WHAT ARE THE HEALTH RISKS OF OBESITY?

The problem of childhood obesity in the United States has grown considerably in recent years. Approximately 12.7 million, or 17 percent, of children and adolescents are obese. Obesity is among the easiest medical conditions to recognize but most difficult to treat. Unhealthy weight gain due to poor diet and lack of exercise is responsible for over 300,000 deaths each year. Overweight children are much more likely to become overweight adults unless they adopt and maintain healthier patterns of eating and exercise.

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The prevalence of obesity was 40.0% among adults aged 20 to 39 years, 44.8% among adults aged 40 to 59 years, and 42.8% among adults aged 60 and older.
 
The causes of obesity are complex and include genetic, biological, behavioral and cultural factors. Obesity occurs when a person eats more calories than the body burns. If one parent is obese, there is a 50 percent chance that his or her child will also be obese. However, when both parents are obese, their children have an 80 percent chance of being obese. Although certain medical disorders can cause obesity, less than 1 percent of all obesity is caused by physical problems. Obesity in childhood and adolescence can be related to:

• poor eating habits
• overeating or binging
• lack of exercise (i.e., couch potato kids)
• family history of obesity
• medical illnesses (endocrine, neurological problems)
• medications (steroids, some psychiatric medications)
• stressful life events or changes (separations, divorce, moves, deaths, abuse)
• family and peer problems
• low self-esteem
• depression or other emotional problems

Child and adolescent obesity is also associated with increased risk of emotional problems. Teens with weight problems tend to have much lower self-esteem and be less popular with their peers. Depression, anxiety, and obsessive compulsive disorder can also occur.

 
While genetic influences are important to understanding obesity, they cannot explain the current dramatic increase seen within specific countries or globally. Though it is accepted that energy consumption in excess of energy expenditure leads to obesity on an individual basis, the cause of the shifts in these two factors on the societal scale is much debated. There are a number of theories as to the cause but most believe it is a combination of various factors.

The correlation between social class and BMI varies globally. A review in 1989 found that in developed countries women of a high social class were less likely to be obese. No significant differences were seen among men of different social classes. In the developing world, women, men, and children from high social classes had greater rates of obesity. An update of this review carried out in 2007 found the same relationships, but they were weaker. The decrease in strength of correlation was felt to be due to the effects of globalization. Among developed countries, levels of adult obesity, and percentage of teenage children who are overweight, are correlated with income inequality. A similar relationship is seen among US states: more adults, even in higher social classes, are obese in more unequal states.

Many explanations have been put forth for associations between BMI and social class. It is thought that in developed countries, the wealthy are able to afford more nutritious food, they are under greater social pressure to remain slim, and have more opportunities along with greater expectations for physical fitness. In undeveloped countries the ability to afford food, high energy expenditure with physical labor, and cultural values favoring a larger body size are believed to contribute to the observed patterns. Attitudes toward body weight held by people in one's life may also play a role in obesity. A correlation in BMI changes over time has been found among friends, siblings, and spouses. Stress and perceived low social status appear to increase risk of obesity.
 
In the United States the number of children a person has is related to their risk of obesity. A woman's risk increases by 7% per child, while a man's risk increases by 4% per child. This could be partly explained by the fact that having dependent children decreases physical activity in Western parents.
In the developing world urbanization is playing a role in increasing the rate of obesity. In China overall rates of obesity are below 5%; however, in some cities rates of obesity are greater than 20%.

What is obesity?

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health. It is defined by body mass index (BMI) and further evaluated in terms of fat distribution via the waist–hip ratio and total cardiovascular risk factors. BMI is closely related to both percentage body fat and total body fat. In children, a healthy weight varies with age and sex. Obesity in children and adolescents is defined not as an absolute number but in relation to a historical normal group, such that obesity is a BMI greater than the 95th percentile. The reference data on which these percentiles were based date from 1963 to 1994, and thus have not been affected by the recent increases in weight.
 
Obesity is a complex health issue resulting from a combination of causes and individual factors such as behavior and genetics. Behaviors can include physical activity, inactivity, dietary patterns, medication use, and other exposures. Additional contributing factors include the food and physical activity environment, education and skills, and food marketing and promotion.

Obesity is serious because it is associated with poorer mental health outcomes and reduced quality of life. Obesity is also associated with the leading causes of death in the United States and worldwide, including diabetes, heart disease, stroke, and some types of cancer.

What are risks and complications of obesity?
People who have obesity, compared to those with a healthy weight, are at increased risk for many serious diseases and health conditions, including the following:

• All-causes of death (mortality)
• High (hypertension)
• High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Gallbladder disease
• Osteoarthritis (a breakdown of cartilage and bone within a joint)
• Sleep apnea and breathing problems
• Many types of cancers
• Low quality of life
• Mental illness such as clinical depression, anxiety, and other mental disorders
• Body pain and difficulty with physical functioning

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Treatment for obesity
Common treatments for overweight and obesity include losing weight through healthy eating, being more physically active, and making other changes to your usual habits. Weight-management programs may help some people lose weight or keep from regaining lost weight. Some people who have obesity are unable to lose enough weight to improve their health or are unable to keep from regaining weight. In such cases, a doctor may consider adding other treatments, including weight-loss medicines, weight-loss devices, or bariatric surgery.

Experts recommend losing 5 to 10 percent of your body weight within the first 6 months of treatment.  If you weigh 200 pounds, this means losing as little as 10 pounds. Losing 5 to 10 percent of your weight may

• help lower your chances of developing health problems related to overweight and obesity
• improve health problems related to overweight and obesity, such as high blood pressure and high cholesterol levels

Healthy eating plan and regular physical activity.

Following a healthy eating plan with fewer calories is often the first step in trying to treat those that are overweight and suffer from obesity.
People who are overweight or have obesity should also start regular physical activity when they begin their healthy eating plan. Being active may help you use calories. Regular physical activity may help you stay at a healthy weight.

Changing your habits

• Be prepared for setbacks—they are normal. After a setback, like overeating at a family or workplace gathering, try to regroup and focus on getting back to your healthy eating plan as soon as you can. Try to eat only when you’re sitting at your dining room or kitchen table. At work, avoid areas where treats may be available. Track your progress using online food or physical activity trackers, such as the Body Weight Planner, that can help you keep track of the foods you eat, your physical activity, and your weight. These tools may help you stick with it and stay motivated.
• Set goals. Having specific goals can help you stay on track. Rather than “be more active,” set a goal to walk 15 to 30 minutes before work or at lunch on Monday and Friday. If you miss a walk on Monday, pick it up again Tuesday.
• Seek support. Ask for help or encouragement from your family, friends, or health care professionals. You can get support in person, through email or texting, or by talking on the phone. You can also join a support group. Specially trained health professionals can help you change your lifestyle.

Weight-management programs
Some people benefit from a formal weight-management program. In a weight-management program, trained weight-management specialists will design a broad plan just for you and help you carry out your plan. Plans include a lower-calorie diet, increased physical activity, and ways to help you change your habits and stick with them. You may work with the specialists on-site (that is, face-to-face) in individual or group sessions. The specialists may contact you regularly by telephone or internet to help support your plan. Devices such as smartphones, pedometers, and accelerometers may help you track how well you are sticking with your plan.

Some people may also benefit from online weight-management programs or commercial weight-loss programs.

Weight-loss medicines

When healthy eating and physical activity habits are not enough, your doctor may prescribe medicines to treat overweight and obesity.
You should try to stick with your healthy eating plan and continue getting regular physical activity while taking weight-loss medicines.
You may see ads for herbal remedies and dietary supplements that claim to help you lose weight. Talk with your doctor before taking any over-the-counter herbal remedies or dietary supplements for the purpose of trying to lose weight.

Weight-loss devices

• Electrical stimulation system. The electrical stimulation system uses a device a surgeon places in your abdomen with laparoscopic surgery. The device blocks nerve activity between your stomach and brain.
• Gastric balloon system. For the gastric balloon system, a doctor places one or two balloons in your stomach through a tube that goes in your mouth. Once the balloons are in your stomach, the surgeon fills them with salt water so they take up more space in your stomach and help you feel fuller.
• Gastric emptying system. A gastric emptying system uses a pump to drain part of the food from your stomach after a meal. The device includes a tube that goes from the inside of your stomach to the outside of your abdomen. About 20 to 30 minutes after eating, you use the pump to drain the food from your stomach through the tube into the toilet.

Bariatric surgery

Bariatric surgery includes several types of operations that help you lose weight by making changes to your digestive system. Bariatric surgery may be an option if you have extreme obesity and haven’t been able to lose enough weight to improve your health or keep from gaining back the weight you lost with other treatments. Bariatric surgery also may be an option at lower levels of obesity if you have serious health problems, such as type 2 diabetes or sleep apnea, related to obesity. Bariatric surgery can improve many of the medical conditions linked to obesity, especially type 2 diabetes.

Special diets

Calorie-restricted diets

Your doctor may recommend a lower-calorie diet such as 1,200 to 1,500 calories a day for women and 1,500 to 1,800 calories a day for men. The calorie level depends on your body weight and physical activity level. A lower calorie diet with a variety of healthy foods will give you the nutrients you need to stay healthy.

Intermittent fasting
Intermittent fasting is another way of reducing food intake that is gaining attention as a strategy for weight loss and health benefits. Alternate-day fasting is one type of intermittent fasting that consists of a “fast day” (eating no calories to one-fourth of caloric needs) alternating with a “fed day,” or a day of unrestricted eating. Researchers have conducted only a few studies of intermittent fasting as a strategy for weight loss. They have no long-term data on the safety and effectiveness of intermittent fasting for long-term weight maintenance.

ACUNPUCTURE
Many people are adding acupuncture to their weight loss plan and having great success. Traditional Chinese Medicine (TCM) has been proven to assist in weight loss. Acupuncture is not a miracle cure, but it is very effective in making it easier to lose weight and maintain that loss.
 
HYPNOSIS
Weight-loss hypnosis may help you shed an extra few pounds when it's part of a weight-loss plan that includes diet, exercise and counseling. But it's hard to say definitively because there isn't enough solid scientific evidence about weight-loss hypnosis alone.

Hypnosis is a state of inner absorption and concentration, like being in a trance. Hypnosis is usually done with the help of a hypnotherapist using verbal repetition and mental images.

When you're under hypnosis, your attention is highly focused, and you're more responsive to suggestions, including behavior changes that can help you lose weight.

A few studies have evaluated the use of weight-loss hypnosis. Most studies showed only slight weight loss, with an average loss of about 6 pounds (2.7 kilograms) over 18 months. But the quality of some of these studies has been questioned, making it hard to determine the true effectiveness of weight-loss hypnosis.

However, a recent study, which only showed modest weight loss results, did find that patients receiving hypnosis had lower rates of inflammation, better satiety and better quality of life. These might be mechanisms whereby hypnosis could influence weight. Further studies are needed to fully understand the potential role of hypnosis in weight management.

Weight loss is usually best achieved with diet and exercise. If you've tried diet and exercise but are still struggling to meet your weight-loss goal, talk to your health care provider about other options or lifestyle changes that you can make.
Relying on weight-loss hypnosis alone is unlikely to lead to significant weight loss, but using it as an adjunct to an overall lifestyle approach may be worth exploring for some people.

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HOMEOPATHY
When proper constitutional remedies are selected for patients with obesity and being overweight, besides their mental and emotional characteristics, improves the patient as a whole not just considering their excess weight without considering their psychiatric aspect. The longer the patients are under proper treatment with proper remedies, the more weight they may lose. Randomized clinical trials are suggested to show the efficacy of homeopathic remedies in weight loss to reduce health risks due to obesity and being overweight.

GROUP SUPPORT
Commercial programs that rely on group support, discussions about exercise and diet and assignments, such as keeping a food diary, can be a good choice. In one study, researchers looked at the effectiveness of Weight Watchers versus a self-help approach consisting of two brief sessions with a dietician plus printed materials. The researchers found that the Weight Watchers participants lost more than three times the pounds of the self-help group the first year. On average, the Weight Watchers group lost almost 10 pounds compared to three pounds in the self-help group. By the end of the second year, both groups had regained weight. But while the self-help group returned to their starting weight, the average Weight Watchers participant kept off more than six pounds.

BENEFITS OF LOSING WEIGHT
You don’t have to lose hundreds of pounds to enjoy the physical health benefits of weight loss. If you are currently overweight or obese, you may be able to lose just a small amount of weight to improve your overall health. In fact, some studies show that just a 5% to 10% decrease in your weight can affect your health. Losing weight can mean:

• Decreased joint pain
• Decreased risk of certain cancers
• Decreased risk of diabetes
• Decreased risk of heart disease
• Decreased risk of stroke
• Decreased risk or improvement in symptoms of osteoarthritis
• Decreased risk or improvement in symptoms of sleep apnea
• Improved blood sugar levels
• Improved cholesterol levels
• Improved mobility
• Lowered blood pressure
• Reduced back pain

• Better sleep
• Decreased stress
• Greater confidence
• Improved body image
• Improved energy
• Improved mood
• Improved sex life
• Improved vitality
• More active social life

While working out comes with many health and lifestyle benefits, it also boasts many mental health advantages. A 2019 scientific review determined that exercise can be as effective for treating depression as other first-line treatments and is vastly underutilized as a treatment method.

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