Obesity

Definition

According to the Centers for Disease Control, obesity is a complex, multi-factorial chronic disease involving environmental (social and cultural), genetic, physiologic, metabolic, behavioral and psychological components.

According to the American Obesity Association, obesity is a disease that affects nearly one-third of the adult American population (approximately 60 million). The number of overweight and obese Americans has continued to increase since 1960, a trend that is not slowing down. Today, 64.5 percent of adult Americans (about 127 million) are categorized as being overweight or obese. Each year, obesity causes at least 300,000 excess deaths in the U.S., and healthcare costs of American adults with obesity amount to approximately $100 billion. Obesity is the second leading cause of unnecessary deaths.

Morbid obesity, also referred to as clinically severe obesity or extreme obesity, is a chronic disease that afflicts approximately 9 million adult Americans. The health effects associated with morbid obesity are numerous and can be disabling. Often, individuals with morbid obesity suffer with more than one health effect, creating a situation that can shorten life span and negatively impact quality of life.

Statistics

Data referring to the Overall Prevalenceof Obesity, according to the Centers for Disease Control is as follows:

  • Approximately 127 million adults in the U.S. are overweight, 60 million obese, and 9 million severely obese.
  • The number of adults who are overweight or obese has continued to increase. Currently, 64.5 percent of U.S. adults, age 20 years and older, are overweight and 30.5 percent are obese. Severe obesity prevalence is now 4.7 percent, up from 2.9 percent reported in the 1988 - 1994 National Health and Nutrition Examination Survey (NHANES) by the Centers for Disease Control and Prevention (CDC).

Causes

In short, weight gain, and overweight and obesity conditions are caused by an Energy imbalance - When the number of calories consumed (food taken in) is not equal to the number of calories used (used through physical activity). This is a simplistic view at a complex disabling condition, however, as the following points illustrate:

  • Obesity is a chronic disease with a strong familial component.
  • Obesity increases one's risk of developing conditions such as high blood pressure, diabetes (type 2), heart disease, stroke, gallbladder disease and cancer of the breast, prostate and colon.
  • The tendency toward obesity is fostered by our environment: lack of physical activity combined with high-calorie, low-cost foods.
  • If maintained, even weight losses as small as 10 percent of body weight can improve one's health.
  • Although there are several factors involved in causing overweight, morbid obesity has a stronger genetic component than moderate levels of excess weight. In a study of adults who were candidates for bariatric surgery, approximately 85 percent had "elements in their history to suggest a genetic risk for morbid obesity."
  • Genetics and the environment may increase the risk of personal weight gain. However, the choices a person makes in eating and physical activity also contributes to overweight and obesity. Behavior can increase a person’s risk for gaining weight.

Course of the Illness

According to the CDC, overweight and obese individuals (BMI of 25 and above) are at increased risk for physical ailments such as High blood pressure, hypertension

  • High blood cholesterol, dyslipidemia
  • Type 2 (non-insulin dependent) diabetes
  • Insulin resistance, glucose intolerance
  • Hyperinsulinemia
  • Coronary heart disease
  • Angina pectoris
  • Congestive heart failure
  • Stroke
  • Gallstones
  • Cholescystitis and cholelithiasis
  • Gout
  • Osteoarthritis
  • Obstructive sleep apnea and respiratory problems
  • Some types of cancer (such as endometrial, breast, prostate, and colon)
  • Complications of pregnancy such as; gestational diabetes, gestational hypertension and preeclampsia as well as complications in operative delivery (i.e., c-sections).
  • Poor female reproductive health (such as menstrual irregularities, infertility, irregular ovulation)
  • Bladder control problems (such as stress incontinence)
  • Uric acid nephrolithiasis
  • Psychological disorders (such as depression, eating disorders, distorted body image, and low self-esteem).
  • Obesity is associated with increases in deaths from all-causes.
  • Individuals with obesity are at higher risk for impaired mobility.
  • Overweight or obese individuals experience social stigmatization and discrimination in employment and academic situations.
  • Morbid obesity can also cause or worsen depression. Some individuals with morbid obesity have low self-esteem and other psychological difficulties attributed to feeling "shunned, insulted and ridiculed by outsiders."

Diagnosis

Desirable weight standards are derived in a number of ways:

  • By using a mathematical formula known as Body Mass Index (BMI), which represents weight levels associated with the lowest overall risk to health. Desirable BMI levels may vary with age.
  • By using actual heights and weights measured and collected on people who are representative of the U.S. population by the NationalCenter for Health Statistics. Other desirable weight tables have been created by the Metropolitan Life Insurance Company, based on their client populations.

Body Mass Index BMI is a common measure expressing the relationship (or ratio) of weight-to-height. It is a mathematical formula in which a person's body weight in kilograms is divided by the square of his or her height in meters (i.e., wt/(ht)2.

Morbid obesity is defined as having a Body Mass Index (BMI) of 40 or more. This equates to approximately 100 pounds more than ideal weight.

Body fat distribution can be estimated by skinfold measures, waist-to-hip circumference ratios, or techniques such as ultrasound, computed tomography, or magnetic resonance imaging.

Individuals with a BMI of 25 to 29.9 are considered overweight, while individuals with a BMI of 30 or more are considered obese.

Treatment

Dietary Therapy, Physical Activity, Behavior Therapy, Drug Therapy, Combined Therapy, and Surgery are the current treatment alternatives for obesity.

Weight loss of about 10 percent of body weight is proven to benefit health by reducing many obesity-related risk factors. Recommendations for treatment are now focusing on 10 percent weight loss to help patients with long-term maintenance of weight loss. Health professionals including physicians, nutritionists, exercise physiologists, psychologists and bariatric surgeons help persons with overweight and obesity to determine the most appropriate treatment.

Of course, Prevention is a strategy that would negate the need for treatment. The following are some CDC Recommended Strategies to Prevent Chronic Diseases and Obesity:

CDC's Division of Nutrition and Physical Activity is committed to leading the nation's efforts in reducing the prevalence of overweight, obesity and related chronic disease through

  • nutrition and physical activity research.
  • surveillance.
  • public health programs.
  • communication strategies.
  • private and public partnerships.

Accommodations

Common accommodation situations that arise for people who are obese include:

Climbing steps: An individual who is obese can benefit from an elevator or a large-rated stair lift or large-rated wheelchair lift.

Sitting:Large-rated ergonomic chairs are available as options.

Seat Belt Extenders: Seat belt extenders are available for some vehicles and industrial equipment.

Using Safety Products: Specially designed ladders and harnesses are available.

Walking: A large-rated wheelchair or scooter may accommodate this limitation.

Recommended Readings

  • American Obesity Association - The American Obesity Association (AOA) has been formed to address obesity as a public health concern and to remove the barriers to effective treatment through vigorous advocacy and education
  • International Association for the Study of Obesity -
  • Obesityhelp.com – Of particular interest in this resource is the part on “what employers should know”
  • The North American Association for the Study of Obesity -
  • American Society for Bariatric Surgery - They have a link that clearly describes the rationale for this type of surgery
  • Research Article:

Hebl, M., & Kleck, R.E. Acknowledging one's stigma in the interview setting: Effective strategy or liability? Journal of Applied Social Psychology. Vol 32(2) Feb 2002, 223-249.