| Obesity is an increase in body weight beyond the limitation of skeletal and physical requirements as the result of an excessive accumulation of fat in the body.
Most commonly, obesity occurs when energy intake (calories) exceeds energy use. Obesity can also occur as a result of disturbances in body hormones or certain genetic conditions. In these cases, the cause of the imbalance between energy intake and energy use remains unclear.
Simple obesity differs from morbid obesity. Morbidly obese individuals have a body weight that is 2, 3, or more, times the ideal weight and includes the state reached when the degree of obesity begins to interfere with normal physiological functions, such as breathing. Morbid obesity may lead to hypertension, diabetes, joint disease, and certain types of cancers.
The greater the obesity, the greater the risk of disease and death. Obesity as defined by a body mass index (BMI) of 30.0 to 34.9 kg/m2 carries a high-risk of disease. Individuals with a BMI of 35.0 to 39.9 kg/m2 are at very high-risk of disease, and those with a BMI of 40.0 or greater are at extremely high-risk (Klein 1619).Risk: Evidence suggests obesity often has more than one cause. Genetic, environmental, psychological, and other factors may play a part.
Obesity tends to run in families, which suggests a genetic cause. However, family members not only share genes but also diet and lifestyle habits that may contribute to obesity. An individual's environment includes lifestyle behaviors such as what he or she eats and the amount of activity expended. Americans tend to have high-fat diets because they often put taste and convenience ahead of nutritional content. Most Americans do not get enough exercise and often eat high-fat fast food.
In the US, more men than women are overweight, but more women than men meet the criteria for obesity. The proportion of men and women who are obese vary greatly according to ethnicity; black women are 80% more likely to be obese than black men. Mexican-American women are also more often obese than Mexican-American men. However, men in all ethnic groups are more likely to have abdominal obesity, which predisposes them to heart disease. Overall, the highest prevalence of overweight and obesity are found in black women and Mexican-American men and women. Obesity is most prevalent in adults aged 20 to 60 years, after which point it drops off considerably.
Obesity is most prevalent in the East South-Central US (21.2%) and least prevalent in the Mountain region (14.5%) (Zimmerman 229).
Many individuals eat in response to negative emotions, such as boredom, sadness, or anger. While most overweight individuals have no more psychological disturbance than normal-weight individuals, about 30% of those seeking treatment for serious weight problems have difficulties with binge eating. Research shows that binge eaters have more difficulty losing weight and keeping the weight off than individuals without binge eating problems.
Some rare illnesses can cause obesity, including hypothyroidism, Cushing's syndrome, depression, and certain neurologic problems. Certain drugs, such as steroids and some antidepressants, may cause excessive weight gain. Incidence and Prevalence: The prevalence of obesity (defined as a body mass index [BMI] of over 30) in the US has risen dramatically over the past several decades. Sixty-one percent (110 million) of individuals aged 20 to 74 years in the US are considered overweight (Klein 1625). US population surveys have shown that the prevalence of overweight increased from 30.5% to 34.0% and the prevalence of obesity more than doubled, from 12.8% to 27%, from 1960 to 2003; children and adolescents have also been dramatically affected, with 10% to 15% of children aged 6 to 17 years now classified as overweight (Klein 1625). Recent estimates attribute 300,000 deaths a year in the US to obesity, making it second only to cigarette smoking as a cause of death (Klein 1619). Worldwide, about 8.2% of the population is considered obese. The prevalence of obesity varies greatly throughout the world. According to the World Health Organization, the number of obese adults rose 50% from 1995 to 2000 to 300 million. |
Source: Medical Disability Advisor
| History: Obese individuals are often cognizant of being overweight. Complaints may include shortness of breath (dyspnea); fatigue; joint pains in the hips, knees, and ankles; and a general dissatisfaction with state of health. Family history may point to diabetes or obesity. Physical exam: The exam includes a method for measuring body fat based on height and weight measurements called the body mass index (BMI). Other measurements include the waist-to-hip ratio, and skinfold measurements, which are taken by skinfold calipers and are measured at various locations on the individual's body. It is derived by dividing an individual's weight in kilograms by his or her height in meters squared (BMI = kg/m2). Multiplying an individual's weight in pounds by 704 and then dividing it twice by individual's height in inches can also compute BMI. For example, a woman who weighs 150 pounds and is 68 inches tall has a BMI of 22.8. The result is graded on a scale to indicate levels of body fat. Federal guidelines define overweight as a BMI of 25 to 29.9 and obesity as a BMI of 30 or greater. Individuals with a BMI greater than 40 are considered morbidly obese. The prevalence of diseases related to obesity (e.g., diabetes, hypertension, dyslipidemia, ischemic heart disease) begins to rise at BMIs greater than 25 kg/m2.
To compute an individual's waist-to-hip ratio, divide the waist measurement (measured at narrowest point) by the hip measurement (measured at fullest point). Women with waist-to-hip ratios of more than 0.8 or men with waist-to-hip ratios of more than 1.0 are "apples" (because of their apple shape). Apples are at considerably greater health risk because of their fat distribution than are "pears." Tests: Blood sugar (glucose) measurements at various times, including after fasting or after ingestion of glucose (tolerances), are used to evaluate diabetes. Blood tests may also reveal high cholesterol, high fats (hyperlipidemia), and elevated uric acid levels (hyperuricemia). Thyroid stimulating hormone (TSH) should be measured to exclude thyroid deficiency. |
Source: Medical Disability Advisor
| The five medically accepted treatment modalities are diet modification, exercise, behavior modification, drug therapy, and surgery. All these modalities, alone or in combination, are capable of inducing weight loss sufficient to produce significant health benefits in many obese individuals. Unfortunately, health benefits are not maintained if weight is regained. With the exception of surgery, it is difficult for most individuals to adhere to these modalities in a manner sufficient to maintain long-term weight loss.
Calorie restriction has remained the cornerstone of the treatment of obesity. The standard dietary recommendations for losing weight include reducing calorie intake by 500 to 1,000 calories a day and having a fat intake of no more than 30% of total calories. Saturated fats should be avoided.
The addition of an exercise program to diet modification results in more weight loss than dieting alone and seems especially helpful in maintaining weight loss and preserving lean body mass. Although vigorous workouts do not immediately burn great numbers of calories, the metabolism remains elevated after exercise. The more strenuous the exercise, the longer the metabolism continues to burn calories before returning to its resting level. Although the calories lost during the postexercise period are not high, over time they may count significantly for maintaining a healthy weight. Included in any regimen should be resistance or strength training 3 or 4 times a week. Even moderate regular exercise helps improve insulin sensitivity and in turn helps prevent heart disease and diabetes. Exercising regularly is critical because it improves psychological well-being, replaces sedentary habits that usually lead to snacking, and may act as a mild appetite suppressant.
Behavior modification for obesity refers to a set of principles and techniques designed to modify eating habits and physical activity. It is most helpful for mildly to moderately obese individuals. One frequently used form of behavior modification called cognitive therapy is very useful in preventing relapse after initial weight loss.
Drug options include anorexiants, which help individuals feel full after eating less food, and a drug that blocks the absorption of fat from the diet. These drugs are adjunctive rather than solo therapy.
Surgery, which carries significant morbidity and mortality, is reserved for well-informed and motivated severely or morbidly obese adults (more than 180% overweight or whose BMI is greater than 40) whose condition has failed to respond to medical weight control. Surgery may also be considered for individuals with less severe obesity (BMI between 35 and 40) who have disabling joint disease, pulmonary insufficiency, hypertension, or diabetes. The most common surgical procedures used to achieve weight loss are gastric bypass and gastric banding. Other procedures include gastroplasty, partial biliopancreatic bypass, and jejunoileal bypass.
Some individuals choose a cosmetic procedure called body contouring, which involves the suctioning of fat and/or the removal of skin from the abdomen, buttocks, and/or thighs. When this procedure is performed on the abdomen, it is called abdominoplasty. |
Source: Medical Disability Advisor
| If an individual strictly follows a sensible diet and exercise program and loses the needed number of pounds, the prognosis is excellent provided the individual continues with the program or with a maintenance program based on the original program. The benefits of weight loss are dependent on the amount of weight lost and take effect only after at least 5% of body weight is lost. Research shows that most individuals who successfully achieve their weight loss goals return to pretreatment weight within 5 years.
For untreated obesity, the prognosis is poor and tends to worsen. |
Source: Medical Disability Advisor
| Obesity is associated with a number of complications detrimental to health and quality of life. Included are the individual's continued inability to lose weight, the metabolic syndrome (also called the insulin resistance syndrome or syndrome X), cataracts, diabetes, high blood pressure, osteoarthritis, cancer (type varies for men and women), gum disease, gallstones, reproductive and hormonal problems, lung diseases, stoppage of breathing during sleep (sleep apnea) and other sleep disorders, binge eating and other eating disorders, and emotional and social problems.
Very-low-calorie diets (VLCDs) are associated with transient fatigue, hair loss, dizziness, and other symptoms. More serious adverse events associated with periods of severe caloric restriction include the development of gallstones and acute gallbladder disease. The risk of cardiac arrhythmias and death was eliminated with a supplementation diet of high quality protein, minerals, and electrolytes.
Diseases formerly associated only with adults are increasingly seen in children as the prevalence of overweight and obesity grows. These diseases include type II diabetes, hypertension, gallbladder disease, hyperlipidemia, sleep apnea, and orthopedic conditions. |
Source: Medical Disability Advisor
| Some obese individuals, especially those who are morbidly obese, may no longer be able to perform their duties efficiently because obesity tends to lead to fatigue. Weight-related conditions and diseases may also occur. Accommodations may include the possibility of a more sedentary position or one that incorporates limited exertion. A position that involves walking and moving around may also be beneficial because it engages the individual in exercise while working.
Individuals may need additional time away from work for appointments with the physician, dietitian, or personal trainer. A flextime arrangement may be a consideration for the individual whose weight reduction plan includes regular visits to a fitness club. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have genetic predisposition to obesity?
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Does individual have history of hypothyroidism, Cushing's syndrome, depression, or certain neurological problems?
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Is individual taking drugs that may cause weight gain, such as steroids or certain antidepressants?
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What does individual eat? Is individual active?
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Does individual eat in response to negative emotions, such as boredom, sadness, or anger?
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Is individual binge eater?
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Is individual very conscious of being overweight?
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Does individual complain of shortness of breath (dyspnea); fatigue; joint pains in the hips, knees, and ankles; or a general dissatisfaction with state of health?
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Was individual's body mass index (BMI) measured? Was it 30 or greater?
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Was blood sugar (glucose) measured at various times, including after a fast or ingestion of glucose (glucose tolerance)?
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Were blood tests taken to measure fats (lipids) and uric acid levels?
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Was diagnosis of obesity confirmed?
Regarding treatment:
- Was caloric intake reduced by about 500 to 1,000 calories per day?
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Was fat intake kept to no more than 30% of total calories per day? Does individual avoid saturated fats?
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Is individual involved in exercise program that promotes recommended amount of physical activity?
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Would individual benefit from enrollment in community exercise or weight-loss program?
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Did individual maintain weight loss? Was individual compliant with treatment regimen? What could be done to increase compliance?
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Would behavior modification program be beneficial?
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Did individual with more than 180% overweight or with a BMI greater than 40 have surgery?
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What surgical procedure was performed? Gastric bypass or lap band? How effective was procedure?
Regarding prognosis:
- Has individual depended on diet alone to lose weight?
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Does individual understand importance of keeping exercise regimen?
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How successful was individual in keeping weight off?
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How much is obesity impacting individual's health?
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Is individual candidate for more stringent, multidisciplinary weight-loss program or for surgical intervention?
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Do benefits of surgery outweigh risks?
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If weight does not decrease, can individual still perform daily activities?
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Source: Medical Disability Advisor
| Klein, S., and J. A. Romijn. "Obesity." Williams Textbook of Endocrinology. Eds. R. H. Williams and Reed P. Larsen. 10th ed. Philadelphia: Elsevier, Inc., 2003. 1419-1635.Zimmerman, R. L. "The Obesity Epidemic in America." Clinics in Family Practice 4 2 (2002): 229-229. |
Source: Medical Disability Advisor
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