Dr. M.J. Bazos, MD. Patient Handout
About Your Diagnosis
Obesity is an increased percentage of total body fat compared to normal. Overweight is an increased body weight relative to height. Both factors have
an important impact on overall health. Obesity is caused by an excess of caloric intake in the diet relative to caloric output by physical activity. Both genetic and environmental factors appear to be important in obesity. According to the National Center for Health Statistics, greater than 40% of men and women older than 35 years are obese. This percentage continues to increase every year. Body mass index (BMI) is one measure to determine whether someone is overweight. Body mass index is derived as follows: BMI = Weight (kg) /Height2 (m2). Lowest mortality is associated with a BMI between 22 and 25 according to life insurance tables. The U.S. Department of Health and Human Services recommends that men and women aged 19–35 years maintain a BMI between 19 and 25. Individuals older than 35 years should maintain a BMI of 21– 27. Treatment is indicated for those individuals with a BMI greater than 27 who have other diseases, such as high blood pressure, diabetes, pulmonary hypertension, or coronary artery disease. Treatment is indicated in all individuals with a BMI greater than 30.
To determine the relative obesity of an individual, estimates are made of body fat content using skinfold measurements. Body fat distribution is determined by measuring waist and hip size. Males with a body fat content greater than 25%, and females with a body fat content greater than 33% are considered obese. An increased waist-to-hip ratio is a risk factor for diabetes and heart disease. Other techniques to measure body fat content are available but mainly used for obesity research. Numerous treatments are available to reduce body weight or fat and decrease the risk of medical complications from obesity.
Living With Your Diagnosis
Obesity is a risk factor for high blood pressure, diabetes, coronary artery disease, and pulmonary hypertension. It adds strain to arthritic joints.
Diet, exercise, medications, and surgery have all been used to treat obesity. Individuals 20% to 40% above ideal body weight or with a BMI of 27–30 should follow a low-fat, low-calorie diet in the range of 1,200–1,800 kilocalories per day. This should be designed by a registered dietician. Those 41% to 100% over the ideal body weight or with a BMI between 30 and 40 may benefit from short-term, very low calorie diets in the range of 400–800 kilocalories per day to achieve rapid weight loss over the short-term. Medical supervision is required for such a restrictive diet. Exercise is very effective in reducing weight over the long-term. An individualized, medically supervised exercise program is recommended to prevent complications. Few medications are available for treating obesity. A careful trial of diet and exercise must be instituted before resorting to the use of medicines. Amphetamines may lead to weight loss, but their use is limited because they cause anxiety and tremulousness. Dietary fat absorption inhibitors such as orlistat are available to limit the amount of calories that enter the bloodstream. This medicine causes flatulence and diarrhea. Surgery is an option for the morbidly obese who are greater than 100% above their ideal body weight or have a BMI over 40. Gastric bypass or vertical band gastroplasty are the procedures of choice. Surgery leads to rapid weight loss over 12–18 months, with successful long-term weight reduction maintained in many patients. These procedures should be reserved for patients who have failed all other therapy. Infection, poor wound healing, and dumping syndrome (abdominal cramping or diarrhea) are potential complications that must be considered before undergoing surgery.
The Dos:• Learn your current weight, body mass index, and body fat content.
• Understand your risk factors for diabetes and heart disease.
• Begin a medically supervised diet and exercise program before considering medicines for your obesity.
• Consider surgery if you are greater than 100% above your ideal body weight and no other treatment has been successful
The DON’Ts: • Don’t smoke cigarettes to control body weight.
• Don’t follow fad diets.
• Don’t become discouraged if your weight stabilizes after an initial weight loss.
When to Call Your Doctor: • Your weight continues to increase despite diet and exercise.
• You have side effects from the medicines prescribed.
• You have severe diarrhea or low blood sugars after surgery.