Obesity is one of the most serious public health problems of the 21st century. Health care expenditures for obese Americans accounted for 35% of all costs in 2006, or $303 billion, (Mr. Obama take note). This has increased from $167 billion in 2001. From 2001 to 2006 the number of obese Americans increased from 48 million to 59 million people. The day I wrote this article 45% of the patients I saw in my office practice were obese.
Obesity is a condition where excess body fat has accumulated to the extent that it adversely affects your health. Most people recognize obesity on sight. A medical degree is not necessary to make the diagnosis. A good estimate of obesity is to calculate a number called body mass index (BMI). This number is obtained by measuring a personʼs height and weight and applying a simple formula. I do it for every patient in my office practice. A normal healthy value for BMI is between 18.5 and 24.9. From 25-29.9 a person is considered to be “overweight”. Anything above 30 is “obese”. Anything above 40 is considered “morbidly obese”, and above 50 “super obese”.
Obesity is a leading cause of death worldwide. A BMI of 30-35 reduces a personʼs life expectancy by 2-4 years. A BMI of more than 40 reduces life expectancy for men by 20 years and for women by 5 years.
Many common diseases are strongly associated with obesity particularly heart disease, Type 2 diabetes, breathing difficulties during sleep, certain types of cancer, and osteoarthritis. It is estimated that obesity is the cause of 64% of the cases of Type 2 diabetes in men and 77% of the cases in women.
Obesity is caused by a combination of excessive dietary calories (eating too much), lack of physical activity, and genetic susceptibility. In the American society the increased rates of obesity are felt to be due to easy accessibility of food and an increased reliance on cars and mechanized manufacturing. Our diets contain an increased percentage of processed fatty foods and sugars, and less whole grains, fruits, and vegetables. The alarming increase in childhood obesity correlates with increased time spent watching T.V. and playing video games, as well as a poor diet.
The primary treatment for obesity is dieting and physical exercise. In my practice I find most people have trouble doing either. Diets may produce weight loss over the short term, but keeping weight off is a problem and requires making exercise and a lower calorie diet a permanent part of your lifestyle. Success rates long- term are low (2-20%). Commercial diet programs like Jenny Craig, Weight-Watchers, or Nutri-Systems can be useful to help achieve weight loss.
Exercise alone in sufficient quantity will produce weight loss. In one study, during 20 weeks of basic military training with no dietary restrictions, obese military recruits lost an average of 27.6 pounds.
If diet and exercise alone fail, anti-obesity drugs may be tried to reduce appetite or inhibit fat absorption. Only 2 drugs are approved for long term use by the FDA. Meridia (an appetite suppressant), and Orlistat (inhibits fat absorption). Other drugs may be prescribed on a short term basis (usually 3 months or less).
For morbidly obese individuals, the last resort is Bariatric surgery, which reduces the ability to eat large quantities and absorb calories. These procedures have risks, but can be very successful at producing significant and permanent weight reduction. 
The potential benefits of weight reduction are significant. In one study intentional weight loss of any amount was associated with a 20% reduction in all-cause mortality.
Obesity is an extremely common problem and a very serious health concern. It goes far beyond cosmetics. It is an excellent reason to visit your doctor and begin a discussion. Getting your weight under control will improve your appearance, your energy level, and your health.
Written by Richard J. Wilbur, M.D., Board Certified in Internal Medicine.
