Obesity: Public Enemy Number One

The Definition of Obesity is an excess accumulation of body fat of, usually 20% or more over an individual's ideal body weight. Obesity is a chronic disorder and associated with a multitude of medical disorders, including early death. Obesity does have various classifications: those who are 20-40% over their ideal weight are considered mildly obese, those over 40-100% over ideal weight are moderately obese and those over 100% over ideal weight are morbidly obese. Today, these arbitrary numbers are rarely used and a measurement called BMI (Body mass index) is used where the weight is compared to the height. When the BMI is over 30, one is considered obese. Today obesity has reached epidemic proportions not only in North America, but in Europe as well as Asia. However, obesity in america is rampant with Obesity Statistics indicating that nearly 60% of all Americans are overweight. One thing that has been acknowledged is that drugs may not be the answer in controlling the obesity epidemic and a change in life style is mandatory. Therefore, along with these weight loss physicians, there has been an explosion of nutritionists, exercise gyms, herbal therapists, psychologists, spiritualists, yogis and a whole host of other experts- all who have been burdened with solving Americas number one health problem. The majority of these so called experts are in the business to make money and Quack therapy is very prevalent in the obesity business. All the excess weight may be good to prevent one from feeling cold, but apart from this benefit, obesity is a life threatening illness and associated with diabetes, arthritis, hypertension infertility and even cancer. Obesity has now overtaken smoking as the number one public health problem. The sad obesity facts show that at least 300,000 deaths are directly attributed to obesity and countless more complications go unreported. Get the obesity help you need and change your life around today.

In simple obesity occurs when there are more calories consumed than the body burns and these excess calories are stored as fat. Why this happens is not known but Research on Obesity indicate that there are several reasons:

Genetics: when something can’t be explained in medicine, we always blame genes. The role of genes is still being debated in obesity- we do, however, know that obesity is increased in an individual if any other members of the family are obese. However, despite what the genes say, one can also become thin if one makes an effort.

Age: As one gets older one tends to become less active and weight gain does occur. In addition, the metabolism of food is also slowed in the elderly.

Sex: Females generally are more obese than men. Women tend to have less muscle and more fat deposits.

Diet: Eating and binging on everything in site is the most common cause of obesity. Pizza, hamburgers, steak and the likes are not good on a daily basis. In North America, we have too many individuals who spend the entire day eating and drinking. Genes are not the cause of obesity, just eating foolishly.

Inactivity: We have become a nation of couch potatoes and next to eating too much, this is the second most common contributory cause of obesity. Seating on couch does not burn calories nor does it build any muscles, but will sure bring out your hemorrhoids. Make sure to vary up your routine and don’t allow yourself to become a candidate to obtain morbid obesity.

Smoking: When individuals who smoke quit smoking they gain weight. Smoking is the number one evil in this universe and obesity is a close second. And smoking and obesity combined is definitely going to make your life miserable, sooner or later- so quit smoking and start walking

Pregnancy: A transient cause of weight gain is pregnancy. Most women who get pregnant do tend to put on weight. Some get rid of this excess weight after delivery and some do not. Those who have difficulty with weight loss after delivery should resume exercise because if the weight is not shed, it is very difficult to get rid of it later.

Medications: Certain medications such as corticosteroids and tricyclic anti depressants can lead to weight gain. The weight gain however, is reversible and disappears once the pills are stopped.

Medical disorders: Some medical conditions can also cause obesity and the most common is hypothyroidism, or an excess of hormones from the adrenal gland (Cushing’s syndrome). Another very common cause of weight gain is polycystic ovarian syndrome.

The major symptoms of obesity are related to its complications. Obesity affects almost every organ in the body and leads to several conditions including: - osteoarthritis - back and muscle pain - groin and abdominal hernias - reflux and heart burn - Asthma. - Oral cavity and dental disease - Hypertension - Diabetes - High cholesterol - Gall stones - Amenorrhea - Decreased fertility - Sleep apnea - Pulmonary hypertension - Depression - Skin fold infections

The diagnosis of obesity is straightforward, unless the physician is blind. Ideally, BMI is calculated. This involves the use of height versus weight ration to calculate a patient’s risk of developing obesity related complications. Other ways to measure body fat content involves the use of calipers to measure skin fold thickness in the back of the upper arm. There are other methods to determine fat content. Women whose body fat exceeds 30% and men whose body fat exceeds 25% are generally considered obese. Doctors may also observe the distribution of fat on the individual. Men usually develop and "Apple-shaped" body with weight around the abdomen and waist. These individuals are generally more prone to a higher risk for cancer, heart disease, stroke, and diabetes than "pear-shaped" females whose extra pounds settle primarily in their hips and thighs.

Treatment of obesity is not as simple as it sounds. It depends on a number of factors; the most important are the individual’s health status and his weight. The treatment is a life long commitment and requires drastic changes in one lifestyle. One must have a realistic goal and not some whimsy washy view point by watching all those males in TV ads. If there is no firm commitment to weight loss, you can rest assured that all the hard work you put to lose whatever number of pounds, is soon going to come back. Weight loss is a serious issue and must be undertaken with that perspective in mind. The goal of obesity treatment is to achieve and maintain a healthier weight. The amount of weight you need to lose to improve your health does not mean shedding all the excess weight. In some cases, even just a 5-10% weight loss can bring health improvements. That means that an individual weighing 200 lbs can lose 10-20 pounds and feel better. This is the starting point. Unfortunately, most individuals are unrealistic and expect a weight reduction of 100 pounds in a few months. The trick is to lose a few pounds every month, continue the same process and be patient. Achieving a healthy weight is usually done through dietary changes, increased physical activity, behavior modification, drugs and surgery.

Behavior focused treatments teach an individual on what and how much one eats, how to respond to food cravings, and incorporating physical activity. These are an integral part of everyday life and a key to achieving and maintaining weight loss. One has to start slowly and build stamina. Varying routines and trying newer exercises also prevents one from getting bored and discouraged. For those mildly obese individuals, the behavior changes entail life-style changes and do require supervision from a health care worker (while you are trying to dump the weight, doctors want to load their pockets).

There are weight watcher programs across the entire country. These programs are more suitable for the mildly obese individual. Every mall has these weight watcher programs and one can find coupons to enroll in every piece of junk mail. The most difficult thing is to asses how effective these programs are. There are numerous anecdotal reports of individual having lost weight but these individuals are only seen on TV and never in real life (and they get paid to do that commercial). In general, these programs do little except take the weight of money away from your pockets. All data indicate that drop rates are very high, the programs are never supervised by any health care professional and there is no quality control. The only thing all these programs have in common is the posh interior, a fancy new machine with numerous gadgets and numbers and an expensive joining fee. These programs have been in existence since time immemorial- do you not think that if these programs were effective we would have cured obesity by now? On the positive side, these programs do educate the obese individual about their diet and lifestyle. However, they promise the sky just so that the customer remains happy and continues with the membership- money my friends keep the world going round. Unfortunately, many physicians have also opened the same type of fitness and exercise parlors- the only difference is that they supervise the program. These programs are more suitable for the moderately obese. The physician typically employs a dietician and physiotherapist and even a psychologist. In addition, the doctors also encourage low calorie diets for prolonged periods. The results of these doctor supervised parlors are about the same as the non physician supervised spas but also albeit, more expensive. Again there is high drop rate and long term follow up usually reveals that most individuals only lose a few pounds here and there (a lot more from their pockets than elsewhere).

The control of obesity with drugs has been a major struggle for more than 3 decades. All types of drugs have been used in the past to treat obesity. In the past, thyroid hormone and diuretics were often used inappropriately. Other dangerous drugs such as dinitrophenol and amphetamines were also prescribed and caused serious side effects. With a better understanding of obesity in the 1980s, different types of weight loss drugs were manufactured. Drugs like fen-phen helped individuals continue to maintain their weight loss. However, the drug was associated with serious cardiac side effects and its use has been banned universally. There are various guidelines and most recommend that drug therapy for weight loss should start when an individual has a body mass index (BMI) of > 27 or those who have obesity-related risk factors or co-morbidities, and in obese patients whose life style is severely affected. Under certain circumstances, weight loss drugs may also be effective for other patients. Some physicians also consider using obesity medications to patients with a BMI above 25 who have not responded to a rigorous program combining behavior modification, dietary changes and exercise. Over the last 4 decades, numerous drugs have come and gone as the cure for obesity. There are infact numerous drugs but the concern over their safety has led to their withdrawal from the market. The majority of these drugs act in the brain by affecting neurochemicals which stimulate appetite. They are effective in decreasing weight but as soon as they are stopped the weight is regained. And thus, they have to be taken in continuously. Anti-obesity medications fall into two broad categories based on how they help patients fight fat. One group helps reduce food intake, while the other prevents fat absorption. Since then, two new drugs with different mechanisms of action have been approved for use by the FDA. Sibutramine (Meridia) is a serotonin-norepinephrine reuptake inhibitor acts on the appetite center in the brain, and orlistat (Xenical) is a pancreatic lipase inhibitor and inhibits the absorption of fat from the abdomen. However, these drugs do have side effects and their long term complications remain unknown. At present we have a huge gap in our armamentarium to treat obesity.

Bariatric surgery offers some advantages over drugs for treatment of obesity. The benefit of obesity surgery is that it can cause rapid weight loss and therefore rapidly improves the symptoms of obesity. The majority of individuals who undergo surgery claim that the weight loss is much greater than with the use of drugs. In addition, there is no guarantee of weight loss with drugs and over time the drugs are expensive and have significant side effects.

All physicians agree that clinical features alone are not adequate regarding the decision to undergo surgery. Over the years, a few guidelines have been offered in the selection of patient and these include: - Patients who have failed drug therapy - Patients who have tried other non surgical methods to lose weight and failed - Patients who have a BMI in excess of 40 kg/m2 - Patients with a BMI between 35 and 40 kg/m2 along with more than one high-risk co-morbid condition, such as severe diabetes, or poor function. For those patients who have medical coverage, the criteria for weight loss surgery are more stringent and include: - a body weight more than 100% above ideal body weight - weight-related co-morbidities - Failed attempts at nonoperative, medically supervised weight-loss programs. These criteria are guidelines only, however, and physicians need to evaluate the expected health benefits and acceptable risks of bariatric surgery for the individual patient. All individuals have to have realistic goals and must have a commitment towards weight reduction.

The absolute contraindications to bariatric surgery are: - psychotic illness - active substance abuse - defined noncompliance with previous medical care - Other psychiatric conditions, including borderline personality disorder - uncontrolled depression - patients who are at high risk of heart disease Bariatric surgery requires a strong commitment and can interfere with various aspects of one’s social life and eating habits. A commitment towards weight loss means having to sacrifice friends, family, food and adopt a rigid life style.

There are three general types of bariatric surgery for obesity: restrictive, malabsorptive, and combined restrictive and malabsorptive. Restrictive (Limiting intake or altering digestion) The restrictive procedures limit food intake by decreasing the size of the stomach so that there is a sensation of "fullness" (or pain) occurs after ingestion of small amount of food. Gastric banding Gastric banding involves no suturing, stapling or cutting of the stomach; rather a strip of plastic band is placed around the upper part of the stomach to limit entry of food into the stomach. The new stomach pouch formed usually fills quickly with food but emptied very slowly, giving a sensation of food in the stomach at all times. Over eating can cause pain or vomiting. Individuals who undergo gastric banding can expect to lose up to 60 pounds or more in one year. The duration of weight loss and number of pounds lost, however, is variable. Malabsorptive procedures Malabsorptive procedures alter and divert the digestion process, thus causing food to be poorly digested, incompletely absorbed and the majority is excreted in the stool. There are numerous variations for creation of malabsorption. The stomach is not removed but is bypassed using various surgical techniques. The principle behind restrictive surgery is to create a small gastric reservoir that forces the patient to eat less at any one time. The surgery is done to reduce the stomach size and leave only a small channel to allow for food to pass through. Malabsorptive bypass procedures in general produce more weight loss than restrictive operations and are more effective in reversing the health problems associated with severe obesity. Patients who have malabsorptive operations generally can lose > 75-150 pounds within 1-2 years. The weight loss generally continues for 1½ years before stabilizing. Unlike older bypass procedures that involve removal of the stomach, current procedures pose fewer operative risks.

Older bariatric surgery procedures required a long midline abdominal incision and the post operative recovery was about 4-6 weeks long. Today, minimally invasive surgical techniques are available that enable the doctors to perform both restrictive and malabsorptive bariatric procedures without making big incisions in the abdomen. The minimally invasive approach achieves results comparable to those associated with open surgery, but with less post-operative pain and rapid recovery. Patients who undergo minimally invasive bariatric surgery can expect to return to work 1-2 weeks after undergoing surgery.

Despite many hospitals and surgeons claiming that the risks of bariatric surgery are rare, this is false. Patient data are not always available and anecdotal data suggest that complications are frequent and occasionally serious. Surgery for weight reduction isn't a miracle procedure. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after gastric bypass surgery depends on your commitment to making lifelong changes in your eating and exercise habits.

It seems one can’t treat anything in medicine without herbs. Herb mania is a North America fad without any scientific backup. Over the years, almost every herb under the sun has been claimed to decrease weight. Yet the search for Shangri La goes on. A few herbs have been noted to decrease weight and include Ephedra: This Chinese herb (Ephedra sinica), has been shown to be effective in reducing weight when combined with a low fat diet and exercise. However, ephedra also has numerous side effects which include: - anxiety, nervous - palpitation - increased blood pressure - chest pain or heart attack - lack of sleep - seizures Ephedra should not be used by anyone with a history of diabetes, heart disease, or thyroid problems. In fact, the American Medical Association has strongly advised against the use of ephedra. Other herbs used to decrease body weight include diuretic herbs which increase urine production, laxatives (psyllium, Metamucil), red peppers and mustard. In each of these cases, the weight loss is either from excess water loss from the body or a lot of POOP excreted from the bowel. All this accounts for the weight loss seen with these herbs- nothing magical about that but is sure associated with a lot of physiological problems including dehydration and electrolyte deficiencies. Recently herbs from china have found to be contaminated with pharmaceutical medications to produce the real effect and trick the customer- so buyer beware.

There are numerous other homeopathic and alternative methods which have been postulated to treat obesity. This includes acupressure, acupuncture, aromatherapy, massage, yoga, electrical shock therapy, music and colon hydrotherapy. Whatever makes money is always a cure for something.

Unfortunately, no matter what we see on the Oprah or Maury show, the majority of dieters regain the weight they lose over time. There is no doubt that a few individuals do lose weight, but in the long term, many do regain it. The major reason for the weight gain is going back to the sedentary life style and no exercise.

If you really want to prevent weight gain, the best approach is to focus on lifestyle changes and develop an eating plan that's enjoyable, yet healthy and low in calories. This approach results in weight loss that you can live with — that is, that you can maintain over a long period of time. With childhood obesity rates rising, it is important that you also take these preventative measures for your children, if you have any. Exercise: This most hated part of our life is essential if one is to maintain a decent weight. One should not go overboard and join every exercise club. Just simple walking twice a day should be adequate. For those who are more active, any exercise including swimming, jogging and aerobics is helpful Healthy eating: The major problem with most obese individuals is that they eat too much and then blame genes. Eat healthy meals that consist of vegetables and fruits. Sure eating meat products is fun and enjoyable, but this should be reserved as a delicacy. If the calories are limited, then weight gain can be avoided Monitor your weight regularly: weigh your self regularly but do not become obsessive. Weight monitoring should be a fun and not cause any anxiety or apprehension. Those who regularly monitor their weight generally are successful in keep weight off Realistic and consistent: Preventing weight gain requires a lot of work and determination. Like everything else in life, weight gain requires consistency and determination and there should be no exceptions. Do not go binge eating and drinking on every birthday, vacation and holiday- this does not help. The only way to prevent obesity is to cut down what one eats and exercise, at least a little bit. This simple fact does not require a brain of a NASA scientist for understanding. Cutting down on calories is the key, but unfortunately, we have failed at that. It appears the desire to eat has taken over the mind. There are new diets on the market, millions of books and dieticians all telling these individuals what to eat and what not to. It does not matter what one eats- the main thing is eat less and walk more. Keeping a diary and checking how many calories are present on each food label and going crazy about what type of fats are present, is all a bunch of nonsense. Walking a little, eating a little and avoiding nonsensical advice will get the obese patient the result he wants- if he is patient. The problem is that our society wants results instantly and if those are not readily coming, they seek some type of therapy- only to lose their money at the end of it.

Obesity carries a lot of emotional baggage and many individuals go through difficult times. Our society is not kind to obese individuals and the repercussions are high- both psychological and physical. To help cope, one should join a support group, talk to friends and family and even discuss the issues with the doctor. For all obese individuals, a positive outlook is important and one should not let society take over one’s feeling. Be strong, have the right attitude and one can lose weight.

Obesity is at an all time epidemic proportions and if nothing is done, society is going to have a very rude awakening. Recently an old diabetic drug, metformin, has been found to decrease weight and also control diabetes. Unfortunately, it is only good for obese diabetic. Individuals who do not have diabetes should not take this medication Current research involving various hormones that modulate fat may lead to newer medications in the future. However, in the meantime, we do not have a cure or a magical pill to treat obesity. The best advice is to cut down on the food and walk a little. There is no easy solution to weight loss and more than anything else, it requires a lot of hard work.