What
Is Obesity?
Obesity is the result of excessive accumulation of fat beyond
the body’s requirements. According to the National Institute
of Health (NIH), health problems are associated with weighing
20% more than one’s ideal body weight. The most accurate
way to quantify "obesity" is by associating an individual's
weight with his/her height. This relationship is known as
Body Mass Index (BMI). BMI is calculated by dividing actual
body weight (measured in pounds or kilograms) by height (expressed
as square meters or square inches). According to the National
Heart, Lung, and Blood Institute (NHLBI), a BMI between 18.5
and 25 Kg/m2 is considered to be within the normal range.
Individuals with BMI’s between 25 and 29.9 kg/m2 are
considered overweight and those with BMI’s between 30
and 39.9 Kg/m2 are considered obese. Morbid obesity is defined
as body weight greater than 100 lbs above the ideal body weight,
BMI of 40 Kg/m2 or BMI of 35 Kg/m2 when associated with other
health problems or co-morbidities. Currently, more than 50%
of Americans are considered overweight and more than 5 million
are considered morbidly obese. Furthermore, childhood obesity
is becoming an epidemic in the United States.
What
Causes Morbid Obesity?
It would not only be simplistic but probably erroneous to
explain obesity as the result of overeating. The medical literature
has shown that there are multiple, complex factors that contribute
to weight gain, which include genetic predisposition, environmental
factors, lifestyle, psychological factors and specific hormones
(leptine and Ghrelin).
What are the Dangers of Being
Obese?
 Research
has shown that the risk for developing health problems such
as heart attack, Type 2 Diabetes, hypertension and dyslipidemia,
sleep apnea, menstrual problems, infertility, urinary stress,
gastroesophageal reflux disease and depression increases with
increasing BMI. In fact, patients whose weight exceeds twice
their ideal body weight have double the risk for an early
death compared to non-obese individuals. Obesity has been
correlated with increased mortality associated with several
cancers, including endometrial (5.4 times), gallbladder (3.6
times) uterine/cervix (2.4 times), prostate (1.3 times) and
colorectal (1.7 times) cancer (5). In addition, the social,
psychological and economic effects of morbid obesity can be
especially devastating for the individual and his/her family.
Importantly, studies have shown that weight loss can reduce
obesity-related health risks. For example, a 10% weight reduction
results in a 20% reduction in the risk for developing coronary
heart disease.
What Treatments are Available
for Obesity?
Currently, several treatment options are available to “fight”
obesity.
Dietary Therapy:
 The
objective of all diets is to customize caloric intake to individual
needs. It is important to realize that reducing calories should
be done in a slow and methodic fashion. Rapid, unsupervised
weight loss is associated with serious deleterious effects
to the body such as malnutrition and metabolic disorders.
Physical Activity:
A sedentary lifestyle and lack of exercise are major contributors
to obesity. Physical activity is necessary to maintain weight
loss. Regular exercise re-sets the internal “thermostat”
to a higher metabolic steady state, enhancing calorie and
fat burning.
Thirty minutes or more of daily physical activity is recommended
to maintain or control weight.
Drug Therapy:
 Drug
therapy is usually reserved for individuals with a BMI greater
than 30 Kg/m2 or greater than 27 Kg/m2 with co-morbidities
(hypertension, dyslipidemia, sleep apnea and type 2 diabetes).
In order to avoid health problems such as malnutrition, any
patient participating in a drug therapy regimen must be assessed
at regular intervals by the medical team. Currently, the US
Food and Drug Administration (FDA) has approved three drugs
for the treatment of obesity: Orlistat (Xenical), Phentermine
and Sibutramine (Meridia). These drugs act by either blocking
fat absorption by suppresing appetiteTo be effective, drug
therapy should be administered in conjunction with lifestyle
modifications.
Surgery:
 Surgery
is only indicated for weight control when all other medical/dietary
treatment has failed. Furthermore, the 1991 NIH consensus
recommends that all candidates considered for Bariatric Surgery
meet the following criteria:
- BMI > 40
- BMI >35 with co-morbidities
- Failed medical management
- No psychological contraindications
- Age of less than 60 years old
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