Difference between revisions of "Obesity"

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[[File:Obesity6.JPG|thumb|Obesity]]
  
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'''[[Glossary of obesity terms]]'''
  
'''Obesity''' is a condition in which the natural energy reserve, stored in the [[adipose tissue|fatty tissue]] of [[human]]s and [[mammal]]s, is increased to a point where it is thought to be a risk factor for certain health conditions or increased mortality. Obesity develops from the interaction of individual biology and the environment. Excessive body weight has been shown to correlate with various [[diseases]], particularly [[cardiovascular disease]], [[diabetes mellitus type 2]], [[sleep apnea]], and [[osteoarthritis]]. U.S. Dept. of Health and Human Services, National Institutes of Health, 'The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults 5 (2000) [http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf PDF]. Obesity is both an individual clinical condition and is increasingly viewed as a serious public health problem.
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Overweight and obesity are increasingly common conditions in the United States. They are caused by the increase in the size and the amount of fat cells in the body. Doctors measure body mass index (BMI) and waist circumference to screen and diagnose overweight and obesity. Obesity is a serious medical condition that can cause complications such as metabolic syndrome, high blood pressure, atherosclerosis, heart disease, diabetes, high blood cholesterol, cancers and sleep disorders. Treatment depends on the cause and severity of your condition and whether you have complications. Treatments include lifestyle changes, such as heart-healthy eating and increased physical activity, and Food and Drug Administration (FDA)-approved weight-loss medicines. For some people, surgery may be a treatment option.
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==Definition==
 
  
In the clinical setting, obesity is typically evaluated by measuring BMI (Body Mass Index), waist circumference, and evaluating the presence of risk factors and [[morbidity|comorbidities]]. In [[epidemiology|epidemiological]] studies BMI alone is used to define obesity.
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===Body Mass Index===
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==Causes- Overweight and Obesity== <!--T:3-->
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Energy imbalances, somegenetic or endocrine medical conditions, and certain medicines are known to cause overweight or obesity.
  
Body mass index is a practical and simple way to measure weight. Although not perfect or without flaws, BMI is a reliable indicator of body fatness for most people except for heavy body builders. It is calculated based on your weight relative to your height.
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===- Overweight and Obesity=== <!--T:4-->
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Energy imbalances can cause overweight and obesity. An energy imbalance means that your energy IN does not equal your energy OUT. This energy is measured in calories. Energy IN is the amount of calories you get from food and drinks. Energy OUT is the amount of calories that your body uses for things such as breathing, digesting, being physically active, and regulating body temperature.
  
BMI was developed by the [[Belgium|Belgian]] statistician and [[anthropometry|anthropometrist]] [[Adolphe Quetelet]] :
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* A BMI less than 18.5 is ''underweight''
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Overweight and obesity develop over time when you take in more calories than you use, or when energy IN is more than your energy OUT. This type of energy imbalance causes your body to store fat.
* A BMI of 18.5 - 24.9 is ''normal weight''
 
* A BMI of 25.0 - 29.9 is ''overweight''
 
* A BMI of 30.0 - 39.9 is ''obese''
 
* A BMI of 40.0 or higher is ''severely (or morbidly) obese''
 
  
BMI is a simple and widely used method for estimating body fat. BMI as an indicator of a clinical condition is used in conjunction with other clinical assessments. In a ''clinical'' setting, physicians take into account race, ethnicity, lean mass (muscularity), age, sex, and other factors which can affect the interpretation of BMI. In [[epidemiology|epidemiological analyses]] BMI alone is used as an indicator of [[prevalence]] and [[incidence]].
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Your body uses certain nutrients such as carbohydrates or sugars, proteins, and fats from the foods you eat to:
  
=== Waist Circumference ===
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*'''make energy''' for immediate use to power routine daily body functions and physical activity.
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*'''store energy''' for future use by your body. Sugars are stored asglycogen in the liver and muscles. Fats are stored mainly as triglyceride in fat tissue.
  
Another important measure to know your risk related to excess weight is to know your waist to hip ratio or simply your waist circumference as a big waist circumference is associated with higher risk of developing obesity-related conditions:
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The amount of energy that your body gets from the food you eat depends on the type of foods you eat, how the food is prepared, and how long it has been since you last ate.
  
* A man with a waist circumference of 40 inches
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* A woman whose waist circumference is more than 35 inches (lower in Asians)
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The body has three types of fat tissue—white, brown, and beige—that it uses to fuel itself, regulate its temperature in response to cold, and store energy for future use. Learn about the role of each fat type in maintaining energy balance in the body.
  
Excessive abdominal or belly fat increases the risk for developing obesity-related conditions, such as Type 2 Diabetes, high blood cholesterol, high triglycerides, high blood pressure, and coronary artery disease.
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*'''White''' fat tissue can be found around the kidneys and under the skin in the buttocks, thighs, and abdomen. This fat type stores energy, makes hormone that control the way the body regulates urges to eat or stop eating, and makesinflammatory substances that can lead to complications.
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*'''Brown''' fat tissue is located in the upper back area of human infants. This fat type releases stored energy as heat energy when a baby is cold. It also can make inflammatory substances. Brown fat can be seen in children and adults.
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*'''Beige''' fat tissue is seen in the neck, shoulders, back, chest and abdomen of adults and resembles brown fat tissue. This fat type, which uses carbohydrates and fats to produce heat, increases when children and adults are exposed to cold.
  
===Online BMI calculator===
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===- Overweight and Obesity=== <!--T:11-->
* [http://www.w8md.com/81-w8md-patient-portal/76-w8md-bmi-calculator Adult BMI Calculator]
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Some genetic syndromes and endocrine disorders can cause overweight or obesity.
  
===Waist circumference===
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===Genetic syndromes=== <!--T:12-->
BMI does not take into account differing ratios of adipose to lean tissue; nor does it distinguish between differing forms of adiposity, some of which may correlate more closely with cardiovascular risk. Increasing understanding of the biology of different forms of adipose tissue has shown that ''visceral'' fat or ''[[central obesity]]'' (male-type or apple-type obesity) has a much stronger correlation, particularly with [[cardiovascular disease]], than the BMI alone.  ...Learn more on risk of [http://www.youtube.com/watch?v=D6tXDis4C3w belly fat], or [http://www.pinterest.com/w8md/52-weeks-of-weight-loss-and-wellness/ abdominal weight gain]
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Several genetic syndromes are associated with overweight and obesity, including the following.
  
{{causes}}
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The absolute waist circumference (>102 cm in men and >88 cm in women) or [[waist-hip ratio]] (>0.9 for men and >0.85 for women are both used as measures of central obesity.
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*Prader-Willi syndrome
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*Bardet-Biedl syndrome
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*Alström syndrome
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*Cohen syndrome
  
===Body fat measurement===
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An alternative way to determine obesity is to assess percent [[body fat]]. Doctors and scientists generally agree that men with more than 25% body fat and women with more than 30% body fat are obese. However, it is difficult to measure body fat precisely. The most accepted method has been to weigh a person underwater, but underwater weighing is a procedure limited to laboratories with special equipment. Two simpler methods for measuring body fat are the ''skinfold test'', in which a pinch of skin is precisely measured to determine the thickness of the [[subcutaneous]] fat layer; or [[bioelectrical impedance analysis]], usually only carried out at specialist clinics.
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The study of these genetic syndromes has helped researchers understand obesity.
  
===Gestalt===
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===Endocrine disorders=== <!--T:15-->
In practice, in most examples of overweight that may designate risk, both doctor and patient can see "by eye" whether excess fat is a concern. In these cases, BMI thresholds provide simple targets all patients can understand.
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Because the endocrine system produces hormones that help maintain energy balances in the body, the following endocrine disorders or tumor affecting the endocrine system can cause overweight and obesity.
  
===Risk factors and comorbidities===
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The presence of risk factors and diseases associated with obesity are also used to establish a clinical diagnosis. Coronary heart disease, Type II diabetes, and sleep apnea are possible life-threatening risk factors that would indicate clinical treatment of obesity. Smoking, hypertension, age and family history are other risk factors that may indicate treatment Diabetes and heart disease are risk factors used in epidemiological studies of obesity.
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*'''Hypothyroidism'''. People with this condition have low levels of thyroid hormones. These low levels are associated with decreased metabolism and weight gain, even when food intake is reduced. People with hypothyroidism also produce less body heat, have a lower body temperature, and do not efficiently use stored fat for energy.
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*'''Cushing’s syndrome.''' People with this condition have high levels of glucocorticoids, such ascortisol, in the blood. High cortisol levels make the body feel like it is underchronic stress. As a result, people have an increase in appetite and the body will store more fat. Cushing’s syndrome may develop after taking certain medicines or because the body naturally makes too much cortisol.
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*'''Tumors'''. Some tumors, such as craneopharingioma, can cause severe obesity because the tumors develop near parts of the brain that control hunger.
  
==Causes==
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===Causative factors===
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Medicines such as antipsychotics, antidepressants, antiepileptics, and antihyperglycemics can cause weight gain and lead to overweight and obesity.
When [[food energy]] intake exceeds energy expenditure, fat cells (and to a lesser extent muscle and [[liver]] cells) throughout the body take in the energy and store it as fat. In its simplest conception, therefore, obesity is only made possible when the lifetime energy intake exceeds lifetime energy expenditure by more than it does for individuals of "normal weight".
 
  
In all individuals, the excess energy utilized to generate fat reserves is minute relative to the total number of calories consumed. This means that very fine perturbations in the energy balance can lead to large fluctuations in weight over time. To illustrate, an obese 40 year old who carries 100 lb of adipose tissue has only consumed about 25 more calories per day than he has burned on average - or the equivalent of an apple every three days. In comparison a very lean 40-year-old who carries only 15 lb of body fat will have exceeded his daily energy expenditure by about four calories a day - the equivalent of an apple every 18 days.  
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Talk to your doctor if you notice weight gain while you are using one of these medicines. Ask if there are other forms of the same medicine or other medicines that can treat your medical condition, but have less of an effect on your weight'''. Do not stop taking the medicine without talking to your doctor'''.
  
Factors that have been suggested to contribute to the development of obesity include:
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* Sedentary lifestyle
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Several parts of your body, such as your stomach, intestines, pancreas, and fat tissue, use hormones to control how your brain decides if you are hungry or full. Some of these hormones are insulin, leptin, glucagon-like peptide (GLP-1), peptide YY, and ghrelin.
* A high [[glycemic index|glycemic]] diet (i.e. a diet that consists of meals that give high postprandial [[blood sugar]])
 
* Weight cycling, caused by repeated attempts to lose weight by dieting
 
* Underlying illness (e.g. [[hypothyroidism]])
 
* [[Genetic disorders]] (e.g. [[Prader-Willi syndrome]])
 
* [[Eating disorder]]s (such as [[binge eating disorder]])
 
* [[Stress (medicine)|Stressful]] mentality
 
* Insufficient [[sleep]]
 
* Certain medications (e.g. [[atypical antipsychotic]]s)
 
* [[Smoking cessation]]
 
* [[genetics|Genetic]] factors
 
  
As with many medical conditions, the caloric imbalance that results in obesity often develops from a combination of genetic and environmental factors. [[Polymorphism]]s in various [[gene]]s controlling [[appetite]], [[metabolism]], and [[adipokine]] release predispose to obesity, but the condition requires availability of sufficient calories, and possibly other factors, to develop fully. Various genetic abnormalities that predispose to obesity have been identified (such as [[Prader-Willi syndrome]] and [[leptin]] receptor mutations), but known single-locus mutations have been found in only about 5% of obese individuals. While it is thought that a large proportion of the causative genes are still to be identified, much obesity is likely the result of interactions between multiple genes, and non-genetic factors are likely also important.  
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==Risk Factors- Overweight and Obesity== <!--T:20-->
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There are many risk factors for overweight and obesity. Some risk factors can be changed, such as unhealthy lifestyle habits and environments. Other risk factors, such as age, family history and genetics, race and ethnicity, and sex, cannot be changed. Heathy lifestyle changes can decrease your risk for developing overweight and obesity.
  
Some eating disorders are associated with obesity, especially binge eating disorder (BED). As the name indicates, patients with this disorder are prone to overeat, often in binges. A proposed mechanism is that the eating serves to reduce [[anxiety]], and some parallels with [[substance abuse]] can be drawn. An important additional factor is that BED patients often lack the ability to recognize [[hunger]] and [[satiety]], something that is normally learned in childhood. [[Learning theory (education)|Learning theory]] suggests that early childhood conceptions may lead to an association between food and a calm mental state.
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===- Overweight and Obesity=== <!--T:21-->
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Lack of physical activity, unhealthy eating patterns, not enough sleep, and high amounts of stress can increase your risk for overweight and obesity.
  
===Evolutionary aspects===
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===Lack of physical activity=== <!--T:22-->
Although there is no definitive explanation for the recent increase of obesity, the [[thrifty gene hypothesis]] provides some understanding of this phenomenon, and suggests why certain populations and individuals may be more prone to obesity than others. In times when food was scarce, the ability to take advantage of rare periods of abundance and use such abundance by storing energy efficiently was undoubtedly an evolutionary advantage. Individuals with greater adipose reserves were more likely to survive famine. This tendency to store fat is likely maladaptive in a society with adequate and stable food supplies. Although many people likely have a genetic propensity towards obesity, in most cases this propensity requires the modern environment with increased caloric availability and decreased requirements for physical labor in order to be expressed fully.
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Lack of physical activity due to high amounts of TV, computer, videogame or other screen usage has been associated with a highbody mass index. Healthy lifestyle changes, such as being physically active and reducing screen time, can help you aim for a healthy weight.
  
===Neurobiological mechanisms===
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===Unhealthy eating behaviors=== <!--T:23-->
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Some unhealthy eating behaviors can increase your risk for overweight and obesity.
  
Flier summarizes the many possible [[pathophysiology|pathophysiological]] mechanisms involved in the development and maintenance of obesity. This field of research had been almost unapproached until [[leptin]] was discovered in [[1994]]. Since this discovery, many other hormonal mechanisms have been elucidated that participate in the regulation of [[appetite]] and food intake, storage patterns of [[adipose tissue]], development of [[insulin resistance]]. Since leptin's discovery, [[ghrelin]], [[orexin]], [[PYY 3-36]], [[cholecystokinin]], [[adiponectin]], and many other mediators have been studied. The [[adipokine]]s are mediators produced by adipose tissue; their action is thought to modify many obesity-related diseases.
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*'''Eating more calories than you use'''. The amount of calories you need will vary based on your sex, age, and physical activity level. Find out your daily calorie needs or goals with the Body Weight Plannerexternal link.
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*'''Eating too much saturated and ''trans'' fats'''
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*'''Eating foods high in added sugars'''
  
Leptin and ghrelin are considered to be complementary in their influence on appetite, with ghrelin produced by the [[stomach]] modulating short-term appetitive control (i.e. to eat when the stomach is empty and to stop when the stomach is stretched). Leptin is produced by adipose tissue to signal fat storage reserves in the body, and mediates long-term appetitive controls (i.e. to eat more when fat storages are low and less when fat storages are high). Although administration of leptin may be effective in a small subset of obese individuals who are leptin-deficient, many more obese individuals are thought to be leptin-resistant, and this resistance has been implicated in obesity in some people, is thought to explain in part why administration of leptin has not been shown to be effective in suppressing appetite in most obese subjects.
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Visit Heart-healthy eating for more information about healthy eating patterns.
  
[[Neuroscience|Neuroscientific]] approaches hinge on the action of the aforementioned mediators on the [[hypothalamus]], the part of the brain that is thought to process signals related to metabolic state and energy storage and to shift the energy balance in either a positive or negative direction, primarily by acting on appetite and energy expenditure. [[Lesion|Lesion studies]] in the 1940s and 1950s identified two regions of the hypothalamus &mdash; the lateral hypothalamus (LH) and ventromedial hypothalamus (VMH) &mdash; as the brain's hunger and satiety centers, respectively. Specific lesions to a mouse's LH suppressed its appetite while damaging the VMH caused overeating.
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===Not enough sleep=== <!--T:26-->
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Many studies have seen a high BMI in people who do not get enough sleep. Some studies have seen a relationship between sleep and the way our bodies use nutrients for energy and how lack of sleep can affect hormones that control hunger urges. Visit our Sleep Deprivation and Deficiency Health Topic for more information about lack of sleep.
  
Studies of the distribution of the leptin receptor in the mid-1990s cast doubt upon this dual center theory of hunger and satiety. Leptin's effect on the [[arcuate nucleus]] melanocortin system is now considered central to the regulation of feeding and metabolism.
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===High amounts of stress=== <!--T:27-->
{{blame}}
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Acute stress and chronic stress affect the brain and trigger the production of hormones, such as cortisol, that control our energy balances and hunger urges. Acute stress can trigger hormone changes that make you not want to eat. If the stress becomes chronic, hormone changes can make you eat more and store more fat.
  
===Poverty link===
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==Other Risk factors== <!--T:28-->
Some obesity co-factors are resistant to the theory that the "epidemic" is a new phenomenon. In particular, a [[social class|class]] co-factor consistently appears across many studies. Comparing net worth with BMI scores, a 2004 study<ref>Zagorsky JL. Is Obesity as Dangerous to Your Wealth as to Your Health? ''Res Aging'' 2004;26:130-152. [http://roa.sagepub.com/cgi/reprint/26/1/130 PDF fulltext].{{doi|10.1177/0164027503258519}}.<!--No PMID--></ref> found obese American subjects approximately half as wealthy as thin ones. When income differentials were factored out, the inequity persisted &mdash; thin subjects were inheriting more wealth than fat ones. Another study finds women who married into higher status predictably thinner than women who married into lower status.
 
  
==Complications==
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==Age== <!--T:29-->
Obesity, especially [[central obesity]] (male-type or waist-predominant obesity), is an important risk factor for the "[[metabolic syndrome]]" ("syndrome X"), the clustering of a number of diseases and risk factors that heavily predispose for [[cardiovascular disease]]. These are [[diabetes mellitus|diabetes mellitus type 2]], [[arterial hypertension|high blood pressure]], [[hypercholesterolemia|high blood cholesterol]], and [[hypertriglyceridemia|triglyceride levels]] ([[combined hyperlipidemia]]). An [[inflammation|inflammatory state]] is present, which &mdash; together with the above &mdash; has been implicated in the high prevalence of [[atherosclerosis]] (fatty lumps in the arterial wall), and a [[thrombosis|prothrombotic]] state may further worsen cardiovascular risk.
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Childhood obesity remains a serious problem in the United States, and some populations are more at risk for childhood obesity than others. The risk of unhealthy weight gain increases as you age. Adults who have a healthy BMI often start to gain weight in young adulthood and continue to gain weight until 60 to 65 years old, when they tend to start losing weight.
  
Apart from the metabolic syndrome, obesity is also [[correlation|correlated]] (in population studies) with a variety of other complications. For many of these complaints, it has not been clearly established to what extent they are caused directly by obesity itself, or have some other cause (such as limited exercise) that causes obesity as well. Most confidence in a direct cause is given to the mechanical complications in the following list, compiled by the [[American Medical Association]] for general physicians:
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===Genetic studies have found that overweight and obesity can run in families, so it is possible that our genes or DNA can cause these conditions. Research studies have found that certain DNA elements are associated with obesity.=== <!--T:30-->
* ''[[Cardiovascular]]'': [[congestive heart failure]], [[cardiomegaly|enlarged heart]] and its associated [[arrhythmia]] and dizziness, [[cor pulmonale]], [[varicose veins]], and [[pulmonary embolism]]
 
*''[[Endocrine]]'': [[polycystic ovarian syndrome]] (PCOS), [[menstruation|menstrual]] disorders, and [[infertility]]
 
* ''[[Gastrointestinal]]'': [[gastroesophageal reflux disease]] (GERD), [[non-alcoholic steatohepatitis|fatty liver disease]], [[cholelithiasis]] (gallstones), [[hernia]], and [[colorectal cancer]]
 
* ''Renal and [[genitourinary]]'': [[urinary incontinence]], [[glomerulopathy]], [[hypogonadism]] (male), [[breast cancer]] (female), [[endometrial cancer|uterine cancer]] (female), [[stillbirth]]
 
* ''[[Integument]]'' (skin and appendages): [[stretch mark]]s, [[acanthosis nigricans]], [[lymphedema]], [[cellulitis]], [[carbuncle]]s, [[intertrigo]]
 
* ''Musculoskeletal'': [[hyperuricemia]] (which predisposes to [[gout]]), immobility, [[osteoarthritis]], [[low back pain]]
 
* ''Neurologic'': [[stroke]], [[meralgia paresthetica]], [[headache]], [[carpal tunnel syndrome]], [[dementia]]{{mnb|Whitmer|10}} <ref>{{cite journal | author=Whitmer RA, Gunderson EP, Barrett-Connor E, Quesenberry CP Jr, Yaffe K | title=Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study | journal=BMJ | year=2005 | pages=1360 | volume=330 | issue=7504 | id=PMID 15863436}}</ref>
 
* ''[[Respiratory]]'': [[dyspnea]], [[obstructive sleep apnea]], [[hypoventilation]] syndrome, [[Pickwickian syndrome]], [[asthma]]
 
* ''[[Psychological]]'': [[Clinical depression|Depression]], low [[self esteem]], [[body image disorder]], social stigmatization
 
  
While being severely obese has many health ramifications, those who are somewhat overweight face little increased [[mortality]] or [[morbidity]]. Some studies suggest that the somewhat "overweight" tend to live longer than those at their "ideal" weight [http://www.chron.com/cs/CDA/ssistory.mpl/nation/3142605]. This may in part be attributable to lower mortality rates in diseases where death is either caused or contributed to by significant weight loss due to the greater risk of being underweight experienced by those in the ideal category. Another factor which may confound mortality data is smoking, since obese individuals are less likely to smoke. [[Osteoporosis]] is known to occur less in slightly overweight people.
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===Did you know obesity can change your DNA and the DNA you pass on to your children? Learn more about these DNA changes.=== <!--T:31-->
{{5 proven}}
 
==Therapy==
 
The mainstay of treatment for obesity is an energy-limited [[dieting|diet]] and increased exercise. In studies, diet and exercise programs have consistently produced an average weight loss of approximately 8% of total body mass on average (excluding study drop-outs). While not all dieters will be satisfied with this outcome, studies have shown that a loss of as little as 5% of body mass can create enormous health benefits.
 
  
A more intractable therapeutic problem appears to be weight loss maintenance. Of dieters who manage to lose 10% or more of their body mass in studies, 80-95% will regain that weight within two to five years. It appears that the [[homeostasis|homeostatic]] mechanisms regulating body weight are very robust (see [[leptin]], for example), and vigorously defend against weight loss. Much important research is now being devoted to determining what factors can improve the currently dismal weight loss maintenance rates.  
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===Eating too much or eating too little during your pregnancy can change your baby’s DNA and can affect how your child stores and uses fat later in life. Also, studies have shown that obese fathers have DNA changes in their sperm that can be passed on to their children.=== <!--T:32-->
  
Recent scientific research has cast some doubt over whether or not dieting actually improves health, with some studies indicating that dieting may in fact be more detrimental than remaining overweight.
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==Screening and Prevention- Overweight and Obesity== <!--T:33-->
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Children and adults should be screened at least annually to see if they have a high or increasing body mass index (BMI), which allows doctors to recommend healthy lifestyle changes to prevent overweight and obesity.
  
In a [[clinical practice guideline]] by the [[American College of Physicians]], the following five recommendations are made:
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===- Overweight and Obesity=== <!--T:34-->
# People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss.
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To screen for overweight and obesity, doctors measure BMI using calculations that depend on whether you are a child or an adult. After reading the information below, talk to your doctor or your child’s doctor to determine if you or your child has a high or increasing BMI.
# If these goals are not achieved, pharmacotherapy can be offered. The patient needs to be informed of the possibility of [[Adverse effect (medicine)|side-effects]] and the unavailability of long-term safety and efficacy data.
 
# Drug therapy may consist of [[sibutramine]], [[orlistat]], [[phentermine]], [[diethylpropion]], [[fluoxetine]], and [[bupropion]]. For more severe cases of obesity, stronger drugs such as [[amphetamine]] and [[methamphetamine]] may be used on a selective basis. Evidence is not sufficient to recommend [[sertraline]], [[topiramate]], or [[zonisamide]].
 
# In patients with BMI > 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for [[bariatric surgery]] may be indicated. The patient needs to be aware of the potential complications.
 
# Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications.
 
  
Much research focuses on new [[medication|drugs]] to combat obesity, which is seen as the biggest health problem facing developed countries. Nutritionists and many doctors feel that these research funds would be better devoted to advice on good [[nutrition]], healthy eating, and promoting a more active lifestyle.
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*'''Children''': A healthy weight is usually when your child’s BMI is at the 5th percentile up to the 85th percentile, based on growth charts for children who are the same age and sex. To figure out your child’s BMI, use the Center for Disease Control and Prevention (CDC) BMI Percentile Calculator for Child and Teenexternal link and compare the BMI with the table below.
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*'''Adults''': A healthy weight for adults is usually when your BMI is 18.5 to less than 25. To figure out your BMI, use the National Heart, Lung, and Blood Institute’s online BMI calculator and compare it with the table below. You can also download the BMI calculator app for iPhoneexternal link and Androidexternal link.
  
Medication most commonly prescribed for diet/exercise-resistant obesity is [[orlistat]] (Xenical®, which reduces intestinal fat absorption by inhibiting [[pancreas|pancreatic]] [[lipase]]) and [[sibutramine]] (Reductil®, Meridia®, an [[anorectic]]). In the presence of [[diabetes mellitus]], there is evidence that the [[anti-diabetic drug]] [[metformin]] (Glucophage®) can assist in [[weight loss]] &mdash; rather than [[sulfonylurea]] derivatives and [[insulin]], which often lead to further weight gain. The [[thiazolidinedione]]s ([[rosiglitazone]] or [[pioglitazone]]) can cause slight weight gain, but decrease the "pathologic" form of abdominal fat, and are therefore often used in obese [[diabetes mellitus|diabetics]].
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Body mass index (BMI) is used to determine if you or your child are underweight, healthy, or overweight or obese. Children are underweight if their BMI is below the 5th percentile, healthy weight if their BMI is between the 5th to less than the 85th percentile, overweight if their BMI is the 85th percentile to less than the 95th percentile, and obese if their BMI is the 95th percentile or above. Adults are underweight if their BMI is below 18.5, healthy weight if their BMI is 18.5 to 24.9, overweight if their BMI is 25 to 29.9, and obese if their BMI is 30 or above. *A child’s BMI percentile is calculated by comparing your child’s BMI to growth charts for children who are the same age and sex as your child.
  
Increasingly, ''[[bariatric surgery]]'' is being used to combat obesity. The most common weight loss surgery in [[Europe]] and [[Australia]] is the [[adjustable gastric band]] where a silicone ring is placed around the top of the stomach to help restrict the amount of food eaten in a sitting. This surgery has been FDA approved in the United States since [[2001]] but has been being used in other parts of the world since the early 1990s.  It is considered the safest and least invasive of the available weight loss surgeries such as [[Roux-en-Y gastric bypass surgery]] (RNY), [[biliopancreatic diversion]], and [[stomach stapling]] (also known as "vertical banded gastroplasty", VBG).  Unlike those more invasive techniques the band surgery does not cut into or reroute any of the digestive tract and is completely reversible.  Removing the implant returns the stomach to its pre-surgical norm.  All of these surgeries can be done [[laparoscopic surgery|laparoscopically]].   The more invasive of the surgeries usually bypass or remove some portion of the patient's intestines which causes  [[malabsorption]] and [[Gastric dumping syndrome|dumping]]. 
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=====Healthy lifestyles===== <!--T:37-->
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If your BMI indicates you are getting close to being overweight, or if you have certain risk factors, your doctor may recommend you adopt healthy lifestyle changes to prevent you from becoming overweight and obese. Changes include healthy eating, being physically active, aiming for a healthy weight, and getting healthy amounts of sleep. Read healthy lifestyle changes for more information
  
All of these surgeries come with risk to the patient. For instance a recent study by the U.S. Department of Health and Human Service showed a 40% complication rate within 180 days of bariatric surgery. Moreover these surgeries do not guarantee either successful weight loss or reduced morbidity and mortality. Patients are also required to to make lifelong changes to their diet if they are to keep the lost weight off in the long term. Therefore, as with any major surgery, patients needs to carefully evalute the long term ramifications of their choice.
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There are no specific symptoms of overweight and obesity. The signs of overweight and obesity include a high body mass index (BMI) and an unhealthy body fat distribution that can be estimated by measuring your waist circumference. Obesity can cause complications in many parts of your body.  
  
==Cultural and social significance==
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===- Body Mass Index=== <!--T:39-->
===Etymology===
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A high BMI is the most common sign of overweight and obesity.
''Obesity'' is the nominal form of ''obese'' which comes from the [[Latin]] ''obēsus'', which means "stout, fat, or plump."  ''Ēsus'' is the past participle of ''edere'' (to eat), with ''ob'' added to it. In [[Classical Latin]], this verb is seen only in past participial form. Its first attested usage in [[English language|English]] was in [[1651]], in [[Noah Biggs]]'s ''Matæotechnia Medicinæ Praxeos''
 
  
===Culture and obesity===
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<!--T:40-->
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Body mass index (BMI) is used to determine if you or your child are underweight, healthy, or overweight or obese. Children are underweight if their BMI is below the 5th percentile, healthy weight if their BMI is between the 5th to less than the 85th percentile, overweight if their BMI is the 85th percentile to less than the 95th percentile, and obese if their BMI is the 95th percentile or above. Adults are underweight if their BMI is below 18.5, healthy weight if their BMI is 18.5 to 24.9, overweight if their BMI is 25 to 29.9, and obese if their BMI is 30 or above. *A child’s BMI percentile is calculated by comparing your child’s BMI to growth charts for children who are the same age and sex as your child.
  
In several human cultures, obesity is associated with [[physical attractiveness]], [[physical strength|strength]], and [[fertility]]. Some of the earliest known cultural [[artifact (archaeology)|artifact]]s, known as [[Venus figurines]], are pocket-sized [[statue]]ttes representing an obese female figure. Although their cultural significance is unrecorded, their widespread use throughout pre-historic Mediterranean and [[Europe]]an cultures suggests a central role for the obese female form in [[magic and religion|magical]] rituals, and suggests cultural approval of (and perhaps reverence for) this body form.  This is most likely due to their ability to easily bear children and survive [[famine]].  
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===- Fat distribution=== <!--T:41-->
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Another sign of overweight and obesity is having an unhealthy body fat distribution. Fatty tissue is found in different parts of your body and has many functions. Having an increased waist circumference suggests that you have increased amounts of fat in your abdomen. An increased waist circumference is a sign of obesity and can increase your risk for obesity-related complications.
  
In contrast, in modern [[Western culture]], a more slender body shape is more typically considered desirable. "Thinness" is often considered more important for women than men.
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<!--T:42-->
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Did you know that fatty tissue has different functions depending on its location in your body?
  
Obesity was occasionally considered a [[symbol]] of [[wealth]] and [[social status]] in cultures prone to food shortages or famine. Well into the early modern period in European cultures, it often served this role. But as food security was realised, it came to serve more as a visible signifier of "lust for life", appetite, and immersion in the realm of the [[eroticism|erotic]]. This was especially the case in the visual arts, such as the paintings of [[Peter Paul Rubens|Rubens]] ([[1577]]&ndash;[[1640]]), whose regular use of the full female figures gives us the description ''Rubenesque'' for plumpness. Obesity can also be seen as a symbol within a system of prestige. "The kind of food, the quantity, and the manner in which it is served are among the important criteria of social class. In most tribal societies, even those with a highly stratified social system, everyone - royalty and the commoners - ate the same kind of food, and if there was famine everyone was hungry. With the ever increasing diversity of foods, food has become not only a matter of social status, but also a mark of one's personality and taste."
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<!--T:43-->
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Visceral fat is the fatty tissue inside of your abdomen and organs. While we do not know what causes the body to create and store visceral fat, it is known that this type of fat interferes with the body’s endocrine and immune systems and promotes chronic inflammation and contributes to obesity-related complications.
  
Not all contemporary cultures disapprove of obesity, although the Western preference for thinness is increasingly being exported worldwide as part of the process of globalization. Few cultures have escaped the "Westernization" of body shape preference, though cultures which are traditionally more approving (to varying degrees), include some African, Arabic, Indian, and Pacific Island cultures. Especially in the past decades, obesity has come to be seen more as a medical condition.  There is also a small but vocal [[fat acceptance movement]] that seeks to challenge weight-based [[discrimination]].
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=====Obesity may cause the following complications:===== <!--T:44-->
  
===Popular culture===
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<!--T:45-->
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*'''Metabolic Syndrome'''
 +
*'''Type 2 diabetes'''
 +
*'''High blood cholesterol''' and high triglycerideexternal link levels in the blood
 +
*'''Diseases''' '''of the heart and blood vessels''' such as high blood pressure, atherosclerosis, heart attacks and stroke
 +
*'''Respiratory problems''' such as obstructive sleep apnea , asthma, and obesity hypoventilation syndrome
 +
*Back pain  
 +
*'''Non-alcoholic fatty liver disease''' (NAFLD)
 +
*'''Osteoarthritis,''' a chronic inflammation that damages the cartilage and bone in or around the affected joint. It can cause mild or severe pain and usually affects weight-bearing joints in people who are obese. It is a major cause of knee replacement surgery in patients who are obese for a long time.
 +
*'''Urinary incontinence''', the unintentional leakage of urine. Chronic obesity can weaken pelvic muscles, making it harder to maintain bladder control. While it can happen to both sexes, it usually affects women as they age.
 +
*'''Gallbladder disease'''
 +
*'''Emotional health issues''' such as low self-esteem or depression. This may commonly occur in children.
 +
*'''Cancers''' of the esophagus, pancreas, colon, rectum, kidney, endometrium, ovaries, gallbladder, breast, or liver.
  
Various [[stereotype]]s of obese people have found their way into expressions of popular culture. A common stereotype is the obese character who has a warm and dependable personality, but equally common is the obese vicious [[bullying|bully]]. [[Gluttony]] and obesity are commonly depicted together in works of fiction. In cartoons, obesity is often used to comedic effect, with fat [[cartoon]] characters having to squeeze through narrow spaces, frequently getting stuck or even exploding.
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<!--T:46-->
 +
Did you know inflammation is thought to play a role in the onset of certain obesity-related complications?
  
It can be argued that depiction in popular culture adds to and maintains commonly perceived stereotypes, in turn harming [[self esteem]] of obese people. A charge of [[discrimination]] on the basis of appearance could be leveled against these depictions.
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<!--T:47-->
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Researchers now know more about visceral fat, which is deep in the abdomen of overweight and obese patients. Visceral fat releases factors that promote inflammation. Chronic obesity-related inflammation is thought to lead toinsulin resistance and diabetes, changes in the liver or non-alcoholic fatty acid liver disease, and cancers. More research is needed to understand what triggers inflammation in some obese patients and to find new treatments.
  
On the other hand, obesity is often associated with positive characteristics such as good [[humour|humor]] (the stereotype of the jolly fat man like [[Santa Claus]]), and some people are more [[sexual attraction|sexually attracted]] to obese people than to slender people (see [[chubby culture]], [[fat admirer]]).
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==Diagnosis== <!--T:48-->
 +
Your doctor may diagnose overweight and obesity based on your medical history, physical exams that confirm you have a high body mass index (BMI) and possibly a high waist circumference, and tests to rule out other medical conditions.
 +
===- Overweight and Obesity===
 +
To diagnose overweight and obesity, doctors measure BMI using calculations that depend on whether you are a child or an adult.
  
==Public health and policy==
+
<!--T:49-->
The prevalence of overweight and obesity in the United States makes obesity a leading public health problem. From 1980 to 2002, obesity prevalence has doubled in adults and overweight prevalence has has tripled in children and adolescents <ref name=Ogden>Ogden C, Carroll M, Curtin L, McDowell M, Tabak C, Flegal K. Prevalence of Overweight and Obesity in the Unites States, 1999 - 2004. ''JAMA'' 2006;295:1549-1555. PMID 16595758.</ref>. From 2003-2004, "children and adolescents aged 2 to 19 years, 17.1% were overweight...and 32.2% of adults aged 20 years or older were obese."<ref name=Ogden/> The prevalence in the United States continues to rise.<ref name=Ogden>
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*'''Children''': A healthy weight is usually when your child’s BMI is at the 5th percentile up to less than the 85th percentile based on growth charts for children who are the same age and sex. To figure out your child’s BMI, use the Center for Disease Control and Prevention (CDC) BMI Percentile Calculator for Child and Teenexternal link and compare the BMI with the table below.
 +
*'''Adults''': A healthy weight for adults is usually when your BMI is 18.5 to less than 25. To figure out your BMI, use the National Heart, Lung, and Blood Institute’s online BMI calculator and compare it with the table below. You can also download the BMI calculator app for iPhoneexternal link and Androidexternal link. Even if your BMI is in the healthy range, it is possible to be diagnosed as obese if you have a large waist circumference that suggests increased amounts of fat in your abdomen that can lead to complications.
 +
*Your doctor will ask about your eating and physical activity habits, family history, and will see if you have other risk factors Your doctor may ask if you have any other signs or symptoms. This information can help determine if you have other conditions that may be causing you to be overweight or obese or if you have complications from being overweight or obese.
  
Obesity is a public health and policy problem because of its prevalence, costs and burdens.<ref>U.S. Dept. of Health and Human Services, Public Health Service, Office of Surgeon General, ''The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity 2001'' (2001)</ref>. The prevalence of obesity has been continually rising for two decades.<ref>Centers for Disease Control and Prevention, U.S. Obesity Trends 1984 - 2002 [http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm].</ref> This sudden rise in obesity prevalence is attributed to environmental and population factors rather than individual behavior and biology because of the rapid and continual rise in the number of overweight and obese individuals.<ref>Morrill A, Chinn C. The obesity epidemic in the United States. ''J Public Health Policy'' 2004;25:353-366. PMID 15683071.</ref>. The current environment produces risk factors for decreased physical activity and for increased calorie consumption. These environmental factors operate on the population to decrease physical activity and increase calorie consumption.
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=====- Physical exam===== <!--T:50-->
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During your physical exam, your doctor will measure your weight and height to calculate your BMI. Your doctor may also measure your waist circumference to estimate the amount of unhealthy fat in your abdomen. In adults, a waist circumference over 35 inches for women who are not pregnant or 40 inches for men can help diagnose obesity and assess risk of future complications. If you are of South Asian or Central and South American descent, your doctor may use smaller waist circumference values to diagnose your obesity. People from these backgrounds often don’t show signs of a large waist circumference even though they may have unhealthy amounts of fat deep in their abdomens and may be diagnosed with obesity. Visit Assessing Your Weightexternal link for more information.
  
===Environmental causes of obesity===
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<!--T:51-->
While it may often appear obvious why a certain individual gets fat, it is far more difficult to understand why the average weight of certain societies have recently been growing. While genetic causes are central to understanding obesity, they cannot fully explain why one culture grows fatter than another.
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Read Living With for more information about why it is important to monitor your waist circumference to assess your risk for complications.
  
This is most notable in the [[United States]]. In the years from just after the [[Second World War]] until [[1960]] the average person's weight increased, but few were obese. In the two and a half decades since [[1980]] the growth in the rate of obesity has accelerated markedly and is increasingly becoming a [[public health]] concern.
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=====- TESTS===== <!--T:52-->
  
There are a number of theories as to the cause of this change since 1980. Most believe it is a combination of various factors.
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<!--T:53-->
{{exercise}}
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*Your doctor may order some of the following tests to identify medical conditions that may be causing your overweight and obesity.
*''Lack of activity'': obese people appear to be less active in general than lean people, and not just because of their obesity. A controlled increase in calorie intake of lean people did not make them less active; correspondingly when obese people lost weight they did not become more active. Weight change does not affect activity levels, but the converse seems to be the case. <ref>{{cite journal | author=Levine JA, Lanningham-Foster LM, McCrady SK, Krizan AC, Olson LR, Kane PH, Jensen MD, Clark MM | title=Interindividual variation in posture allocation: possible role in human obesity | journal=Science | year=2005 | pages=584-6 | volume=307 | issue=5709 | id=PMID 15681386 {{doi|10.1126/science.1106561}}}}</ref>
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**'''Blood tests.''' Blood tests that check your thyroid hormone levels can help rule out hypothyroidism as a cause of your overweight or obesity. Cortisol and adrenocorticotropic hormone (ACTH) tests can rule out Cushing’s syndrome. Total testosterone and dehydroepiandrosterone sulphate (DHEAS) tests can help rule out polycystic ovary syndrome (PCOS).
 +
**'''Pelvic ultrasound''' to examine the ovaries and detect cysts. This can rule out PCOS.
  
*One of the most important is the much ''lower relative cost of foodstuffs'': massive changes in agricultural policy in the United States and Europe have led to food prices for consumers being lower than at any point in history.  [[Sugar]] and [[corn syrup]], two huge sources of food energy, are some of the most [[subsidy|subsidized]] products by the United States government.  This can raise costs for consumers in some areas but greatly lower it in others.  Current debates into trade policy highlight disagreements on the effects of subsidies.
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==Treatment== <!--T:54-->
  
*''Increased marketing'' has also played a role.  In the early 1980s in America the [[Ronald Reagan|Reagan]] administration lifted most regulations pertaining to sweets and [[fast food advertising]] to children. As a result, the number of advertisements seen by the average child increased greatly, and a large proportion of these were for [[fast food]] and [[sweets]].
 
  
*Changes in ''the price of [[mineral oil]] and [[gasoline|petrol]]'' are also believed to have had an effect, as unlike during the [[1970s]] it is now affordable in the United States to drive everywhere &mdash; at a time when [[public transit]] goes underused. At the same time more areas have been built without [[sidewalk]]s and parks.
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<!--T:55-->
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To help you aim for and maintain a healthy weight, your doctor may recommend that you adopt lifelong healthy lifestyle changes.
  
*The ''changing workforce'' as each year a greater percent of the population spends their entire workday behind a desk or [[computer]], seeing virtually no exercise. In the [[kitchen]] the [[microwave oven]] has seen sales of calorie-dense [[frozen food|frozen convenience foods]] skyrocket and has encouraged more elaborate [[snack]]ing.
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<!--T:56-->
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*Heart-healthy eating. Learn about which foods and nutrients are part of a healthy eating pattern. It’s important to eat the right amount of calories to maintain a healthy weight. If you need to lose weight, try to reduce your total daily calories gradually. Use the Body Weight Plannerexternal link to find out your daily calorie needs and to set goals. Visit healthy recipes and plan for success. Talk with your doctor before beginning any diet or eating plan.
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*Physical activity. Many health benefits are associated with physical activity and getting the recommended amount of physical activity needed each week. Physical activity is an important factor in determining whether a person can maintain a healthy body weight, lose excess body weight, or maintain successful weight loss. Before starting any exercise program, ask your doctor about what level of physical activity is right for you. Visit Physical Activity Has Many Health Benefits
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*Healthy Sleep. Studies have shown some relationship between lack of sleep and obesity.
  
*A social cause that is believed by many to play a role is the increasing number of ''two income households'' in which one parent no longer remains home to look after the house. This increases the number of [[restaurant]] and [[take-out]] meals.
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<!--T:57-->
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Making lifelong healthy lifestyle changes, such as heart-healthy eating and physical activity, can help you modify your energy balance to help you aim for and maintain a healthy weight. For example:
  
*''[[Urban sprawl]]'' may be a factor: obesity rates increase as urban sprawl increases, possibly due to less walking and less time for cooking. <ref>{{cite journal | author=Lopez R | title=Urban sprawl and risk for being overweight or obese | journal=Am J Public Health | year=2004 | pages=1574-9 | volume=94 | issue=9 | id=PMID 15333317}}</ref>
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<!--T:58-->
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*To aim for a healthy weight, or lose weight, you want your energy OUT to be more than your energy IN.
  
*Since 1980 both sit-in and ''[[fast food]] [[restaurant]]s'' have seen dramatic growth in terms of the number of outlets and customers served.  Low food costs, and intense competition for market share, led to increased portion sizes &mdash; for example, [[McDonalds]] [[french fries]] portions rose from 200 Calories (840 [[joule|kilojoules]]) in 1960 to over 600 Calories (2,500 kJ) today.
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<!--T:59-->
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*To maintain weight loss you want your energy IN and energy OUT to be the same.
  
*''Increased food production'' is a probable factor. The U.S. produces three times more food than U.S. residents eat.
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==Behavior modifications== <!--T:60-->
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Your doctor may recommend you enroll in individual or group behavioral weight-loss programs to treat your overweight and obesity. In these programs, a trained healthcare professional will customize a weight-loss plan for you. This plan will include a moderately-reduced calorie diet, physical activity goals, and behavioral strategies to help you make and maintain these lifestyle changes. Read Living With for more information about required follow-up for these behavioral treatment programs.
  
*Increasing ''affluence'' itself (including many of the above factors as accompaniments of affluence) may be a cause, or contributing factor since obesity tends to flourish as a [[diseases of affluence|disease of affluence]] in countries which are developing and becoming westernised [http://www.iotf.org/]. This is supported by a dip in American GDP after 1990, the year of the [[Gulf War]], followed by an exponential increase. U.S. obesity statistics followed the same pattern, offset by two years [http://www.cdc.gov/brfss/].
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<!--T:61-->
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Did you know your brain’s pleasure and reward centers can be stimulated by food and the act of eating, making it harder to change eating patterns and lose weight?
  
*An aging population may also be a major factor, as the likelihood of becoming obese increases with age. Beyond their twenties, the older a person becomes the slower their metabolism becomes, reducing the amount of calories required to sustain the body, thus if a person does not reduce their intake of food with age, they will become obese over time. As the average age of individuals within a society increases, the rate of obesity also increases. This situation is exacerbated by the [[Post-WW2 baby boom|baby boom]] generation, which represents a disproportionately large portion of the population in many countries and is currently nearing the latter end of the typical lifespan in affluent nations, and therefore is in the high-risk zone for obesity.
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<!--T:62-->
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Researchers know that our brains can become patterned so that we feel pleasure or reward from eating. This can make us unconsciously crave food so our bodies feel that sense of pleasure. It can also make it hard to change our eating patterns, lose weight, or maintain a healthy weight. Researchers are studying whether cognitive behavioral therapies can be an effective treatment for overweight and obesity by retraining the brain to not associate pleasure with food and the act of eating.
  
Interestingly an increase in the number of Americans who [[exercise]] and [[dieting|diet]] occurred before the increase in obesity, and some scholars have even argued that these trends actually encouraged obesity. Nearly all diets fail, with participants resuming their previous eating habits or even engaging in binge eating. Many then see an overall increase in their weight. If the diet is then repeated and abandoned again, a pattern of rising and falling weight is established, known as weight cycling.  Similarly those who work out but then stop can end up being heavier than those who never exercised.
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<!--T:63-->
{{w8md}}
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When healthy lifestyle changes are not enough, your doctor may treat your overweight and obesity with FDA-approved medicines. These medicines work in the following parts of your body.
===Public health and policy responses to obesity===
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On top of controversies about the causes of obesity, and about its precise health implications, come policy controversies about the correct [[policy]] approach to obesity. The main debate is between "personal responsibility" advocates, who resist regulatory attempts to intervene in citizen's private dietary habits, and "public interest" advocates, who promote regulations, on the same public health grounds as the restrictions applied to tobacco products. In the U.S., a recent bout in this controversy involves the so-called [[Cheeseburger Bill]], an attempt to indemnify food industry businesses from what some consider to be frivolous lawsuits by obese clients.  
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==Weight loss medicines== <!--T:64-->
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 +
<!--T:65-->
 +
*'''Brain.''' Several medicines change the way the brain regulates the urge to eat, which can help to decrease appetite. Some examples of these medicines are diethylpropion, phendimetrazine, lorcaserin, naltrexone/bupropion, and liraglutide.
 +
*'''Gastrointestinal tract.''' Orlistat is the only available medicine. It blocks your intestines from absorbing fat from foods in your diet.
 +
 
 +
<!--T:66-->
 +
These medicines can help you lose weight but when combined with lifestyle changes may result in greater weight loss. Some of these medicines should not be used if you have certain conditions or are taking certain medicines. Also, these medicines have side effects. Talk to your doctor if you are pregnant, planning to get pregnant, breast feeding, or have a family history of cardiovascular diseases such as high blood pressure, heart attack, or stroke.
 +
 
 +
==Weight Loss Surgery== <!--T:67-->
 +
Some patients with obesity do not respond to healthy lifestyle changes and medicines. When these patients develop certain obesity-related complications, they may be eligible for the following surgeries.
 +
 
 +
<!--T:68-->
 +
*'''Gastric bypass surgery'''. A small part of the stomach is connected to the middle part of the intestine, bypassing the first part of intestine. This decreases the amount of food that you can eat and the amount of fat your body can take in and store.
 +
*'''Gastrectomy'''. A big portion of the stomach is removed to decrease the amount of food that you can eat.
 +
*'''Gastric banding'''. A hollow band is placed around the upper part of the stomach creating a smaller stomach. This decreases the amount of food you can eat.
 +
 
 +
<!--T:69-->
 +
Talk to your doctor to learn more about the benefits and risks of each type of surgery. Possible complications include bleeding, infection, internal rupture of sutures, or even death. Read gastric bypass surgeryexternal link for more information.
 +
 
 +
<!--T:70-->
 +
Interested in learning why these surgeries lead to weight loss in some patients?
 +
 
 +
<!--T:71-->
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First, these surgeries reduce the amount of food stored in the stomach and the amount of calories your body can take in. This can help your body restore energy balance. Second, these surgeries change the levels of certain hormones and the way the brain responds to these hormones to control hunger urges. After surgery, some people are less interested in eating or they prefer to eat healthier foods. In some cases, genetic differences may affect how much weight loss patients experience after bariatric surgery.
 +
{{Blame}}
  
"Personal responsibility" advocates work on the basis that, as the [[microbiologist]] [[Rene Dubos]] once said, health ought not to be considered an end in itself, but "the condition best suited to reach goals that each individual formulates for himself" [http://www.spiked-online.com/Articles/0000000CA7A4.htm]. Any other definition permits authorities to curtail the autonomy of the self-determining individual, imposing quantity over quality of life onto them, undermining their civil liberties. As much as principled doctors, personal responsibility arguments have also been offered by food producer lobbies. In 1961, for example, as President [[John F Kennedy]] raised concerns about a lack of fitness in American society, a spokesman for the U.S. Dairy industry, Frank R. Neu, wrote [[advertorial]]s warning ''We May Be Sitting Ourselves To Death'' [http://www.theatlantic.com/issues/61nov/neu.htm]. Not food regulation, but personal exercising, is moved as the solution.
+
==Prevalence of obesity in the US== <!--T:72-->
 +
{{obesity-state}}
  
When it comes to [[childhood obesity]], personal responsibility also means parental responsibility. A survey by the nonpartisan group [[Public Agenda]] found 68 percent of American parents said it was "absolutely essential" to teach their children good eating habits, but only 40 percent believe they had succeeded. Fewer parents say it's essential to teach their children about physical fitness (51 percent), but more believe they have succeeded (53 percent). Overall, parents said they found it difficult to protect their children from negative social messages on a range of topics, including bad nutrition.
+
==Living With- Overweight and Obesity== <!--T:73-->
 +
If you have been diagnosed with overweight and obesity, it is important that you continue your treatment. Read about tips to help you aim for a healthy weight, the benefit of finding and continuing a behavioral weight-loss program, and ways your doctor may monitor if your condition is stable, worsening, or improving and assess your risk for complications.
  
 +
===- Overweight and Obesity=== <!--T:74-->
 +
Changing lifestyle habits takes time and patience. Follow these tips to help you maintain the healthy lifestyle changes your doctor recommended to aim for a healthy weight.
  
On [[July 16]], [[2004]], the [[United States Department of Health and Human Services]] officially classified obesity as a disease. Speaking to a Senate committee, [[Tommy Thompson]], the Secretary of Health and Human Services, stated that Medicare would cover obesity-related health problems. However, reimbursement would not be given if a treatment was not proven to be effective.
+
<!--T:75-->
 +
*'''Use our Daily Food and Activity Diary''' '''or the United States Department of Agriculture’s online SuperTracker'''external link to record your daily food intake and physical activity. You, your doctor, or health care provider can use this diary to monitor your progress.
 +
*'''Set specific goals.''' An example of a specific goal is to “walk 30 minutes, 5 days a week". Be realistic about your time and abilities.
 +
*'''Set doable goals that don’t change too much at once.''' Consecutive goals that can move you ahead in small steps, are the best way to reach a distant point. When starting a new lifestyle, try to avoid changing too much at once. Slow changes lead to success. Remember, quick weight loss methods do not provide lasting results.
 +
*'''Learn from your slips.''' Everyone slips, especially when learning something new. Don’t worry if work, the weather, or your family causes you to have an occasional slip. Remember that changing your lifestyle is a long-term process. Find out what triggered the slip and restart your eating and physical activity plan.
 +
*'''Celebrate your success.''' Reward yourself along the way as you meet your goals. Instead of eating out to celebrate your success, try a night at the movies, go shopping for workout clothes, visit the library or bookstore, or go on a hike.
 +
*'''Identify temptations.''' Learn what environments or social activities, such as watching TV or going out with friends, may be keeping you from meeting your goals. Once you have identified them, use creative strategies to help keep you on track.  
 +
*'''Plan regular physical activity with a friend.''' Find a fun activity that you both enjoy, such as Zumba, jogging, biking or swimming. You are more likely to stick with that activity if you and a friend have committed to it.  
  
==See also==
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===- Find and continue a behavioral weight-loss program=== <!--T:76-->
*[[Body image]]
+
Some people find it is easier to aim and maintain a healthy weight when they have support from a weight-loss specialist or other individuals who also are trying to lose weight. Behavioral weight-loss programs can provide this support, and they can help you set goals that are specific to your needs. Your weight-loss specialist usually reviews or modifies your goals every six months based on your progress and overall health.
*[[Body mass index]]
 
*[[Cardiovascular disease]]
 
*[[Childhood obesity]]
 
*[[Chubby culture]]
 
*[[Dieting]]
 
*[[Fat acceptance movement]]
 
*[[Fat admirer]]
 
*[[Feeder (fetish)|Feederism]]
 
*[[Healthy eating]]
 
*''[[Honey we're killing the kids]]''
 
*[[Human weight]]
 
*[[Junk food]]
 
*[[List of the most obese humans]]
 
*[[MOMO syndrome]]
 
*[[National Weight Control Registry]]
 
*[[Overweight]]
 
*[[Physical exercise]]
 
*[[Pickwickian syndrome]]
 
*''[[Super Size Me]]''
 
  
 +
<!--T:77-->
 +
When you are choosing a behavioral weight-loss program, you may want to consider whether the program should:
  
 +
<!--T:78-->
 +
*'''offer the service of multiple professionals,''' such as registered dietitians, doctors, nurses, psychologists, and exercise physiologists.
 +
*'''provide goals that have been customized for you''' that consider things such as the types of food you like, your schedule, your physical fitness, and your overall health.
 +
*'''provide individual or group counseling''' to help you change your eating patterns and personal unhealthy habits.
 +
*'''teach long-term strategies''' to deal with problems that can lead to future weight gain, such as stress or slipping back into unhealthy habits.
  
'''Useful weight loss articles and links'''
+
<!--T:79-->
 +
When selecting a program, you may want to ask about:
  
<span class="s1">[http://www.youtube.com/w8md  52 weeks of weight loss and wellness videos ]</span><span class="s2">  |  [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor/exercise-and-weight-loss/|<span class="s1"> Why exercise alone does not help for weight loss? </span> ]| [http://www.w8md.com/physicians-join-w8md-network-of-obesity-medicine-physicians/science-of-weight-loss|Low Fat or Low Carb Diet?] | [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor/fast-weight-loss-tips/12-ways-to-lose-weight-quickly/|12 ways to lose weight quickly  ]| [http://www.w8md.com/physicians-join-w8md-network-of-obesity-medicine-physicians/about-w8md| W8MD weight loss physicians ]  |  [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor/weight-management/weight-loss-supplements-facts-or-fiction/| Weight loss supplements ]  |  [http://www.w8md.com/nutrition_vs_physical_degeneration_dr_weston_price.pdf  Nutrition and physical degeneration by Weston Price ]</span>
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<!--T:80-->
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*the percentage of people who complete the program.
 +
*the average weight loss for people who finish the program.
 +
*possible side effects.
 +
*fees or costs for additional items such as dietary supplements.
  
 +
===- Monitor your condition=== <!--T:81-->
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You should visit your health care provider periodically to monitor for possible complications, which if left untreated can be life-threatening. Your doctor may do any of the following to monitor your condition.
  
<span class="s1">[http://www.w8md.com/w8d-healthy-living/mistakes-to-avoid/ Mistakes to Avoid]</span><span class="s2"> | [http://www.w8md.com/w8d-healthy-living/w8md-articles-and-media/ Media ] | [http://www.w8md.com/w8d-healthy-living/role-of-diet-in-inflammation/ 3 things wrong with our diet  ]| [http://www.w8md.com/w8d-healthy-living/glycemic-index-of-foods/ Insulin Resistance] | [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor Weight Loss Blog ] | [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor/fast-weight-loss-tips/8-amazing-weeks/ 8 Amazing Weeks of Weight Loss] | [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor/weight-loss-articles/ Weight Loss Articles] | [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor/fast-weight-loss-tips/ Fast Weight Loss Tips] | [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor/insurance-coverage-for-weight-loss/ Insurance Coverage] | [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor/w8md-medical-weight-loss-locations/ Locations for weight loss] | [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor/medical-weight-loss-news/ Weight loss news] [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor/medical-weight-loss-news/ weight loss news] | [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor/weight-loss-success-stories/ Success Stories] | [http://www.w8md.com/weight-loss-centers/diet-weight-loss-doctor/medical-weight-loss-videos/ weight loss videos] | [http://www.w8md.com/w8d-healthy-living/qsymia-approved-for-weight-loss medications]  | [http://www.w8md.com/w8d-healthy-living/benefits-of-losing-weight Benefits of weight loss] | [http://www.w8md.com/insurance-covered-medical-weight-loss/w8md-physicians-passion-about-weight-loss/art-of-obesity-medicine Science] | [http://www.w8md.com/how-w8md-weight-loss-works/w8md-advantage/ What makes w8md different?]  |''[http://www.4healthmag.com/obesity-medicine/3343-reduce-your-risk-of-diabetes-ditch-the-food-pyramid-and-change-to-low-glycemic-index-foods-with-adequate-protein.html Published weight loss articles] </span>
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*'''Assess your weight loss since your last visit'''. A weight loss of approximately five percent in an overweight patient may improve the function of the fat tissue and help lower bad cholesterol and other substances that can predispose to complications.
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*'''Measure your waist circumference if you are an adult'''. If your waist circumference is greater than 35 inches for women or greater than 40 inches for men, you may be at risk for heart disease, stroke, or type 2 diabetes. South Asians and South and Central Americans have a higher risk of complications, so waist circumference should be smaller than 35 for man and 31 for women. To correctly measure your waist, stand and place a tape measure around your middle, just above your hip bones. Measure your waist just after you breathe out. Visit Assessing Your Weightexternal link for more information.
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*'''Order blood tests''' to screen for complications. A lipid panel test can check if you have high cholesterol or triglyceride levels in your blood. A liver function test can determine if your liver is working properly. A fasting glucose test can find out if you have prediabetes or diabetes.
  
'''Related weight loss articles and resources:'''
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'''Also see'''
  
* [http://www.w8md.com/ w8md.com]
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* [http://www.philadelphiamedicalweightloss.com/ philadelphiamedicalweightloss.com]
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*Causes of [[weight gain]]
* [http://www.nycmedicalweightloss.com/ nycmedicalweightloss.com]
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*[[Metabolic syndrome]]
* [http://www.polytechsleepservices.com/ polytechsleepservices.com]
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*[[Insulin resistance]]
* [http://www.slumberservices.com/ slumberservices.com]
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*[[Racial disparities in obesity]]
* [http://pinterest.com/w8md pinterest.com]
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*Proven measures for [[losing weight]]
* [http://facebook.com/w8mdusa facebook.com]
 
* [http://w8md.tumblr.com/ w8md.tumblr.com]
 
* [http://twitter.com/w8md twitter.com]
 
* [http://freeweightlossdoctor.wordpress.com/ freeweightlossdoctor.wordpress.com]
 
* [https://plus.google.com/101563438136318945497/posts plus.google.com]
 
* [http://www.yelp.com/biz/poly-tech-sleep-and-w8md-weight-loss-center-philadelphia yelp.com]
 
* [http://www.quora.com/Prab-R-Tumpati quora.com]
 
* [http://www.linkedin.com/company/w8md-medical-weight-loss-centers-of-america linkedin.com]
 
* [http://storify.com/w8md/ storify.com]
 
* [https://foursquare.com/w8md foursquare.com]
 
* [http://www.zocdoc.com/doctor/prab-r-tumpati-md-43309?LocIdent=30725&reason_visit=75&insuranceCarrier=-1&insurancePlan=-1 zocdoc.com]
 
* [http://www.yelp.com/biz/sleep-medical-associates-sleep-and-w8md-weight-loss-center-new-york yelp.com]
 
* [http://www.merchantcircle.com/business/W8MDs.Insurance.Medical.Weight.Loss.And.Sleep.Clinic.-.New.York.City.718-946-5500 merchantcircle.com]
 
* [http://instagram.com/w8md instagram.com]
 
* [http://youtube.com/w8md youtube.com]
 
* [http://vimeo.com/w8md vimeo.com]
 
* [http://weightmd.blogspot.com/ <span class="s1">weightmd.blogspot.com</span>]
 
  
==External links==
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'''[[Glossary of obesity terms]]'''
  
* [http://www.who.int/topics/obesity/en/ World Health Organization] - Obesity pages
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* [http://www.who.int/nutrition/topics/dietnutrition_and_chronicdiseases/en/ Diet, Nutrition and the prevention of chronic diseases] (including obesity) by a Joint [[WHO]]/[[FAO]] Expert consultation (2003). [http://www.greenfacts.org/en/diet-nutrition/l-2/5-obesity-bmi.htm Summary] by [[GreenFacts]].
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* [http://www.endotext.org/obesity/index.htm Obesity at Endotext.org]
 
* [http://www.iotf.org/ International Task Force on Obesity]
 
* [http://www.yaleruddcenter.org/ Rudd Center for Food Policy and Obesity at Yale University]
 
* [http://www.asso.org.au Australasian Society for the Study of Obesity]
 
  
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Revision as of 19:19, 12 August 2019

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Editor-In-Chief: Prab R. Tumpati M.D.. Founder, WikiMD and W8MD Weight Loss, Sleep and MedSpa Centers.

Dr. Tumpati is board certified physician practicing sleep medicine, obesity medicine, aesthetic medicine and internal medicine. Dr. Tumpati’s passion is prevention rather than cure. As a physician with fellowship training in Obesity Medicine, Dr. Tumpati has a unique approach to wellness, weight loss, aesthetics with a focus on prevention rather than cure. Dr. Tumpati believes in educating the public on the true science and art of medicine, nutrition, wellness and beauty.

WikiMD Resources for Obesity

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Obesity

Glossary of obesity terms

Overweight and obesity are increasingly common conditions in the United States. They are caused by the increase in the size and the amount of fat cells in the body. Doctors measure body mass index (BMI) and waist circumference to screen and diagnose overweight and obesity. Obesity is a serious medical condition that can cause complications such as metabolic syndrome, high blood pressure, atherosclerosis, heart disease, diabetes, high blood cholesterol, cancers and sleep disorders. Treatment depends on the cause and severity of your condition and whether you have complications. Treatments include lifestyle changes, such as heart-healthy eating and increased physical activity, and Food and Drug Administration (FDA)-approved weight-loss medicines. For some people, surgery may be a treatment option.


Causes- Overweight and Obesity

Energy imbalances, somegenetic or endocrine medical conditions, and certain medicines are known to cause overweight or obesity.

- Overweight and Obesity

Energy imbalances can cause overweight and obesity. An energy imbalance means that your energy IN does not equal your energy OUT. This energy is measured in calories. Energy IN is the amount of calories you get from food and drinks. Energy OUT is the amount of calories that your body uses for things such as breathing, digesting, being physically active, and regulating body temperature.

Overweight and obesity develop over time when you take in more calories than you use, or when energy IN is more than your energy OUT. This type of energy imbalance causes your body to store fat.

Your body uses certain nutrients such as carbohydrates or sugars, proteins, and fats from the foods you eat to:

  • make energy for immediate use to power routine daily body functions and physical activity.
  • store energy for future use by your body. Sugars are stored asglycogen in the liver and muscles. Fats are stored mainly as triglyceride in fat tissue.

The amount of energy that your body gets from the food you eat depends on the type of foods you eat, how the food is prepared, and how long it has been since you last ate.

The body has three types of fat tissue—white, brown, and beige—that it uses to fuel itself, regulate its temperature in response to cold, and store energy for future use. Learn about the role of each fat type in maintaining energy balance in the body.

  • White fat tissue can be found around the kidneys and under the skin in the buttocks, thighs, and abdomen. This fat type stores energy, makes hormone that control the way the body regulates urges to eat or stop eating, and makesinflammatory substances that can lead to complications.
  • Brown fat tissue is located in the upper back area of human infants. This fat type releases stored energy as heat energy when a baby is cold. It also can make inflammatory substances. Brown fat can be seen in children and adults.
  • Beige fat tissue is seen in the neck, shoulders, back, chest and abdomen of adults and resembles brown fat tissue. This fat type, which uses carbohydrates and fats to produce heat, increases when children and adults are exposed to cold.

- Overweight and Obesity

Some genetic syndromes and endocrine disorders can cause overweight or obesity.

Genetic syndromes

Several genetic syndromes are associated with overweight and obesity, including the following.

  • Prader-Willi syndrome
  • Bardet-Biedl syndrome
  • Alström syndrome
  • Cohen syndrome

The study of these genetic syndromes has helped researchers understand obesity.

Endocrine disorders

Because the endocrine system produces hormones that help maintain energy balances in the body, the following endocrine disorders or tumor affecting the endocrine system can cause overweight and obesity.

  • Hypothyroidism. People with this condition have low levels of thyroid hormones. These low levels are associated with decreased metabolism and weight gain, even when food intake is reduced. People with hypothyroidism also produce less body heat, have a lower body temperature, and do not efficiently use stored fat for energy.
  • Cushing’s syndrome. People with this condition have high levels of glucocorticoids, such ascortisol, in the blood. High cortisol levels make the body feel like it is underchronic stress. As a result, people have an increase in appetite and the body will store more fat. Cushing’s syndrome may develop after taking certain medicines or because the body naturally makes too much cortisol.
  • Tumors. Some tumors, such as craneopharingioma, can cause severe obesity because the tumors develop near parts of the brain that control hunger.

Medicines such as antipsychotics, antidepressants, antiepileptics, and antihyperglycemics can cause weight gain and lead to overweight and obesity.

Talk to your doctor if you notice weight gain while you are using one of these medicines. Ask if there are other forms of the same medicine or other medicines that can treat your medical condition, but have less of an effect on your weight. Do not stop taking the medicine without talking to your doctor.

Several parts of your body, such as your stomach, intestines, pancreas, and fat tissue, use hormones to control how your brain decides if you are hungry or full. Some of these hormones are insulin, leptin, glucagon-like peptide (GLP-1), peptide YY, and ghrelin.

Risk Factors- Overweight and Obesity

There are many risk factors for overweight and obesity. Some risk factors can be changed, such as unhealthy lifestyle habits and environments. Other risk factors, such as age, family history and genetics, race and ethnicity, and sex, cannot be changed. Heathy lifestyle changes can decrease your risk for developing overweight and obesity.

- Overweight and Obesity

Lack of physical activity, unhealthy eating patterns, not enough sleep, and high amounts of stress can increase your risk for overweight and obesity.

Lack of physical activity

Lack of physical activity due to high amounts of TV, computer, videogame or other screen usage has been associated with a highbody mass index. Healthy lifestyle changes, such as being physically active and reducing screen time, can help you aim for a healthy weight.

Unhealthy eating behaviors

Some unhealthy eating behaviors can increase your risk for overweight and obesity.

  • Eating more calories than you use. The amount of calories you need will vary based on your sex, age, and physical activity level. Find out your daily calorie needs or goals with the Body Weight Plannerexternal link.
  • Eating too much saturated and trans fats
  • Eating foods high in added sugars

Visit Heart-healthy eating for more information about healthy eating patterns.

Not enough sleep

Many studies have seen a high BMI in people who do not get enough sleep. Some studies have seen a relationship between sleep and the way our bodies use nutrients for energy and how lack of sleep can affect hormones that control hunger urges. Visit our Sleep Deprivation and Deficiency Health Topic for more information about lack of sleep.

High amounts of stress

Acute stress and chronic stress affect the brain and trigger the production of hormones, such as cortisol, that control our energy balances and hunger urges. Acute stress can trigger hormone changes that make you not want to eat. If the stress becomes chronic, hormone changes can make you eat more and store more fat.

Other Risk factors

Age

Childhood obesity remains a serious problem in the United States, and some populations are more at risk for childhood obesity than others. The risk of unhealthy weight gain increases as you age. Adults who have a healthy BMI often start to gain weight in young adulthood and continue to gain weight until 60 to 65 years old, when they tend to start losing weight.

Genetic studies have found that overweight and obesity can run in families, so it is possible that our genes or DNA can cause these conditions. Research studies have found that certain DNA elements are associated with obesity.

Did you know obesity can change your DNA and the DNA you pass on to your children? Learn more about these DNA changes.

Eating too much or eating too little during your pregnancy can change your baby’s DNA and can affect how your child stores and uses fat later in life. Also, studies have shown that obese fathers have DNA changes in their sperm that can be passed on to their children.

Screening and Prevention- Overweight and Obesity

Children and adults should be screened at least annually to see if they have a high or increasing body mass index (BMI), which allows doctors to recommend healthy lifestyle changes to prevent overweight and obesity.

- Overweight and Obesity

To screen for overweight and obesity, doctors measure BMI using calculations that depend on whether you are a child or an adult. After reading the information below, talk to your doctor or your child’s doctor to determine if you or your child has a high or increasing BMI.

  • Children: A healthy weight is usually when your child’s BMI is at the 5th percentile up to the 85th percentile, based on growth charts for children who are the same age and sex. To figure out your child’s BMI, use the Center for Disease Control and Prevention (CDC) BMI Percentile Calculator for Child and Teenexternal link and compare the BMI with the table below.
  • Adults: A healthy weight for adults is usually when your BMI is 18.5 to less than 25. To figure out your BMI, use the National Heart, Lung, and Blood Institute’s online BMI calculator and compare it with the table below. You can also download the BMI calculator app for iPhoneexternal link and Androidexternal link.

Body mass index (BMI) is used to determine if you or your child are underweight, healthy, or overweight or obese. Children are underweight if their BMI is below the 5th percentile, healthy weight if their BMI is between the 5th to less than the 85th percentile, overweight if their BMI is the 85th percentile to less than the 95th percentile, and obese if their BMI is the 95th percentile or above. Adults are underweight if their BMI is below 18.5, healthy weight if their BMI is 18.5 to 24.9, overweight if their BMI is 25 to 29.9, and obese if their BMI is 30 or above. *A child’s BMI percentile is calculated by comparing your child’s BMI to growth charts for children who are the same age and sex as your child.

Healthy lifestyles

If your BMI indicates you are getting close to being overweight, or if you have certain risk factors, your doctor may recommend you adopt healthy lifestyle changes to prevent you from becoming overweight and obese. Changes include healthy eating, being physically active, aiming for a healthy weight, and getting healthy amounts of sleep. Read healthy lifestyle changes for more information

There are no specific symptoms of overweight and obesity. The signs of overweight and obesity include a high body mass index (BMI) and an unhealthy body fat distribution that can be estimated by measuring your waist circumference. Obesity can cause complications in many parts of your body.  

- Body Mass Index

A high BMI is the most common sign of overweight and obesity.

Body mass index (BMI) is used to determine if you or your child are underweight, healthy, or overweight or obese. Children are underweight if their BMI is below the 5th percentile, healthy weight if their BMI is between the 5th to less than the 85th percentile, overweight if their BMI is the 85th percentile to less than the 95th percentile, and obese if their BMI is the 95th percentile or above. Adults are underweight if their BMI is below 18.5, healthy weight if their BMI is 18.5 to 24.9, overweight if their BMI is 25 to 29.9, and obese if their BMI is 30 or above. *A child’s BMI percentile is calculated by comparing your child’s BMI to growth charts for children who are the same age and sex as your child.

- Fat distribution

Another sign of overweight and obesity is having an unhealthy body fat distribution. Fatty tissue is found in different parts of your body and has many functions. Having an increased waist circumference suggests that you have increased amounts of fat in your abdomen. An increased waist circumference is a sign of obesity and can increase your risk for obesity-related complications.

Did you know that fatty tissue has different functions depending on its location in your body?

Visceral fat is the fatty tissue inside of your abdomen and organs. While we do not know what causes the body to create and store visceral fat, it is known that this type of fat interferes with the body’s endocrine and immune systems and promotes chronic inflammation and contributes to obesity-related complications.

Obesity may cause the following complications:
  • Metabolic Syndrome
  • Type 2 diabetes
  • High blood cholesterol and high triglycerideexternal link levels in the blood
  • Diseases of the heart and blood vessels such as high blood pressure, atherosclerosis, heart attacks and stroke
  • Respiratory problems such as obstructive sleep apnea , asthma, and obesity hypoventilation syndrome
  • Back pain  
  • Non-alcoholic fatty liver disease (NAFLD)
  • Osteoarthritis, a chronic inflammation that damages the cartilage and bone in or around the affected joint. It can cause mild or severe pain and usually affects weight-bearing joints in people who are obese. It is a major cause of knee replacement surgery in patients who are obese for a long time.
  • Urinary incontinence, the unintentional leakage of urine. Chronic obesity can weaken pelvic muscles, making it harder to maintain bladder control. While it can happen to both sexes, it usually affects women as they age.
  • Gallbladder disease
  • Emotional health issues such as low self-esteem or depression. This may commonly occur in children.
  • Cancers of the esophagus, pancreas, colon, rectum, kidney, endometrium, ovaries, gallbladder, breast, or liver.

Did you know inflammation is thought to play a role in the onset of certain obesity-related complications?

Researchers now know more about visceral fat, which is deep in the abdomen of overweight and obese patients. Visceral fat releases factors that promote inflammation. Chronic obesity-related inflammation is thought to lead toinsulin resistance and diabetes, changes in the liver or non-alcoholic fatty acid liver disease, and cancers. More research is needed to understand what triggers inflammation in some obese patients and to find new treatments.

Diagnosis

Your doctor may diagnose overweight and obesity based on your medical history, physical exams that confirm you have a high body mass index (BMI) and possibly a high waist circumference, and tests to rule out other medical conditions.

- Overweight and Obesity

To diagnose overweight and obesity, doctors measure BMI using calculations that depend on whether you are a child or an adult.

  • Children: A healthy weight is usually when your child’s BMI is at the 5th percentile up to less than the 85th percentile based on growth charts for children who are the same age and sex. To figure out your child’s BMI, use the Center for Disease Control and Prevention (CDC) BMI Percentile Calculator for Child and Teenexternal link and compare the BMI with the table below.
  • Adults: A healthy weight for adults is usually when your BMI is 18.5 to less than 25. To figure out your BMI, use the National Heart, Lung, and Blood Institute’s online BMI calculator and compare it with the table below. You can also download the BMI calculator app for iPhoneexternal link and Androidexternal link. Even if your BMI is in the healthy range, it is possible to be diagnosed as obese if you have a large waist circumference that suggests increased amounts of fat in your abdomen that can lead to complications.
  • Your doctor will ask about your eating and physical activity habits, family history, and will see if you have other risk factors Your doctor may ask if you have any other signs or symptoms. This information can help determine if you have other conditions that may be causing you to be overweight or obese or if you have complications from being overweight or obese.
- Physical exam

During your physical exam, your doctor will measure your weight and height to calculate your BMI. Your doctor may also measure your waist circumference to estimate the amount of unhealthy fat in your abdomen. In adults, a waist circumference over 35 inches for women who are not pregnant or 40 inches for men can help diagnose obesity and assess risk of future complications. If you are of South Asian or Central and South American descent, your doctor may use smaller waist circumference values to diagnose your obesity. People from these backgrounds often don’t show signs of a large waist circumference even though they may have unhealthy amounts of fat deep in their abdomens and may be diagnosed with obesity. Visit Assessing Your Weightexternal link for more information.

Read Living With for more information about why it is important to monitor your waist circumference to assess your risk for complications.

- TESTS
  • Your doctor may order some of the following tests to identify medical conditions that may be causing your overweight and obesity.
    • Blood tests. Blood tests that check your thyroid hormone levels can help rule out hypothyroidism as a cause of your overweight or obesity. Cortisol and adrenocorticotropic hormone (ACTH) tests can rule out Cushing’s syndrome. Total testosterone and dehydroepiandrosterone sulphate (DHEAS) tests can help rule out polycystic ovary syndrome (PCOS).
    • Pelvic ultrasound to examine the ovaries and detect cysts. This can rule out PCOS.

Treatment

To help you aim for and maintain a healthy weight, your doctor may recommend that you adopt lifelong healthy lifestyle changes.

  • Heart-healthy eating. Learn about which foods and nutrients are part of a healthy eating pattern. It’s important to eat the right amount of calories to maintain a healthy weight. If you need to lose weight, try to reduce your total daily calories gradually. Use the Body Weight Plannerexternal link to find out your daily calorie needs and to set goals. Visit healthy recipes and plan for success. Talk with your doctor before beginning any diet or eating plan.
  • Physical activity. Many health benefits are associated with physical activity and getting the recommended amount of physical activity needed each week. Physical activity is an important factor in determining whether a person can maintain a healthy body weight, lose excess body weight, or maintain successful weight loss. Before starting any exercise program, ask your doctor about what level of physical activity is right for you. Visit Physical Activity Has Many Health Benefits
  • Healthy Sleep. Studies have shown some relationship between lack of sleep and obesity.

Making lifelong healthy lifestyle changes, such as heart-healthy eating and physical activity, can help you modify your energy balance to help you aim for and maintain a healthy weight. For example:

  • To aim for a healthy weight, or lose weight, you want your energy OUT to be more than your energy IN.
  • To maintain weight loss you want your energy IN and energy OUT to be the same.

Behavior modifications

Your doctor may recommend you enroll in individual or group behavioral weight-loss programs to treat your overweight and obesity. In these programs, a trained healthcare professional will customize a weight-loss plan for you. This plan will include a moderately-reduced calorie diet, physical activity goals, and behavioral strategies to help you make and maintain these lifestyle changes. Read Living With for more information about required follow-up for these behavioral treatment programs.

Did you know your brain’s pleasure and reward centers can be stimulated by food and the act of eating, making it harder to change eating patterns and lose weight?

Researchers know that our brains can become patterned so that we feel pleasure or reward from eating. This can make us unconsciously crave food so our bodies feel that sense of pleasure. It can also make it hard to change our eating patterns, lose weight, or maintain a healthy weight. Researchers are studying whether cognitive behavioral therapies can be an effective treatment for overweight and obesity by retraining the brain to not associate pleasure with food and the act of eating.

When healthy lifestyle changes are not enough, your doctor may treat your overweight and obesity with FDA-approved medicines. These medicines work in the following parts of your body.

Weight loss medicines

  • Brain. Several medicines change the way the brain regulates the urge to eat, which can help to decrease appetite. Some examples of these medicines are diethylpropion, phendimetrazine, lorcaserin, naltrexone/bupropion, and liraglutide.
  • Gastrointestinal tract. Orlistat is the only available medicine. It blocks your intestines from absorbing fat from foods in your diet.

These medicines can help you lose weight but when combined with lifestyle changes may result in greater weight loss. Some of these medicines should not be used if you have certain conditions or are taking certain medicines. Also, these medicines have side effects. Talk to your doctor if you are pregnant, planning to get pregnant, breast feeding, or have a family history of cardiovascular diseases such as high blood pressure, heart attack, or stroke.

Weight Loss Surgery

Some patients with obesity do not respond to healthy lifestyle changes and medicines. When these patients develop certain obesity-related complications, they may be eligible for the following surgeries.

  • Gastric bypass surgery. A small part of the stomach is connected to the middle part of the intestine, bypassing the first part of intestine. This decreases the amount of food that you can eat and the amount of fat your body can take in and store.
  • Gastrectomy. A big portion of the stomach is removed to decrease the amount of food that you can eat.
  • Gastric banding. A hollow band is placed around the upper part of the stomach creating a smaller stomach. This decreases the amount of food you can eat.

Talk to your doctor to learn more about the benefits and risks of each type of surgery. Possible complications include bleeding, infection, internal rupture of sutures, or even death. Read gastric bypass surgeryexternal link for more information.

Interested in learning why these surgeries lead to weight loss in some patients?

First, these surgeries reduce the amount of food stored in the stomach and the amount of calories your body can take in. This can help your body restore energy balance. Second, these surgeries change the levels of certain hormones and the way the brain responds to these hormones to control hunger urges. After surgery, some people are less interested in eating or they prefer to eat healthier foods. In some cases, genetic differences may affect how much weight loss patients experience after bariatric surgery.

What went wrong with our diet?

Instead of blaming the victim for obesity, or yourself for obesity, it is important to understand what drives the weight gain, such as insulin resistance that affects up to 71 percent of the entire population out of which 35 percent already have metabolic syndrome.

Confusing choices

With over 20,000 books written on this topic with so much misleading information, let a trained practicing weight loss physician, Dr Prab R. Tumpati,MD educate you on the true science and art of obesity medicine.

Why the food pyramid failed?

The now withdrawn and failed food guide pyramid was a disaster as it advocated a low fat, but glycemic diet that leads to increased risk of insulin resistance which in turn causes weight gain.

Metabolic starvation in the obese

Most people that gain weight are not on a mission to gain weight intentionally. It is the paradoxical metabolic starvation that happens in the obese due to insulin resistance with a compensatory increase in the anabolic hormone called insulin that drives weight gain, hunger and metabolic starvation leading to food cravings, and weight gain!

3 things wrong with our diet | How insulin resistance causes weight gain? | Causes of weight gain | Skin tags and insulin resistance | Sugar rush and crash | How to lose weight? | Weight loss information

Ted Talks: Why blaming the obese is blaming the victim?

52 weeks of weight loss and wellness videos

Prevalence of obesity in the US

In the United States, the prevalence of obesity was 39.8% and affected about 93.3 million of US adults in 2015, according to the data from Centers for Disease Control. Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer that are some of the leading causes of preventable, premature death. The estimated annual medical cost of obesity in the United States was $147 billion in 2008 US dollars; the medical cost for people who have obesity was $1,429 higher than those of normal weight.

Obesity statistics, strategies, and treatment options by State and Territory in the United States.

Prevalence of Self-Reported Obesity by State and Territory in the United States, BRFSS, 2017
Obesity statistics
US State Obesity Prevalence 95% Confidence Interval
Alabama 36.3 (34.7, 38.0)
Alaska 34.2 (31.4, 37.1)
Arizona 29.5 (28.5, 30.5)
Arkansas 35.0 (32.6, 37.5)
California 25.1 (23.8, 26.4)
Colorado 22.6 (21.6, 23.7)
Connecticut 26.9 (25.6, 28.1)
Delaware 31.8 (29.7, 34.0)
District of Columbia 23.0 (21.4, 24.7)
Florida 28.4 (27.0, 29.9)
Georgia 31.6 (30.0, 33.2)
Guam 34.3 (31.2, 37.6)
Hawaii 23.8 (22.4, 25.2)
Idaho 29.3 (27.5, 31.2)
Illinois 31.1 (29.5, 32.7)
Indiana 33.6 (32.5, 34.7)
Iowa 36.4 (35.1, 37.7)
Kansas 32.4 (31.5, 33.2)
Kentucky 34.3 (32.6, 36.0)
Louisiana 36.2 (34.4, 38.1)
Maine 29.1 (27.7, 30.6)
Maryland 31.3 (30.0, 32.6)
Massachusetts 25.9 (24.1, 27.7)
Michigan 32.3 (31.1, 33.4)
Minnesota 28.4 (27.5, 29.4)
Mississippi 37.3 (35.3, 39.3)
Missouri 32.5 (30.9, 34.0)
Montana 25.3 (23.8, 26.9)
Nebraska 32.8 (31.6, 34.0)
Nevada 26.7 (24.5, 29.0)
New Hampshire 28.1 (26.3, 29.9)
New Jersey 27.3 (25.8, 28.7)
New Mexico 28.4 (26.8, 30.0)
New York 25.7 (24.6, 26.9)
North Carolina 32.1 (30.4, 34.0)
North Dakota 33.2 (31.6, 34.7)
Ohio 33.8 (32.5, 35.1)
Oklahoma 36.5 (34.9, 38.1)
Oregon 29.4 (27.9, 30.9)
Pennsylvania 31.6 (30.0, 33.2)
Puerto Rico 32.9 (31.0, 34.9)
Rhode Island 30.0 (28.1, 31.9)
South Carolina 34.1 (32.8, 35.4)
South Dakota 31.9 (29.8, 34.1)
Tennessee 32.8 (31.1, 34.6)
Texas 33.0 (31.2, 34.9)
Utah 25.3 (24.2, 26.4)
Vermont 27.6 (26.0, 29.2)
Virginia 30.1 (28.7, 31.4)
Washington 27.7 (26.6, 28.7)
West Virginia 38.1 (36.4, 39.7)
Wisconsin 32.0 (30.3, 33.8)
Wyoming 28.8 (27.1, 30.6)

Living With- Overweight and Obesity

If you have been diagnosed with overweight and obesity, it is important that you continue your treatment. Read about tips to help you aim for a healthy weight, the benefit of finding and continuing a behavioral weight-loss program, and ways your doctor may monitor if your condition is stable, worsening, or improving and assess your risk for complications.

- Overweight and Obesity

Changing lifestyle habits takes time and patience. Follow these tips to help you maintain the healthy lifestyle changes your doctor recommended to aim for a healthy weight.

  • Use our Daily Food and Activity Diary or the United States Department of Agriculture’s online SuperTrackerexternal link to record your daily food intake and physical activity. You, your doctor, or health care provider can use this diary to monitor your progress.
  • Set specific goals. An example of a specific goal is to “walk 30 minutes, 5 days a week". Be realistic about your time and abilities.
  • Set doable goals that don’t change too much at once. Consecutive goals that can move you ahead in small steps, are the best way to reach a distant point. When starting a new lifestyle, try to avoid changing too much at once. Slow changes lead to success. Remember, quick weight loss methods do not provide lasting results.
  • Learn from your slips. Everyone slips, especially when learning something new. Don’t worry if work, the weather, or your family causes you to have an occasional slip. Remember that changing your lifestyle is a long-term process. Find out what triggered the slip and restart your eating and physical activity plan.
  • Celebrate your success. Reward yourself along the way as you meet your goals. Instead of eating out to celebrate your success, try a night at the movies, go shopping for workout clothes, visit the library or bookstore, or go on a hike.
  • Identify temptations. Learn what environments or social activities, such as watching TV or going out with friends, may be keeping you from meeting your goals. Once you have identified them, use creative strategies to help keep you on track.  
  • Plan regular physical activity with a friend. Find a fun activity that you both enjoy, such as Zumba, jogging, biking or swimming. You are more likely to stick with that activity if you and a friend have committed to it.  

- Find and continue a behavioral weight-loss program

Some people find it is easier to aim and maintain a healthy weight when they have support from a weight-loss specialist or other individuals who also are trying to lose weight. Behavioral weight-loss programs can provide this support, and they can help you set goals that are specific to your needs. Your weight-loss specialist usually reviews or modifies your goals every six months based on your progress and overall health.

When you are choosing a behavioral weight-loss program, you may want to consider whether the program should:

  • offer the service of multiple professionals, such as registered dietitians, doctors, nurses, psychologists, and exercise physiologists.
  • provide goals that have been customized for you that consider things such as the types of food you like, your schedule, your physical fitness, and your overall health.
  • provide individual or group counseling to help you change your eating patterns and personal unhealthy habits.
  • teach long-term strategies to deal with problems that can lead to future weight gain, such as stress or slipping back into unhealthy habits.

When selecting a program, you may want to ask about:

  • the percentage of people who complete the program.
  • the average weight loss for people who finish the program.
  • possible side effects.
  • fees or costs for additional items such as dietary supplements.

- Monitor your condition

You should visit your health care provider periodically to monitor for possible complications, which if left untreated can be life-threatening. Your doctor may do any of the following to monitor your condition.

  • Assess your weight loss since your last visit. A weight loss of approximately five percent in an overweight patient may improve the function of the fat tissue and help lower bad cholesterol and other substances that can predispose to complications.
  • Measure your waist circumference if you are an adult. If your waist circumference is greater than 35 inches for women or greater than 40 inches for men, you may be at risk for heart disease, stroke, or type 2 diabetes. South Asians and South and Central Americans have a higher risk of complications, so waist circumference should be smaller than 35 for man and 31 for women. To correctly measure your waist, stand and place a tape measure around your middle, just above your hip bones. Measure your waist just after you breathe out. Visit Assessing Your Weightexternal link for more information.
  • Order blood tests to screen for complications. A lipid panel test can check if you have high cholesterol or triglyceride levels in your blood. A liver function test can determine if your liver is working properly. A fasting glucose test can find out if you have prediabetes or diabetes.

Also see

Glossary of obesity terms

Portions of content adapted from Wikipedias article on Obesity licensed under GNU FDL.

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