Obesity — A Fast Growing Problem

One of the fastest growing epidemics in the United States today is obesity. Over 165 million Americans, ages 20 and up, are considered overweight and more than 62 million Americans are considered obese. The implications on health care in America are staggering. It may soon surpass smoking as the number one most preventable cause of death in America. Isn’t it ironic that in the United States we have people dying of obesity while in other parts of the world, people are dying of starvation?

The Body Mass Index (BMI) is used to determine weight classification. The BMI is a measure of an adult’s weight in relation to his or her height, more specifically the adult’s weight in kilograms divided by the square of his or her height in meters. The classification is as follows:

Healthy Weight: BMI > 18.5 to < 25
Overweight: BMI = 25
Obesity: BMI = 30

Obesity trends in the USA and around the world have risen dramatically over the past 20 years. Why? A tendency toward obesity is fostered by our environment today — a lack of physical activity, combined with high calorie and low cost foods. The number of overweight and obese children and adolescents is rising parallel with adults. Early obesity in children increases the risk of adult obesity and weight-related risk factors for cardiovascular disease, high blood pressure and Type 2 diabetes. Participation in high school physical education classes declined in the 1990s, from 34.2% of students physically active for 20 minutes or more per day in 1991 to 21.7% in 1997. Walking and bicycling by children aged 5 to 15 years declined 40% between 1977 and 1995, while time spent in sedentary activities such as watching television, playing video games, or using a computer has increased. The No Child Left Behind Act was introduced in schools to increase scholastic scores, however physical education funding has been cut.

Obesity and a sedentary lifestyle have an enormous impact on public health. There are over 300,000 premature deaths caused by diseases associated with obesity. Obesity increases one’s risk of developing high blood pressure, heart failure, coronary artery disease, strokes, colon cancer, gallbladder cancer and most importantly, Type 2 diabetes. One study estimates the costs associated with treating major disorders related to obesity cost the nation as much as $102 billion in 1999. Obesity and inactivity accounted for 9.4% of all US direct health care costs, (comparable to cigarette smoking). The benefits of weight loss and increased physical activity are substantial. Studies show that by losing at least 10 lbs and maintaining that loss for 36 months, people would see a decrease in their blood pressure. Even a modest weight loss is associated with improvements in cholesterol, glucose tolerance and/or insulin resistance, and sleep apnea.

Physical activity has similar benefits. Aerobic exercise has also been found to reduce blood pressure. Regular physical activity increases HDL cholesterol (good cholesterol) and decreases triglyceride levels. Higher physical activity can also decrease the risk of Type 2 diabetes. You should work with your doctor to set a reasonable weight loss target — usually 5-10% below your current weight at a rate of 0.5 to 2 lb lost per week. This is best achieved by restricting intake through eating smaller portion sizes, minimizing snacks and desserts, taking advantage of lower fat and lower-calorie food choices, and increasing physical activity. Physical activity includes exercising 30 minutes 5-7 days per week. Strength training is recommended as well. A patient with a starting BMI of 30 or higher (or BMI 27 with another disease such as high blood pressure or diabetes) whose weight does not respond after 6 months may be a candidate for medical intervention.

Bariatric surgery may be an option for severely obese patients when efforts of lifestyle modification and drug therapy have failed. Unfortunately we have very few medications available to treat obesity. There are many "weight loss medications" at the local supermarket and on the TV. These non-FDA approved medications will often take your money and eventually take away your spirit as well. The FDA approved medications are Sibutramine and Orlistat. Sibutramine affects chemicals in our body that affect weight management. There are many side affects with this medication and failure rate is high. Orlistat, which is now approved for over-the-counter, inhibits fat absorption when we eat. It also has many unpleasant side effects such as abdominal pain, bloating and diarrhea. We all need to educate our children about the importance of exercise and maintaining a healthy diet. Start in your own home and make some lifestyle changes. Truly the best way to lose weight is the "old fashioned" way — with exercise and a well balanced diet.