Nicole B. White, MD: On Obesity

Obesity

According to the NIH, More than half of the U.S. population is overweight. But being obese is different from being overweight. An adult male is considered obese when his weight is 20% or more over the maximum desirable for their height; a woman is considered obese at 25% or more than this maximum weight. Anyone more than 100 pounds overweight is considered morbidly obese.

Rates of obesity are climbing. An ominous statistic is that the percentage of children and adolescents who are obese has doubled in the last 20 years.

Obesity increases a person's risk of illness and death due to diabetes, stroke, coronary artery disease, hypertension, high cholesterol, and kidney and gallbladder disorders. Obesity may increase the risk for some types of cancer. It is also a risk factor for the development of osteoarthritis and sleep apnea.

Genetic factors play some part in the development of obesity -- children of obese parents are 10 times more likely to be obese than children with parents of normal weight.

The term morbid obesity refers to patients who are 50 - 100% -- or 100 pounds above -- their ideal body weight. Alternatively, a BMI (body mass index) value greater than 39 may be used to diagnose morbid obesity.

For these people, bariatric, or weight loss surgery, is often the best choice for long term, permanent weight loss.

Definitions

Bariatric: from the Greek Baros: weight

Iatrikos: medicine

Obesity: An excess of body fat. Obesity develops when energy intake exceeds energy expenditure over a long period.

Body Mass Index(BMI) : Obesity is classified according to body mass index

Body Mass Index(BMI)= weight(kg) height(m2)

BMI	Term	Class of Obesity
25-29.9	Overweight
30-34.9	Obese	I
35-39.9	Moderately Obese	II
40-49.9	Morbidly Obese	III
>50	Super Morbidly Obese	IV

Obesity Facts

World Epidemic of Overweight estimated to encompass 1.7 Billion Individuals
2/3 of the U.S. population are overweight and of those, 1/2 are obese
BMI>25: 130 Million
BMI>30: 60 Million
BMI>35 and at least 1 obesity related complication: 15 Million
BMI>40: 9 Million
Prevalence of obesity in persons older than 18 years of age increased 5.6% in just one year from 2000 to 2001
Each year, an estimated 365,000 adults in the U.S. die of obesity-related causes
Direct cost of obesity: estimated at 9.4% of U.S. health care expenditures($117 Billion per year)
Nurses’ Health Study:
- Direct relationship between increasing BMI and relative risk of dying prematurely
- >100% increase in relative risk as BMI increased from <19 to >32
- Framingham data:
  Only 1 in 7 obese individuals will reach U.S. life expectancy of 76.9 years
  In the morbidly obese population, the average life expectancy is reduced by:
  9 years in women, 12 years in men
- An estimated 14% of all cancer deaths in men are due to obesity
- An estimated 20% of all cancer deaths in women are due to obesity

Medical Implications of Obesity

Diabetes
Hypertension
Lipid Disorders
Heart disease
Asthma
Sleep apnea
Gallstones
NASH (non-alcohol steatohepatitis)
Urinary incontinence
Gastroesophageal reflux
Obstetric complications

Low back pain
Osteoarthritis and gout
Infertility and menstrual problems
DVT and Thromboembolism
Depression
Immobility
Cancer (breast, colorectal, prostate, endometrial, etc.)
Venous/stasis ulcers
Skin infections
Intertrigo
Accident proneness

Impact of Obesity

Co morbid diseases
Reduced quality of life
Social Discrimination
Disability
Increased medical costs
Premature death

References
Dietel Obes Surgery 2003; Flegal Int J Obes Relat Metab Disord 1998; Flegal JAMA 2002; Mokdad JAMA 1999; CDC 2002; Buchwald JAMA 2004
Buchwald J Am Coll Surg 2005; Moore Epidemiology 2000; Huang Ann Intern Med 1998; Hensrud Mayo Clinic Proc 2006; Calle N Engl J Med 2003