Obesity: causes, effects, and health interventions

Obesity in America

Introduction to Obesity

Causes and Effects of Obesity

Treatment and Programs for Obesity

Obesity Prevention: Conclusions and Recommendations

Obesity

Introduction to Obesity

While it is common knowledge that many Americans are overweight, many people are surprised to hear that the number of people who are severely obese (at least 100 pounds overweight) has quadrupled since 1986, according to research (Gilles, 2003). Approximately one in every 50 adults is severely overweight. Results of a recent report indicate that severe obesity is not as rare as once believed.

Obese people have a high risk of heart disease (Texas Heart Institute, 2004). This is alarming when we consider than one-third of all Americans is obese. Recent studies have shown that obesity is linked to 280,000 deaths in the United States every year, making it second only to cigarette smoking as a leading cause of death.

The human body is made up of water, fat, protein, carbohydrates, vitamins, and minerals. Obesity simply means that one has too much body fat (Texas Heart Institute, 2004). The size of one's waistline is one way to measure body fat. A high-risk waistline is considered more than 35 inches for women and more than 40 inches for men. Another way to measure obesity is body mass index (BMI), which is a formula of weight in kilograms divided by height in meters squared (BMI =kg/m2).

Physicians use BMI, which compares an individual's weight with his or her height, to determine obesity (Gilles, 2003). An obese person has a BMI of 30 or higher. People with a BMI of 40 or more are severely obese.

According to the National Health and Nutrition Examination Survey (NHANES), in 2000, the majority of American adults were either overweight or obese (CDCP, 2004). Obesity is best defined as an excessively high amount of body fat or adipose tissue in relation to lean body mass. (Stunkard, p14) the amount of body fat (or adiposity) includes concern for both the distribution of fat throughout the body and the size of the adipose tissue deposits. Body fat distribution can be measured by skinfold measures, waist-to-hip circumference ratios, or a variety of other techniques, including ultrasound, computed tomography, and magnetic resonance imaging.

The percentage of children and adolescents who are considered overweight has more than doubled since the early 1970s (CDCP, 2004). About 15% of children and adolescents are now overweight. Despite the public health impact of obesity and overweight, these conditions were not major public health priority in the past. Reversing the increasing trend of the obesity epidemic is something that requires effective collaboration among government, voluntary, and private sectors, as well as a commitment to action by individuals and communities in the United States.

Causes and Effects of Obesity

Experts believe the increasing number of people who are obese in the United States is due to a combination of genetics, environmental factors, and psychological issues (Gilles, 2003). While obesity is often a genetic issue, such lifestyle behaviors as overeating and lack of physical activity also play a role. Psychological factors may also influence eating habits, causing people to eat in response to a variety of negative emotions, including boredom, sadness, or anger.

Because of the increasing rate of obesity in the United States, health officials are becoming more active in the fight against obesity (Gilles, 2003). According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than 60% of Americans over the age of 20 are overweight, and 25% are obese. About 280,000 people die every year of obesity-related conditions.

Severe obesity puts people at serious risk for the following health hazards (Gilles, 2003):

Diabetes

Heart disease

High blood pressure

Stroke

Cancer

People who are severely obese tend to use healthcare services more frequently because many already have one or more chronic conditions (Gilles, 2003). For this reason, and many others, it is in the best interests of national leaders to make efforts to reduce obesity.

It is no longer believed that obesity is caused by a lack of willpower when it comes to eating and laziness when it comes to exercising (Medical Network, 2004). Despite the fact that the basis of obesity is not fully understood, the condition has been recognized since 1985 as a chronic disease caused by numerous factors.

For some people, the cause of obesity is clear: they consume more calories than they burn during exercise and daily life (Texas Heart Institute, 2004).

Another cause of obesity is aging (Texas Heart Institute, 2004). As we get older, our bodies cannot burn energy as quickly, and people do not need as many calories. For this reason, people who eat the same way and do the same activities as they did when they were 20 find that they suddenly gain weight when they get older.

Gender plays a role in obesity, as well (Texas Heart Institute, 2004). Men burn more energy at rest than women, so men require more calories to maintain their body weight. Women usually gain weight after menopause because their ability to burn energy drops even further.

Obesity is genetic (Medical Network, 2004). If a person's parents are obese, his obesity risk is raised because genes determine one's body shape and, in many cases, one's weight. However, just because a person is at risk for obesity does not mean that he will definitely be obese. By learning to control one's diet and exercise habits, one can prevent obesity. Sometimes, medication or surgery also can prevent or treat obesity.

Foods that are high in fat are major contributors to obesity. According to the Medical Network (2004): "Hot dogs, Big Macs, french fries, macaroni and cheese, nachos, potato chips, ice cream -- all these high-fat American favorites are cheap, accessible and delicious. Is it any surprise that fatty foods are contributing to the soaring obesity rates in this country?"

An inactive lifestyle is another major cause of obesity (Medical Network, 2004). Those who spend most of their time sitting on the couch or at their desk have a higher risk for obesity. Likewise, the risk is higher for people whose fat intake is more than 30% of their daily caloric intake. Studies show that people who exercise 20-30 minutes per day are less likely than sedentary people to be obese. One's obesity risk is even lower when he has an active lifestyle and a low-fat, low-calorie diet.

Another cause of obesity is a slow metabolism (Medical Network, 2004). The metabolic rate is the rate at which the human body uses food as a source of energy. Someone with a slow metabolism is more likely to store excess calories in the form of fat. These people need to work harder at losing weight. However, weight loss efforts may ultimately increase one's metabolic rate. Muscle burns more calories than fat, even when one is sedentary. Thus, reducing fat and building muscle through weight-bearing exercise helps burn calories more efficiently.

Last but not least, psychology plays a key role in obesity (Medical Network, 2004). Many people have reported that they overeat or binge when they feel stressed or depressed. According to research, approximately 30% of obese people are binge eaters. According to psychotherapist Shelia Harbet, Ph.D., overeating temporarily relieves the stress of negative feelings. Unfortunately, bingeing is often followed by feelings of guilt, shame, disgust and depression. "Often, binge-eating episodes are followed by resolutions by the compulsive overeater to stop bingeing and adhere to diets," says Harbet, a professor in the department of health sciences at California State University, Northridge (Medical Network, 2004). "These resolutions are eventually broken, filling compulsive eaters with guilt and depression, leading them back to binge eating again."

Treatment and Programs for Obesity

Treatment for obesity differs, depending on one's BMI and other health considerations (Gilles, 2003). Obesity treatments include a combination of diet, exercise, behavior modification to address habitual patterns, and, in many cases, the use of weight-loss drugs. In people who are severely obese, gastrointestinal surgery is sometimes recommended to drastically reduce the absorption of food. However, approximately 10% of those having this surgery experience serious complications.

According to Gilles (2003): "A less invasive method that may soon be available to treat severe obesity involves the use of what's known as a gastric stimulator. This is a device about the size of a silver dollar that is implanted in the wall of the stomach during outpatient surgery and acts like a pacemaker to reduce feelings of hunger. Research has shown that people using this device lose, on average, 50 pounds over the course of a year. The device is currently available in Europe, but has not been approved for use in the United States."

According to the Texas Heart Institute (2004): "Obesity is usually treated with lifestyle changes, including diet and exercise. Many doctors have changed the way they approach their patients' weight loss. Studies have shown that even a modest weight loss -- 10% of body weight -- can reverse some of the risks of obesity. Rather than having patients set goals that they might not be able to achieve, this "10% solution" has become the goal of most treatment programs. In some cases, doctors can prescribe weight-loss medicines along with a program of diet and exercise."

Researchers believe that anyone with a BMI of 30 or higher can improve his health through weight loss (Gilles, 2003). This is particularly true for those who are severely obese. Sometimes a weight loss of just 5 to 10% can vastly improve health by lowering blood pressure and cholesterol levels.

An increase in physical activity is one highly recommended form of treatment for obese people (Pories et al., 1995). Exercise increases energy expenditure, improves health conditions, combats depression, and helps maintain weight loss. In most cases, 30 minutes of moderate-intensity physical activity is recommended most days of the week. In a study of women who had regained lost weight compared to those who maintained their weight loss, researchers found that 90% of maintainers engaged in vigorous exercise at least three times per week for at least 30 minutes, whereas only 34% of the regainers reported this level of activity.

Surgery for obesity is another common treatment. It alters the stomach or the intestines so that the person digests less food or is satisfied with less food (the Center for the Study and Treatment of Obesity, 2004). These operations have improved over the years and are now considered a safe and acceptable way to help obese people lose weight and maintain weight loss.

Like all operations, surgery for weight loss is risky, and for that reason, surgery is recommended only for morbidly obese persons (BMI greater than 40, or greater than 35 if the person has serious obesity-related medical problems) (the Center for the Study and Treatment of Obesity, 2004). According to Valley Health, patients usually lose 50% of their excess weight during the first 12 to 18 months following surgery. Five years after surgery, the success rate is 70% to 80%.

Obesity Prevention: Conclusions and Recommendations

Obese children are more likely to be obese as adults (Texas Heart Institute, 2004). Researchers believe that the fat cells gained as children stay with adults. Obese children may have five times more fat cells than children of normal weight. Dieting in adulthood decreases the fat-cell size but not the actual number of fat cells.