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 2. Twenty to forty percent over ideal weight is considered mildly obese; 4. More recent guidelines for obesity use a measurement called BMI (body mass index) which is the individual's weight multiplied by 7. BMI of 2. 5. 9- 2. BMI over 3. 0 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 1. Other studies have actually estimated that a full 5. 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 3. 00,0. Surgeon General C. Everett Koop, M. D., to label obesity . 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. If you've ever Googled, "Is diet or exercise more important for weight loss?" you've probably come across this seemingly arbitrary formula for dropping pounds: It's. The Rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn. In the New York Times this morning, writer Andrew Carroll expresses his frustration about how a show like The Biggest Loser, while being reality TV crack, is also a. Men. Height. Small Frame. Medium Frame. Large Frame. 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 cortisolhypothyroidism, a condition caused by an underactive thyroid glandneurologic disturbances, such as damage to the hypothalamus, a structure located deep within the brain that helps regulate appetiteconsumption 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 painherniasheartburnadult- onset asthmagum diseasehigh cholesterol levelsgallstoneshigh blood pressuremenstrual irregularities or cessation of menstruation (amenorhhea)decreased fertility, and pregnancy complicationsshortness of breath that can be incapacitatingsleep apnea and sleeping disordersskin disorders arising from the bacterial breakdown of sweat and cellular material in thick folds of skin or from increased friction between foldsemotional 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 3. 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. However, to be successful, any treatment must affect life- long behavioral changes rather than short- term weight loss. 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. 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. 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 (1. 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 2. 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.(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 1. 99. United States Food and Drug Administration (FDA) approved a new weight- loss drug, sibutramine (Meridia). ANRED: Eating Disorders Statistics. Research suggests that about one percent (1%) of female adolescents have anorexia. That means that about one out of every one hundred young women between ten and twenty are starving themselves, sometimes to death. There do not seem to be reliable figures for younger children and older adults, but such cases, while they do occur, are not common. Research suggests that about four percent (4%), or four out of one hundred, college- aged women have bulimia. About 5. 0% of people who have been anorexic develop bulimia or bulimic patterns. Because people with bulimia are secretive, it is difficult to know how many older people are affected. Bulimia is rare in children. Males with eating disorders. Only about 1. 0% of people with anorexia and bulimia are male. This gender difference may reflect our society’s different expectations for men and women. Men are supposed to be strong and powerful. They feel ashamed of skinny bodies and want to be big and powerful. Women, on the other hand, are supposed to be tiny, waif- like, and thin. They diet to lose weight, making themselves vulnerable to binge eating. Some develop rigid and compulsive overcontrol. Dieting and the resulting hunger are two of the most powerful eating disorders triggers known. What age groups are affected? Anorexia and bulimia affect primarily people in their teens and twenties, but studies report both disorders in children as young as six and individuals as old as seventy- six. Studies suggest that about sixty percent of adult Americans, both male and female, are overweight. About one third (3. Many of these people have binge eating disorder. In addition, about 3. American teenage girls and 2. An additional 1. 5 percent of American teen girls and nearly 1. In other studies, up to two percent, or one to two million adults in the U. S., have problems with binge eating. Eating disorders and substance abuse. About 7. 2% of alcoholic women younger than 3. We have no idea how many people exercise compulsively. Body dysmorphic disorder (includes muscle dysmorphic disorder)Not yet an official diagnosis, but may achieve that status soon. BDD affects about two percent of people in the U. S. Sufferers are excessively concerned about appearance, body shape, body size, weight, perceived lack of muscles, facial blemishes, and so forth. In some cases BDD can lead to steroid abuse, unnecessary plastic surgery, and even suicide. BDD is treatable and begins with an evaluation by a mental health care provider. Subclinical eating disorders. We can only guess at the vast numbers of people who have subclinical or threshhold eating disorders. They are too much preoccupied with food and weight. Their eating and weight control behaviors are not normal, but they are not disturbed enough to qualify for a formal diagnosis. Eating disorders in Western and non- Western countries. In a study reported in Medscape’s General Medicine 6(3) 2. Western countries for anorexia nervosa ranged from 0. Prevalence rates for bulimia nervosa ranged from 0% to 2. Prevalence rates in non- Western countries for bulimia nervosa ranged from 0. Studies of eating attitudes indicate abnormal eating attitudes in non- Western countries have been gradually increasing, presumably because of the influence, at least in part, of Western media: movies, TV shows, and magazines. Researchers conclude that the prevalence of eating disorders in non- Western countries is lower than that of Western countries, but it appears to be increasing. Mortality and recovery rates. Without treatment, up to twenty percent (2. With treatment, that number falls to two to three percent (2- 3%). With treatment, about sixty percent (6. They maintain healthy weight. They eat a varied diet of normal foods and do not choose exclusively low- cal and non- fat items. They participate in friendships and romantic relationships. They create families and careers. Many say they feel they are stronger people and more insightful about life in general and themselves in particular than they would have been without the disorder. In spite of treatment, about twenty percent (2. They remain too much focused on food and weight. They participate only peripherally in friendships and romantic relationships. They may hold jobs but seldom have meaningful careers. Much of each paycheck goes to diet books, laxatives, jazzercise classes, and binge food. The remaining twenty percent (2. They are seen repeatedly in emergency rooms, eating disorders programs, and mental health clinics. Their quietly desperate lives revolve around food and weight concerns, spiraling down into depression, loneliness, and feelings of helplessness and hopelessness. Please note: The study of eating disorders is a relatively new field. We have no good information on the long- term recovery process. We do know that recovery usually takes a long time, perhaps on average three to five years of slow progress that includes starts, stops, slides backwards, and ultimately, movement in the direction of mental and physical health. If you believe you are in the forty percent of people who do not recover from eating disorders, give yourself a break. Get into treatment and stay there. Give it all you have. You may surprise yourself and find you are in the sixty percent after all. From England: A 1. Exeter University included 3. Over half (5. 7. 5%) listed appearance as the biggest concern in their lives. The same study indicated that 5. Dieting teens: More than half of teenaged girls are, or think they should be, on diets. They want to lose all or some of the forty pounds that females naturally gain between 8 and 1. About three percent of these teens go too far, becoming anorexic or bulimic. Unrealistic expectations: Magazine pictures are electronically edited and airbrushed. Many entertainment celebrities are underweight, some anorexically so. How do we know what we should look like? The table below compares average women in the U. It’s not encouraging. Not available. Dress size 1. Bust 3. 6 – 3. 7. The numbers are usually given as percentages, and they are as close as we can get to an accurate estimate of the total number of people affected by eating disorders. Now, that having been said, the journal Clinician Reviews . But there is disagreement. The National Association of Anorexia Nervosa and Associated Disorders states that approximately eight million people in the U. S. Eight million people represents about three percent (3%) of the total population. Put another way, according to ANAD, about three out of every one hundred people in this country eats in a way disordered enough to warrant treatment. If you want to know how they arrived at this number, e- mail their staff.
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