Family Medicine North  
     
     
Obesity
 
 

Obesity is a condition of excess body weight. Males with over 20% body fat or females with over 25% body fat are considered obese. The concept that obesity is a will-power or self-disciplined problem is outdated. However, there is no clear understanding of the biochemical defects that cause it.

Causes

  • Genetic factors
  • Environmental factors including diet and eating habits, activity levels, stress (emotional and physical), drugs, cultural
  • Metabolic and endocrine disorders
  • Abnormal regulation of body weight to body fat
  • Central nervous system lesions

Preventive measures
Life-long adherence to a program consisting of proper diet and nutrition, exercising, and behavior and lifestyle modification as needed.

Expected outcome
If other causes have been excluded, obesity can be controlled with careful attention to diet and exercise. Making healthy choices in grocery stores and in restaurants, and participating in a life-long exercise routine is truly the best medicine.

Possible complications
Obesity may contribute to the development of diabetes, high blood pressure, heart disease and gallbladder disease. It complicates treatment and decreases survival chances of patients with stroke, kidney disease and other disorders.
Psychosocial complications include poor self-image, difficulty in getting jobs, and lack of social contacts with opposite sex.

Diagnosis and treatment
The most accurate method of determining body composition is underwater weighing and skinfold measurements of multiple sites. Also used are BMI (body mass index) and waist to hip ratio (WHR).

Many commercial and community programs are available that provide help in losing weight. Choose a program whose diet plans meet the RDA guidelines for nutrients, provides exercise and behavior counseling, and includes long-term maintenance support.

Keep diaries for food intake, exercise activities and behavior changes. Review them with your weight loss advisor weekly.
Several techniques exist for behavioral modification. Determine the type that fits your needs (e.g., assertiveness, rewards, cognitive, substitution, imagery, and others.

Surgical procedures to reduce weight, such as bypassing part of the intestine or stomach, cutting away fat, fat suctioning, or wiring the jaw shut, are desperate measures. They are used only in extreme circumstances.

Medication
Drug therapy as an aid to weight loss may or may not be helpful.
Drugs for obesity may be recommended for you on a trial basis to see if they might be effective. The effectiveness of all appetite suppressants diminishes after a few weeks. Amphetamine compounds are not recommended for treating obesity.

Activity
Increase your current level of activity. Daily exercise (bicycle riding, walking, swimming and others) helps you lose weight, feel better, and control appetite. Thirty-minutes of activity, 5 times a week should be the goal. Keep and activity diary to monitor your progress.

Diet
Many different diet plans are available to choose from. Diets that are not nutritionally balanced can cause more problems than the obesity. Crash diets diets don’t produce long-term results. Schemes which promise easy weight loss are usually unsuccessful. During your diet and exercise program, there may be periods when you don’t lose weight. This is normal; don’t stop the program. Weight loss will begin again in a week or two.

A realistic weight loss is 1 to 2 ½ pounds a week. This may seem slow, but 1 pound of fat lost per week totals 52 pounds in 1 year! Keep a food diary to record everything you eat.

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