Obesity is a major health concern in the U.S. today. The prevalence of obesity for adults is about 42%, with about 9% of adults being considered morbidly obese.
Obesity is determined by measuring a person’s body mass index (BMI) which considers a person’s weight and height. Since it only takes weight and height into account, it is only a general indicator because it does not account for muscle mass or fat distribution. In general, obesity is considered for a BMI over 30. Morbid obesity is considered for a BMI over 40, or in cases when there are other risk factors such as prediabetes, type 2 diabetes, hyperlipidemia, high blood pressure, osteoarthritis, gastroesophageal reflux (GERD) , obstructive sleep apnea, a BMI over 35 is considered morbidly obese if there are three of the above risk factors. In addition, women with a waist measurement over 35 inches and men with a waist measurement over 40 inches are considered obese.
The incidence of obesity varies markedly by race, ethnicity and geography. Non-Hispanic blacks have an obesity incidence of 49%, Hispanics 45%, non-Hispanic whites 42%, and Asians an incidence of 17%. Groups with lower income and lower educational levels have a higher rate of obesity.
Cultural norms and diets play a major role in obesity. In addition, access to health care, limited access to healthy food, and environmental components, such as limited parks, no sidewalks and no safe place to exercise can all lead to obesity.
Other factors leading to obesity are sedentary lifestyles, poor food choices and eating a diet high in processed foods with white flour, white rice, fast foods and preprepared foods, sugary foods, and portion size. In addition, genetics may play a role in obesity.
The effects of obesity can be devastating. Obesity leads to a higher risk of type two diabetes and its complications, such as kidney issues, nerve issues, vascular issues and eye issues. Obesity leads to a higher risk of coronary artery disease and heart failure. Obesity is a major risk factor for obstructive sleep apnea which can lead to heart failure, major depression, chronic fatigue and lack of productivity. It leads to an increased risk of back issues and osteoarthritis especially of the weight bearing joints like hips, knees, ankles and feet. It leads to an increased risk of gastroesophageal reflux disease which can lead to erosive esophagitis and increase the risk of esophageal cancer. GERD is treated with a group of medications called PPIs which, if taken long term have a whole litany of long-term consequences.
Obesity increases the risk of many types of cancers including breast, colon, endometrial, kidney, ovarian, pancreatic, liver and gall bladder. It is not known if obesity itself causes this or some indirect cause such as effects of a poor diet, or other effects.
And lastly, obesity increases the incidence of gout, restrictive lung disease, gall stones, fatty liver, which can increase the risk of cirrhosis, and obesity can cause fertility issues.
Obesity can lead to mental health issues also. There is a higher risk of depression and anxiety among people who are obese. People with obesity often have low self-esteem and poor body image. Plus, there is still a social stigma to obesity.
Obesity also has a major economic impact. Estimates from 2019 indicate that $173 billion was spent on obesity related health concerns. Actuarial data indicates that obesity costs a person an average of $1860 more per year than the nonobese. Plus, there is lost productivity and shortened life span for the obese.
TREATMENT
One of the most effective ways to treat obesity is through dietary changes. To lose weight, we must create a calorie deficit, which means we need to consume fewer calories than our bodies use. This can be achieved by eating less and/or exercising more. It is important to do this in a healthy way by focusing on the types of foods we eat.
One key dietary change is to focus on nutrient-dense foods. These are foods that provide a lot of nutrients (like vitamins and minerals) for relatively few calories. Fruits and vegetables are packed with vitamins, minerals and fiber. They are low in calories and can help fill you up. Aim to fill half your plate with fruits and vegetables at every meal. Choose a variety of colors to get a wide range of nutrients.
Whole grains, such as brown rice, quinoa, whole wheat bread, and oatmeal, are better choices than refined grains like white rice and white bread. Whole grains contain more fiber, which helps you feel full longer and aids digestion.
Lean proteins like chicken, turkey, fish, beans and legumes provide protein, which is essential for building and repairing tissues. Proteins also help you feel full, making it easier to stick to your calorie goals.
Not all fats are bad. Healthy fats, like those found in avocados, nuts, seeds and olive oil, can be beneficial in moderation. They help keep you satisfied and can improve heart health.
Another important dietary change is to pay attention to portion sizes. Many people eat larger portions than they need, which can lead to overeating. Using smaller plates and bowls can trick your brain into thinking you are eating more than you actually are. This can help reduce the amount of food you consume.
At first it can be helpful to measure your food using cups or a food scale. This will give you a better idea of what a proper portion looks like.
Learn to recognize hunger and fullness cues. Eat when you are hungry, and stop when you feel satisfied, not stuffed. Eating more slowly will give your body time to notice when you are full. Eating rapidly often leads to eating more than you need to because it takes a bit for your body to recognize that it is full.
Planning meals in advance can also help you make healthier choices. When you have a plan, you are less likely to grab unhealthy snacks or fast food. Take some time each week to plan your meals. Decide what you will have for breakfast, lunch and dinner. This will help you make healthier choices and avoid last-minute temptations. Write down the ingredients you need for your planned meals and stick to the list when you go grocery shopping. This will help you avoid buying unhealthy snacks and foods.
Cooking in batches can save time and help you have healthy meals ready to go. Prepare larger portions of healthy recipes and store them in the fridge or freezer for later.
Snacking can be a big part of our diets and it is important to choose healthy snacks. Instead of reaching for chips or candy, try some of these options:
Fruits and vegetables
Nuts and seeds can be a satisfying snack, but be careful with portion sizes as they are calorie dense
Plain Greek yogurt and add your own fruits or a drizzle of honey for sweetness
Whole grain crackers with a little cheese or hummus
Staying hydrated is also essential for weight loss. Sometimes we confuse thirst with hunger. Drinking enough water can help control hunger and support metabolism. Aim to drink at least 8 cups of water daily. Keep a water bottle with you throughout the day to remind yourself to drink more water. If plain water is boring, try adding slices of lemon, lime, cucumber or berries for a refreshing taste. Avoid soda, sweetened teas, and other sugary drinks as they can add a lot of empty calories to your diet.
Adding exercise, or at least increasing your physical activity, will help burn more calories and help with weight loss. Aim for at least 30 minutes of moderate exercise most days of the week. Of course, since we are talking calories, more exercise, up to a point, is more beneficial, so start off slow if you are not used to exercise but aim to add to the time you exercise and the intensity of exercise as you go along.
Both cardio and resistance training have a place in weight loss. You will burn more calories per minute of exercise with cardio, but when you stop exercising you stop burning more calories. With resistance training (weightlifting, body weight exercises, resistance band exercises) you burn less calories per minute of exercising, but you do get what is called an afterburn where you burn extra calories for up to 36 hours later. Resistance training also helps maintain and build new muscle, which is more metabolically active than fat, and also gives you the toned healthy look. Aerobic exercise will not provide these benefits. It is recommended to do resistance training 2-3 days weekly and do cardio the other days.
For more information on exercise, please see my article on the benefits of exercise, and my You Tube videos on walking for exercise, body weight exercises, weight machines, and using free weights.
There are many drugs used in the treatment of obesity. The scope of these drugs is beyond this article, however, please stay tuned to a future article on using GLP1 RA such as Ozempic and Mounjaro in the treatment of obesity.
Also, the surgical treatment of obesity is beyond the scope of this article, however, there are many options available here that are very successful.
The important thing about treating obesity is that there is no one-size fits all solution. Instead, a comprehensive approach that includes different strategies and support systems is often the most effective. This approach involves using multidisciplinary care teams, creating personalized treatment plans, and implementing long-term management strategies. This means bringing together different types of healthcare professionals to work together for the benefit of the patient. Each team member brings their own expertise, which can help address the various aspects of obesity.
Doctors can assess the patient’s overall health and determine if there are any medical issues related to obesity. They can also prescribe medications or surgery if necessary. Dieticians can help create a healthy eating plan tailored to the patient’s needs and preferences. Exercise specialists can develop a safe and effective exercise program that fits the patient’s fitness level and goals. Obesity can often be linked to emotional and psychological issues. Mental health professionals can help patients deal with stress, anxiety or depression, which may be affecting their eating habits. Nurses provide support and education, helping patients understand their treatment plans and encouraging them throughout their journey.
By working together, these professionals can provide comprehensive care that addresses not just the physical aspect of obesity, but also the emotional and social factors. This team approach can lead to better outcomes and help patients feel supported throughout their treatment.
Another essential aspect of treating obesity is creating personalized treatment plans. Every individual is different, and what works for one person may not work for another. Personalized treatment plans take into account a person’s unique needs, preferences and circumstances. For instance, some people may have busy schedules that make it hard to find time for exercise or cooking healthy meals. A personalized plan can offer simple, practical solutions that fit their lifestyle. Food choices can be influenced by cultural backgrounds. A dietician can help develop a meal plan that includes traditional foods while still promoting health and weight loss. If someone has diabetes or heart disease their treatment plan may need to be adjusted to accommodate their specific health needs.
By tailoring treatment plans to each individual, healthcare providers can increase the chances of success. Patients are more likely to stick to a plan that feels relevant and achievable to them.
Long-term management strategies are crucial for maintaining weight loss and preventing obesity from returning. Losing weight is only part of the solution, keeping it off requires ongoing effort and support.
Regular scheduled follow-ups with healthcare professionals can help keep patients accountable. Regular check-ins can also provide motivation and support as patients attempt to maintain their weight loss.
Joining a support group can provide encouragement and help individuals share their experience with others who understand their struggles. This sense of community can be very powerful in maintaining motivation.
Patients should focus on making sustainable lifestyle changes rather than quick fixes. This means adopting healthier eating habits and regular physical activity as part of their everyday life.