group also included a representative (MF) of the International Federation for the Surgery of Obesity – European Chapter (IFSO-EC). We reviewed published national obesity guidelines from several European countries. At the same time, we have adopted a rigorous, evidence-based approach to the development of the practice recommendations, knowing well the limitations of the obesity literature on the issues we dealt. In addition, each recommendation includes a level of evidence (1 to 4) and/or a grade (A, B, C or D) based upon the Scottish Intercollegiate Guidelines Network (SIGN). The level of evidence informs the reader about the strength of the evidence that supports each recommendation while the grade of recommendation reflects both the supporting level of evidence and a consideration, where applicable, of the harms and costs of the intervention and its importance to the individual or population.

Definition and Classification of Obesity

Obesity is a chronic disease characterized by an increase of body fat stores. In clinical practice, the body fatness is assessed by the body mass index (BMI). BMI is calculated as measured body weight (kg) divided by measured height squared (m2).

In adults (age over 18 years) obesity is defined by a BMI ≥ 30 kg/m2 and overweight (also termed pre-obesity) by a BMI between 25 and 29.9 kg/m2. Many people in the overweight range of BMI 25–29.9 kg/m2 will become obese in their lifetime.

Central adiposity is associated with metabolic and cardiovascular diseases. The amount of abdominal fat can be assessed by waist circumference. Waist circumference correlates positively with abdominal fat content. The waist circumference is measured in the horizontal plane midway in the distance of the superior iliac crest and the lower margin of the last rib. The most recent International Diabetes Federation consensus defined central obesity (also called as visceral, android, apple-shaped or upper body obesity) in Europids as a waist circumference ≥ 94 cm in men and ≥ 80 cm in non-pregnant women {level 3}. Lower cut-off points for central obesity are proposed for South Asian (90 cm), Chinese (90 cm) and Japanese (85 cm) men, but higher for Japanese (90 cm) women. Further epidemiological studies are required for formalizing appropriate cut-off points in other ethnic populations (e.g. South and Central Americans, Eastern Mediterranean and Middle East populations, Sub-Saharan Africans) {level 4}. In the meantime, the South Asian cut-off points should be used for the Central and South Americans, and the European cut-off points for the Sub-Saharan and South East European and Middle Eastern populations.