Frequently Asked Questions About Obesity

What is Obesity?
What is a Bariatrician?
How Prevalent is Obesity?
What Are the Costs Associated With Obesity?
Weight Loss Tips - Obesity is a Disease with Serious Health Implications
What Should a Medical Weight Loss Program Provide?
What About Medications and Special Diets?
What Are the Different Categories of Diet Medicines?
How Are Overweight and Obesity Defined?
How is Obesity and Health Risk Measured?
How is a Patient's Health Risk BMI Determined?
Determining Your BMI Health Risk
What Are Some of the Medical Complications of Obesity?
ASBP Position On Online Prescribing (Link)
What's my BMI?
American Obesity Association (Link)
Obesity, Bias, and Stigmatization (Link)
Childhood Overweight (Link)
Can a virus make you fat?
 

What is Obesity?
Obesity used to be looked at as a failure of willpower, - a combination of eating to much and exercising too little.  Now we know that it results from a complex interaction of genetic, metabolic, behavioral and environmental factors causing an imbalance between energy intake and energy expenditure.

Fortunately for the millions of American adults who are overweight, obesity is now regarded as a CHRONIC MEDICAL DISEASE with serious health implications caused by a complex set of factors.

According to the National Institutes of Health, an increase in body weight of 20 percent or more above desirable weight is the point at which excess weight becomes an established health hazard. Lower levels of excess weight can also constitute a health risk, particularly in the presence of other disorders like diabetes, hypertension and heart disease.

Recognized since 1985 as a chronic disease, obesity is the second leading cause of preventable death, exceeded only by cigarette smoking. Obesity has been established as a major risk factor for hypertension, cardiovascular disease, diabetes mellitus and some cancers in both men and women. Obesity affects 58 million people across the nation and its prevalence is increasing. Approximately one-third of adults are estimated to be obese.

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What is a Bariatrician?
A bariatrician is a licensed physician (Doctor of Medicine [MD] or Doctor of Osteopathy [DO]) who, as a member of the American Society of Bariatric Physicians (ASBP), has received special training in bariatric medicine the medical treatment of overweight and obesity and its associated conditions. Bariatricians address the obese patient with a comprehensive program of diet and nutrition, exercise, lifestyle changes and, when indicated, the prescription of appetite suppressants and other appropriate medications. (The word bariatric stems from the Greek word barros, which translates as heavy or large.)

While any licensed physician can offer a medical weight loss program to patients, members of the ASBP have been exposed, through an extensive continuing medical education program, to specialized knowledge, tools and techniques to enable them to design specialized medical weight loss programs tailored to the needs of individual patients and modify the programs, if needed, as the treatment progresses. ASBP members are uniquely equipped to treat persons who are overweight or obesity and their associated conditions.

A physician-supervised medical weight loss program may be the safest and wisest way to lose weight and maintain the loss. The medical conditions of overweight and/or obesity are frequently accompanied by other medical conditions, such as type 2 diabetes, hypertension, cancer and others. A bariatric physician is trained to detect and treat these conditions, which might go undetected and untreated in a non-medical weight loss program.

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How Prevalent is Obesity?
Obesity is a chronic, debilitating and potentially fatal disease that requires treatment by a physician trained in bariatric medicine. It is marked by an excess accumulation of body fat sufficient to endanger health. The United States is currently suffering an obesity epidemic contributing to the premature death, sickness and suffering of millions of Americans.
The U.S. Bureau of the Census estimates that approximately 58 million American adults (26 million men and 32 million women) are obese.
According to the National Institutes of Health, 55% or 97 million adults in the U.S. are overweight or obese, with at least 33% (58 million) of adults considered overweight and 22 % (39 million) considered obese.
The combined prevalence of overweight and obesity in the US has increased from 46% of the adult populations (NHANES II, 1976 to 1980) to 54.9% of the adult population in NHANES III (1988-1994).
The prevalence of obesity increased from 12.0% in 1991 to 17.9% in 1998. A steady increase was observed in all states; in both sexes; across age groups, races and educational levels; and occurred regardless of smoking status. (JAMA 1999;282: 1519-1522)
The prevalence of attempting to lose and maintain weight was 28.8% and 35.1% among men and 43.6% and 34.4% among women respectively. (JAMA 1999;282: 1353-1358)* The prevalence of obesity increased by 9 percent among women and men ages 20 to 74 between 1960 and 1991.
Approximately one third (33.4 percent) of adults are estimated to be obese.
Adult men and women are nearly 8 pounds heavier than they were 15 years ago. Mean body mass index (BMI), a standard measure of obesity, has increased from 25.3 to 26.3 kg/m2.
At any given time, 33 to 40 percent of women and 20 to 24 percent of men are trying to lose weight.
Maintaining weight loss over the long term is exceedingly difficult. Most people regain as much as two-thirds of weight lost within one year and regain all of it within five years.   Weight maintenance support is a critical part of your weight control.  We provide ongoing weight maintenance support and medications, if needed.

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What are the Costs Associated with Obesity?
The total cost attributable to obesity amounted to $99.2 billion in 1995. Approximately $51.65 billion of those dollars were direct medical costs. Compared with 1988 data, in 1994 the number of restricted-activity days, bed-days, and work-lost days increased substantially. The number of physician visits attributed to obesity increased 88 % from 1988 to 1984. (Obesity Research 1998; 6(2):97-106)

The cost of obesity to US business in 1994 was estimated to total $12.7 billion. The health-related economic cost of obesity to US business is substantial, representing approximately 5% of total medical care costs. (American Journal of Health Promotion 1998;13(2): 120-127)

Sustained modest weight loss among obese persons would yield substantial health and economic benefits. (American Journal of Public Health 1999;89(10): 1536-42)

We found that as BMI increases, so do the number of sick days, medical claims and health care costs and that the mean annual health care costs for the BMI “at risk” population was $2,274 versus $1,499 for the “not at risk” group. (Statistical Bulletin of the Metropolitan Insurance Co. 1999 Jul-Sep;80)

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Weight loss tips - Obesity is a disease, with serious Health Implications
Obesity has been established as a major risk factor for diabetes, hypertension, cardiovascular disease and some cancers in both men and women. Other linked conditions include sleep apnea, osteoarthritis, infertility, idiopathic intracranial hypertension, lower extremity venous stasis disease, gastro-esophageal reflux and urinary stress incontinence.

Obesity-related medical conditions contribute to 300,000 deaths each year, second only to smoking as a cause of preventable death. (JAMA, 1996;276:1907-1915).

The estimated number of annual deaths attributable to obesity among US adults is approximately 280,000 based on relative hazard ratio from all subjects and 325,000 based on hazard ratio from only non-smokers and never-smokers. (JAMA, 1999;282: 1530-1538).

One-third of all cases of high blood pressure are associated with obesity, and obese individuals are 50% more likely to have elevated blood cholesterol levels. (American Family Physician 1997;55(2): 551-558).

Adult onset diabetes (type II, non-insulin dependent) accounts for nearly 90% of all cases of diabetes. Researchers estimate that 88 to 97% of type II diabetes cases diagnosed in overweight people are a direct result of obesity. (Shape Up America, December 1995).

Excess weight is an established risk factor for high blood pressure, type 2 diabetes (adult-onset), high blood cholesterol level, coronary heart disease and gallbladder disease. (JAMA, 1999;282:1523-1529).

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What should a weight loss program provide?
According to the ASBP, a comprehensive medical weight loss program should include the following:

1. An initial patient work-up to include medical history, physical examination, appropriate laboratory studies and an electrocardiogram if there is past or present evidence of cardiac disease or if the patient has coronary risk factors.

2. Appropriate counseling on:

Diet and nutrition, including reduced calorie diets and very low calories diets (VLCD) and dietary supplements when needed.
Exercise, tailored to the capabilities and limitations of the overweight patient to ensure safe and effective exercise.
Behavior modification (lifestyle changes), to include discussions of proper eating habits, dealing with stress-related eating, family meal planning changes, healthful snacking, etc.
Prescription appetite suppressants, if indicated, as an adjunct to a comprehensive medical weight loss program, and other medications.
3. If the use of appetite suppressants or other medications is indicated, the patient should be informed about the potential risks of such medication and the physician and patient should weigh the risks of the medication against the benefits, i.e., do the small risks of the medications outweigh the health risk of the patient remaining obese. (The use of appetite suppressants is not indicated for patients with only a small amount of weight to lose.) Often, the loss of only 5 to 10 percent of a patient’s initial weight can lead to significant improvements in health status.

4. Adequate periodic follow-up and counseling, to include a program to help the patient maintain the weight loss that has been achieved.

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What About Medications and Special Diets?
Bariatricians have a wide range of tools to offer their overweight patients, including special diet and nutrition products, individualized exercise programs, suggestions for lifestyle changes and prescription medications, if indicated.

Prescription anti-obesity medications can be a useful adjunct to a medical weight loss program, when used as part of a comprehensive program including diet and nutrition changes, exercise, and lifestyle modification. Medications alone will not lead to successful weight loss and maintenance. These medications are intended for patients who have a great deal of weight to lose, not for someone who wants to lose 5 or 10 pounds or drop a dress size. Many of the appetite suppressants and other medications available today have a long history of safe and successful use. New medications are being researched and will be available after clinical testing and FDA approval.

Just as there are some risks and side effects with almost any medication, including aspirin, acetaminophen and birth control pills, so may there be side effects and risks with anti-obesity medications. For most people, the side effects are minimal and of short duration. Bariatricians are trained to know how to prescribe the drugs properly and monitor patients taking these medications. Obese patients, particularly those with some of the diseases linked to their condition, such as diabetes and cardiovascular disease, may be at greater risk from remaining obese than the risk they might incur by taking the medications. The decision to prescribe anti-obesity medications must be made by the bariatric physician and the patient after carefully weighing the risks of the medications vs. the risks of remaining obese.

Bariatricians frequently prescribe low calorie diets or very low calorie diets (VLCD) along with vitamins and nutritional supplements, together with exercise and lifestyle changes to bring about a relatively rapid loss of weight. The VLCD, especially, should only be used under the careful supervision and monitoring of a physician and other health care personnel trained in its use.

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What are the Different Categories of Diet Medications?
Just as there are side effects of any medications, such as aspirin and penicillin, so are there side effects of taking appetite suppressants. Some common side effects are dryness of the mouth, dizziness, abdominal pain, diarrhea or constipation, nausea, difficulty sleeping, nervousness, increased blood pressure and headache. Most of these drugs affect the body’s nervous system. While they generally suppress appetite, some may also alter the way the body burns calories.

Among the best-known medications:

AMPHETAMINES (amphetamine, dextroamphetamine, methamphetamine) are strong stimulants that are no longer recommended by most authorities for weight control because they are highly addictive. Potential side effects include heart palpitations, elevation of blood pressure, gastrointestinal disturbances and insomnia. Amphetamines are prescribed for other problems than obesity, such as attention deficit disorder (ADD/ADHD) and narcolepsy.

APPETITE SUPPRESSANTS — Phentermine was first approved by the Food and Drug Administration in 1959 as a “short term (a few weeks) adjunct in a regimen of weight reduction based on caloric restriction.” It is sold under the brand names Ionamin, Adipex, Fastin, Banobese, Obenix and Zantryl. Among other drugs of this type are phendimetrizine, mazindol, and the over-the-counter diet aid phenylpropanolamine (Accutrim, Dexatrim). Sibutramine, which is being marketed as Meridia, the newest prescription appetite suppressant, became available in February 1997.

ORLISTAT, which is being marketed as Xenical, became available in the US in May 1999. Not an appetite suppressant, Orlistat is a lipase inhibitor or “fat blocker” drug. It prevents the absorption of about 30 percent of dietary fat by the digestive tract. It is meant to be used in conjunction with a reduced-calorie diet. Some side effects, which are generally mild and transient, may include oily spotting, flatulence with discharge, fecal urgency, oily evacuation and fecal incontinence. Maintaining a diet of no more than 30 percent of calories from fat may minimize these side effects. The medication also reduces the absorption of fat-soluble vitamins; patients are advised to take a daily supplement that contains vitamins A, D, E and K as well as beta-carotene.

LEPTIN is a form of the human protein made in fat cells. It’s currently in human clinical trials and may help reduce body weight and fat through curbs on metabolism and appetite.

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How Are Overweight and Obesity Defined?
The body mass index (BMI) is the most popular tool for defining what is healthy weight, overweight and obesity today. The BMI is calculated by multiplying weight in pounds by 703 and then dividing by the height in inches squared. This approximates BMI in kg/m2. The 1998 Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults, developed by the National Heart, Lung and Blood Institute, recommend the following classifications for BMI:

Underweight - BMI less than 18.5
Normal weight - BMI 18.5 to 24.9
Overweight - BMI 25 to 29.9
Obesity - BMI 30 to 34.9 (Class 1)
Obesity - BMI 35 to 39.9 (Class 2)
Extreme Obesity - BMI greater than 40 (Class 3)
BMI does not actually measure body fat, but generally correlates well with the degree of obesity. For example, a person who is 5 feet, 7 inches tall and weighs 150 pounds would have a BMI of 23, well out of the range of obesity. A person of the same height and weighing 200 pounds would have a BMI of 31 and would be considered obese. BMI charts are widely available.

Calculate your BMI

Here are two different BMI calculators for you to use:

First, from the CDC.gov website - click here.

Second, from Crestor.com (the makers of Lipitor) - "Interactive BMI Calculator" Very cool! Visually see how changes in your weight affect your body shape and BMI, for men and women.  This is a helpful tool for developing your weight loss goal.

Often, a 10 to 15% reduction in an obese person’s body weight can bring about a significant reduction in the person’s health risk from obesity. This “healthy” weight loss does not always equate with a person’s “cosmetic” weight loss goals.

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How is Obesity and Health Risk Measured?
Currently, several different measures are used to evaluate a patient’s weight status and potential health risk. However, a complete evaluation includes assessments of a person’s age, height and weight, fat composition and distribution, and the presence or absence of other health problems and risk factors.

Height-weight tables indicating “ideal” weight have been in use since 1959 but have their shortcomings. A newer measure of obesity that is gaining in popularity among researchers and clinicians is the body mass index (BMI). BMI is the body weight in kilograms divided by the square of the height in meters ([weight in kg] ÷ [height in meters]2). BMI does not actually measure body fat, but generally correlates well with the degree of obesity. The categories of obesity developed by the World Health Organization are:

BMI 25 to 29.9 - Grade 1 obesity (moderate overweight)
BMI 30 to 39.9 - Grade 2 obesity (severe overweight)
BMI > 40 - Grade 3 obesity (massive/morbid obesity).
Using a BMI table, a person 5'6" tall weighing 140 pounds would have a BMI of 23, well out of the range of risk. That same 5'6" person weighing 190 pounds would have a BMI of 31, in the range of Grade 2 obesity.

A BMI of 27 or higher is associated with increased morbidity and mortality; this is generally considered the point at which some form of treatment for obesity is required. A BMI between 25 and 27 is considered a warning sign and may warrant intervention, especially in the presence of additional risk factors.

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How Is a Patient's BMI Health Risk Determined?
BMI is defined as body weight (in kg) divided by height (in m2 ). You can easily calculate your BMI by multiplying your weight in pounds by 703, then dividing the result by your height in inches and dividing that result by your height in inches.

In recent years, researchers and clinicians have shifted focus from “ideal” body weights as reflected in the height-weight tables, to helping patients achieve and maintain “healthy” or “healthier” body weights. Studies have shown that losing even modest amounts of weight — just 5 to 10 percent of initial body weight — and maintaining the loss improves health and well-being and decreases the risk for a variety of obesity-related health complications.

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Determining Your BMI-Related Health Risk

BMI Category

Health Risk

With Comorbidities**

25 - 27 - 30 - 35 - >40

Minimal
Low
Moderate
High
Very High
Extremely High

Low
Moderate
High
Very High
Extremely High
Extremely High


**Hypertension, cardiovascular disease, dyslipidemia, Type II diabetes, sleep apnea, osteoarthritis, infertility, other conditions.

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What Are Some of the Medical Complications of Obesity?

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Can a virus make you fat?
Although the idea sounds more like the premise of a B movie than scientific theory, two scientists at the University of Wisconsin in Madison believe they've found a virus that causes some people to get fat. Nikhil Dhurandhar and Richard Atkinson reported recently that when they injected a virus known as AD36 into mice and chickens, the animals' body fat increased. Because humans were unlikely to volunteer for such experimentation, the scientists decided to test for the presence of antibodies to the virus. Of 154 people tested, about 15 percent of those who were obese had the antibodies. None of the lean people did.

However, the findings don't necessarily prove that the virus caused obesity in the test group. As several virologists have pointed out, obese people may simply be more susceptible to such a virus. Still, in recent years researchers have been surprised to find that viruses can be linked to so many diseases that had been thought to have other origins. For example, viruses are now implicated in several types of cancer, hardening of the arteries, and even mental disorders such as depression. In addition, five viruses besides AD36 have already been shown to cause obesity in animals. The good news is that the same methods that produce flu shots each year could ultimately be used to create an antiobesity injection.

We provide testing for this virus, at an additional charge ($135 plus  shipping), if you are interested.

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