What is Obesity?
The Problem
Former U.S. Surgeon General David Satcher has recently warned that obesity
is overtaking smoking as the No. 1 preventable cause of disease and death in
the United States. In fact, 61% of American adults are either overweight or
obese. Each year, 300,000 Americans will die from health problems directly related
to being overweight-including heart attacks, diabetes and certain cancers.
Obesity becomes "morbid" when it significantly increases the risk
of obesity-related health conditions or serious diseases that result in physical
disability or even death. Morbid obesity is usually referred to as being 100
pounds over your ideal body weight or as having a BMI (body mass index) of 40
or higher. Studies demonstrate that efforts such as dieting and exercise programs
have a limited ability to provide long-term relief for this problem. Current
medical interventions, including weight loss surgery, are attempts to reduce
the effects of excessive weight and to ease the seriousness of physical, emotional
and social consequences of the disease of obesity
Causes of Morbid Obesity
The reasons for obesity are multiple and complex. Despite conventional wisdom,
it is not simply a result of overeating. Research has shown that in many cases
a significant, underlying cause of morbid obesity is genetic. Studies have demonstrated
that once the problem is established, efforts such as dieting and exercise programs
have a limited ability to provide effective long-term relief.
Science continues to search for answers. But until the disease is better understood,
the control of excess weight is something patients must work at for their entire
lives. That is why it is very important to understand that all current medical
interventions, including weight loss surgery, should not be considered medical
cures. Rather they are attempts to reduce the effects of excessive weight and
alleviate the serious physical, emotional and social consequences of the disease.
Contributing
Factors
The underlying causes of severe obesity are not known. There are many factors
that contribute to the development of obesity including genetic, hereditary,
environmental, metabolic and eating disorders. There are also certain medical
conditions that may result in obesity like intake of steroids and hypothyroidism.
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Genetic Factors
Numerous scientific studies have established that your genes play an important
role in your tendency to gain excess weight.
The body weight of adopted children shows no correlation with the body weight
of their adoptive parents, who feed them and teach them how to eat. Their weight
does have an 80 percent correlation with their genetic parents, whom they have
never met.
Identical twins, with the same genes, show a much higher similarity of body
weights than do fraternal twins, who have different genes.
Certain groups of people, such as the Pima Indian tribe in Arizona, have a
very high incidence of severe obesity. They also have significantly higher rates
of diabetes and heart disease than other ethnic groups.
We probably have a number of genes directly related to weight. Just as some
genes determine eye color or height, others affect our appetite, our ability
to feel full or satisfied, our metabolism, our fat-storing ability, and even
our natural activity levels.
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The Pima Paradox
The Pima Indians are known in scientific circles as one of the heaviest groups
of people in the world. In fact, National Institutes of Health researchers have
been studying them for more than 35 years. Some adults weigh more than 500 pounds,
and many obese teenagers are suffering from diabetes, the disease most frequently
associated with obesity.
But here's a really interesting fact - a group of Pima Indians living in Sierra
Madre, Mexico, does not have a problem with obesity and its related diseases.
Why not?
The leading theory states that after many generations of living in the desert,
often confronting famine, the most successful Pima were those with genes that
helped them store as much fat as possible during times when food was available.
Now those fat-storing genes work against them.
Though both populations consume a similar number of calories each day, the
Mexican Pima still live much like their ancestors did. They put in 23 hours
of physical labor each week and eat a traditional diet that's very low in fat.
The Arizona Pima live like most other modern Americans, eating a diet consisting
of around 40 percent fat and engaging in physical activity for only two hours
a week.
The Pima apparently have a genetic predisposition to gain weight. And the environment
in which they live - the environment in which most of us live - makes it nearly
impossible for the Arizona Pima to maintain a normal, healthy body weight.
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Environmental
Factors
Environmental and genetic factors are obviously closely intertwined. If you
have a genetic predisposition toward obesity, then the modern American lifestyle
and environment may make controlling weight more difficult.
Fast food, long days sitting at a desk, and suburban neighborhoods that require
cars all magnify hereditary factors such as metabolism and efficient fat storage.
For those suffering from morbid obesity, anything less than a total change
in environment usually results in failure to reach and maintain a healthy body
weight.
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Metabolism
We used to think of weight gain or loss as only a function of calories ingested
and then burned. Take in more calories than you burn, gain weight; burn more
calories than you ingest, lose weight. But now we know the equation isn't that
simple.
Obesity researchers now talk about a theory called the "set point,"
a sort of thermostat in the brain that makes people resistant to either weight
gain or loss. If you try to override the set point by drastically cutting your
calorie intake, your brain responds by lowering metabolism and slowing activity.
You then gain back any weight you lost.
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Eating Disorders & Medical Conditions
Weight loss surgery is not a cure for eating disorders. And there are medical
conditions, such as hypothyroidism, that can also cause weight gain. That's
why it's important that you work with your doctor to make sure you do not have
a condition that should be treated with medication and counseling.
If you've tried low-fat and high-fat diets, cut carbohydrates, counted
protein grams and calories and still find yourself overweight, you may think
your chances of ever shedding extra pounds are slim to none. But here's
good news: although there are no magic diets or instant fat melters (infomercial
claims to the contrary), there are proven weight-loss options that work.
According to the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), of the National Institutes of Health, gastrointestinal surgery is the
best option for people who are severely obese and cannot lose weight by traditional
means or who suffer from serious obesity-related health problems.
If you fit the profile for surgery, answers to the following questions may
help you decide whether weight-loss surgery is appropriate for you.
Are you:
- unlikely to lose weight successfully with non surgical measures?
- well informed about the surgical procedure and the effects of treatment?
- determined to lose weight and improve your health?
- aware of how your life may change after the operation
- aware of the potential for serious complications, dietary restrictions,
and occasional failures?
- committed to lifelong medical follow-up?
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