What is Obesity?
Obesity used to be understood in fairly simple terms, excess body weight resulting from eating too much and exercising too little, due in large part to a lack of willpower or self-restraint. 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.
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.
Obesity results from a complex interaction of genetic, behavioral and environmental factors causing an imbalance between energy intake and energy expenditure. 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.
Who 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 overweight and obesity and associated conditions. A physician-supervised medical weight loss program may be the safest and wisest way to lose weight and maintain the loss. Overweight and obesity are frequently accompanied by other medical conditions, such as type 2 diabetes, hypertension, cancer and other ailments. A bariatric physician is trained to detect and treat these conditions, which might go undetected and untreated in a non-medical weight loss program.
Prevalence 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.
Prevalence is Obesity
Approximately one in five children in the US between the ages of 6 and 17 is overweight. The number of overweight children in the US has more than doubled in the past 30 years. (NHANES III) • The number of overweight children (age 6-17) has doubled within three decades. (Pediatrics (Suppl) 1998;101(3): 497-504)
A new chronic disease has emerged over the past two decades, one that overshadows all others in frequency in the pediatric population - obesity. Changes in the Western lifestyle have led to significant reductions in energy expenditure of children and have encouraged “super-sizing” of calorie-dense, high-fat foods and snacks. (Journal of Pediatrics (Editorial) 2000;136(6))
Physical inactivity (a 1996 US Surgeon General’s report on fitness says that nearly half of young people ages 12 to 21 are not vigorously active), “junk” food diets (including high calorie soft drinks and fruit beverages), increased television watching accompanied by snacking, increased time playing video and computer games all contribute to increased obesity among the young.
When we think of the major problems facing pediatrics in the next millennium, the disturbing trend toward obesity has to be among the most serious, with all the adverse health implications that obesity carries. (Pediatric Alert, March 27, 1997)
The Health Implications of Obesity
Obesity has been established as a major risk factor for diabetes, hypertension, cardiovascular disease and some cancers in both men and women. Other co-morbid 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)
