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Obesity

Posted by racosta on January 28 2010

OBESITY

Some months ago I congratulated a couple for their determination to lose more than 25 pounds of weight. And because they look different now, I decided to talk a little bit about obesity, the accumulation of excessive body fat.
For most people, the condition of being overweight is easy to recognize. But medically, a distinction is made between being overweight and being obese. The body mass index (BMI) is used to define these conditions. BMI is weight (in kilograms) divided by height (in meters squared). Overweight is defined as a BMI of 25 to 29.9, and obesity is defined as a BMI of 30 or more.
Body composition –the percentage of fat and muscle in the body- is also considered when obesity is defined. Women who have more than 30% body fat or men who have more than 25% body fat are considered obese. Thus people who are very muscular and have low body fat (such as body builders) may have a high BMI without being obese and without increasing health risks.
Obesity is becoming increasingly common throughout the world. In the United States, the increase has been dramatic: Between 1980 and 1999, the percentage of overweight people increased from 47% to 61% and the percentage of obese people increased from 15 to 26%.
Obesity is more common among women than among men. How common it is (prevalence) varies by age and race. For example, prevalence increases from about 14% at age 25 to 32% at age 55, then decreases to 22% at age 75. Obesity is equally common among black and white men and is slightly more common among Hispanic men. However, obesity is much more common among black and Hispanic women than among white women. About 67% of middle-aged black women are overweight or obese compared with 45% of middle-aged white women.
Obesity results from consuming more calories than the body uses. The number of calories needed varies from person to person, depending on age, sex, physical activity, and the person’s metabolic rate –the rate at which the body burns calories.
Genetic and environmental factors influence body weight, buy precisely how they interact is unclear. One proposed explanation is that body weight is regulated around a set point, similar to a thermostat setting. Some people may have a higher-than-normal set point, which may explain why they are obese and why losing weight and maintaining weight loss are difficult for them.
Obesity tends to run in families. However, families share not only genes but also environment, and separating the two influences is difficult. Genetic factors explain about one third to two thirds of the variability in body weight.
Several genes influence weight. One gene that has been identified -the ob gene- controls the production of leptin. Leptin is a protein made by fat cells. Leptin travels to the brain and acts on receptors in the hypothalamus (the part of the brain that helps regulate appetite). The message carried by leptin is to decrease food intake and increase the amount of calories (energy) burned. Researchers discovered that mutations in the ob gene prevent leptin production and result in severe obesity in mice and in a very small number of children. In this cases administration of leptin effectively reduces weight to a normal amount. However, most experts think that in most people, many genes influence weight, and each has a very small effect. These genes have not been identified. Thus, genetic treatment of obesity is unlikely in the near future.
Physical inactivity is one of the main reasons for the increase in obesity among people in affluent societies. It is also a common cause of obesity as people age. Sedentary people need fewer calories. When physical activity increases, food intake does not always decrease accordingly, and for some people, it even increases.
In affluent societies, the diet has become higher in fats. One problem with a high-fat diet is that fats do not appear to trigger the stop-eating (satiety) response as quickly as carbohydrates or proteins. Thus, when a diet is high in fat, more food tends to be eaten. Furthermore, fats have twice as many calories per gram as carbohydrates and proteins.
Drinking alcohol can contribute to obesity. Alcohol tends to increase the number of calories taken in because it is usually consumed in addition to food. A single shot (I ounce) of liquor has 80 to 90 calories. A 12-ounce regular beer (which is about 8% alcohol) has 150 calories. As soon as alcohol is consumed, it is used as energy, causing the calories from food to be stored as fat. Furthermore, alcohol tends to stimulate the appetite and reduce self-control.
Socioeconomic factors strongly influence obesity, especially among women. In the United States and other developed countries, obesity is more than twice as common among women of lower socioeconomic class as it is among women of higher ones.
People who were obese as children are more likely to be obese as adults, largely because when weight is gained during infancy and early childhood, new fat cells form. People who become obese during childhood may have up to 5 times more fat cells than people who maintained a normal weight. Because the number of cells cannot be decreased, weight can be lost only by markedly decreasing the amount of fat in each cell. This fact may limit how much weight can be lost and make maintaining a normal body weight more difficult.
Gaining weight during pregnancy is normal and necessary. However, for a few women, pregnancy is the beginning of weight problems: They gain a large amount of weight and do not lose it afterward. Having several children close together may compound the problem.
After menopause, many women gain weight. At this time, hormonal changes cause fat to be redistributed in the body and to tend to accumulate around the waist rather than the hips and thighs. (This redistribution increases health risks.) Becoming less active, which may occur gradually and unconsciously at this age, also contributes to weight gain.
Psychologic factors, such as emotional disturbances, are no longer considered an important cause of obesity. However, stress can affect weight. When under stress, some people eat more, and some people eat less.
Hormonal disorders rarely cause obesity. Excess production of cortisol by the adrenal glands (Cushing’s syndrome) causes an unusual type of obesity in which fat accumulates only in the trunk while the arms and legs remain thin. Polycystic ovary syndrome may be associated with obesity. Occasionally, an increased level of insulin in the blood (hyperinsulinemia) causes obesity.
Many drugs used for common disorders promote weight gain. Examples are drugs used to treat Psychologic and neurologic disorders (including many antidepressants and antipsychotics), some antihypertensives (such as betablockers), corticosteroids, and some drugs used to treat diabetes (such as insulin).
Stopping smoking usually results in weight gain. Nicotine decreases appetite and increases the metabolic rate. Thus, when nicotine is stropped, food intake increases and the metabolic rate decrease, so that fewer calories are burned. As a result, body weight may increase by 5 to 10%.
And this is all for now. Next time we will talk about symptoms, diagnosis and treatment.
God bless you all!

Rafael Acosta Sr., FDD
Health Services Chairman