Introduction

Obesity has become a growing epidemic that plaques people of different cultures worldwide.
Obesity is such a major health concern because it leads to several fatal diseases. Obesity
sufferers are prone to cardiovascular problems, diabetes, stroke and heart attack. Many of
these health issues are called “silent-killers” because the victim does not even know they have
these diseases. Obesity is not only negatively affecting adults but it affects the younger
generation as well. Children and teenagers are becoming obese at alarming rates. It is said that
if this trend continues our children’s generation will not live as long as their parents. This is a
serious fact that is terrifying on every level. Obesity does not discriminate as it takes out so
many in its path. Obesity is preventable.
The leading cause of obesity is the intake of caloric food consumed being more than the
output of energy the body exerts in a day. Our intake of food must match our output of
energy. If these two numbers do not correspond then fat cells multiply and make a home in
the tissues of the body. Once this occurs a person is on a dangerous path leading to obesity.
Other causes of obesity are a sedentary lifestyle, a decrease in physical activities and manual
labor. We live in a technological revolution. Gadgets make everyday tasks easier and
therefore we have to exert less energy. This is a negative influence though, because it leads to
the onset of obesity and severe health problems.
Obesity is calculated by estimating an individual’s Body Mass Index. A BMI test is a proven
way to calculate obesity and its chance of occurrence. A BMI test calculates and divides a
person’s weight by their height. This gives a percentage and alerts the person to their rate and
chance of being obese. An above normal BMI percentage is twenty-five percent or higher of a
normal body weight. Many Americans fall into this category, causing America, to become a
nation of obese people.
There are many treatment options for people who are suffering from obesity. The best
treatment is for an obese individual to decrease their calorie intake, to decrease their fat
consumption, to only use clinically proven obesity treatment product, to become more active
and to participate in physical manual labor. All of these factors form a winning therapy in
order to fight obesity. Many people will try weight loss pills, whether prescribed or herbal,
but they only work in conjunction with a healthy diet and vigorous exercise program. People
using these pills should be reminded of their serious side effects. Obese people also have the
choice to have surgery performed but this option is usually only used in severe cases.
It used to be that obese people were looked towards as signs of strength and fertility. Today
obese people are stereotyped as they are considered to be lazy and dull minded. These two
factors are far from the truth. Obesity is a huge that problem that keeps getting bigger.
People’s waistlines are rapidly growing and this is leading to a lifetime of health problems.
The sad thing is that obesity affects one generation after another. This is a raging epidemic
that calls for stricter government regulations and a greater sense of personal responsibility.
Obesity can be stopped in its tracks and prevented.

Definition Of Obesity
The English word ‘Obesity’ derives from the Latin Obesus meaning ‘fat’ or ‘plump’. The first
English use of the word was made in 1651 in Noah Bigg’s medical book Mataeotechnia
Medicinae Praxeos.
In medical studies, obesity is defined as a person having more than 20 per cent of ideal
weight. Ideal weight takes into account height, age, sex and build of a person. According to
National Health Institute, USA, the Body Mass Index of a person is the key factor to
define obesity. As per NHI standard, a person with 30 pounds of more fat content in his or
her body is considered obese.
Body Mass Index, or BMI, is a health indicator of the diseases associated with obese men and
women. These health factors include “silent-killers” such as: diabetes, heart disease and
cancer. Many obese individuals do not even realize they have one or more of these diseases.
By waist measurement and BMI, body fat can be measured. Obesity is defined as a waistline
of 35 inches or higher for woman and for men a waistline of 40 inches or higher. The
BMI formula calculates body weight and height. The formula works by dividing an
individual’s weight (Kg) by their height (meters squared). It can also be worked out by
multiplying weight in pounds by 703, and dividing height in inches. Again a division is
necessary by height (inches).
Obesity can also be defined as a BMI of 30 pounds over a person considered normal
weight. Weight standards are calculated according to a person’s height. Excessive obesity is
defined as a BMI of 40 or higher. There is another way of defining obesity. It is overweight,
with a BMI of 25 to less than 30. A person’s BMI of about 25 kg/m (squared) corresponds to
about 10 per cent over a normal weight.
Broadly speaking, obesity can be defined as a body’s extra fat that is stored in tissues as a
result of excessive consumption of caloric food, which is not compatible with the routine
manual labor undertaken. Simply put, what a person takes in they must put out. This involves
the physical act of eating in comparison with the level of physical movement.

Cultural & Social Significance

An obese person, in several different cultures, is associated with strength, fertility and wealth.
In the great Indian epic, The Ramayana, the villain Ravana has an obese brother named
Kumbhakarna who is a strong man with superior fighting qualities.

The Laughing Buddha in ancient China is associated with wealth and

prosperity. The Venus figurines in western culture are obese females, which indicate fertility
and those able to survive famines.
The paintings of Rubens (1577–1640) are plump female figures suggesting fertility and a
symbol of social prestige.
Now, an obese individual has unfortunately become a social and cultural outcast. The
crude treatment put upon obese people is noticed in the past as well as in the present. An
obese is held as somebody with unnatural traits. He or she is often called names. Many times
obese people are considered to be lazy and less intelligent. It is a standard that some members
of society have accepted and have unfairly instrumented this falsity into their thinking
structure.
In the Shakespearean comedy ‘Much Ado about Nothing’ the obese constable Dogberry is
called an ‘Ass’ a ‘Coxcomb’ much to the pleasure of the audience. Nobody takes any offense
in maltreatment of an obese.

The great western comic character Hardy, in Laurel and Hardy, routinely made
fun of his issues surrounding his own obesity. The people crowded the movie halls to see the
tantrums of Laurel and burst into roars of laughter.
In today’s figure conscious society, an obese is a cultural outcast. The overweight body of
an obese with wide waistline is a butt of ridicule. They are always shown in movies and plays
as laughing stocks. In some radical religious beliefs an obese is even held as a person without
soul!
The obese are objects of entertainment. In circus, we see jokers and clowns are always short
and fat. The obesity of humans has even transformed into animals to get uncensored laughter.
Such occurrences are prevalent in cartoon films. Adults and minors are brought together to
laugh at the obese creatures.

Contemporary Culture
Both in fantasy and in real life we see the pathetic conditions of obese people. They are
ostracized once they become overweight. The idea that an obese is worthless dominates the
mindset of contemporary culture.
No scientific analysis is made on the cause of obesity or on the mental conditions of the
obese. The dignity of obese people is sacrificed to the wild and wanton desire of people with a
normal physique. In this process, the cultural common-sense of people, in general, is
darkened.
In contemporary culture, the obese provides enough space to produce laugh scenes in
different mediums of arts. In literary creations, films and cartoons, they are seen in
abundance. The obese sometimes takes the form of a bully, sometimes a selfish human and
again in just a jest-giver.
The post-modern time has arrived with all its complexities. There is the old crude and shabby
social and cultural treatment of the obese individual. Because of this there arises a new
consciousness about the physical and mental conditions of an obese person. There are
listeners to his or her agony. There are voices of protest against maltreatment to a person
suffering from obesity. He or she is no longer treated as a grotesque character in social and
cultural settings by a group of enlightened and educated people.
The social significance of friendly treatment towards an obese lies in the scientific outlook
acquired by the common masses. An obese is a patient, he needs love and affection, care and
treatment – this is the growing trend of a sizeable section of the population these days.
In the post-modern social and cultural milieu, the obese are not stigmatized and ostracized.
The new generation of youth is also taking more health conscious steps towards the early
detection and prevention of obesity. Such occurrences are prevalent in cartoon films. Adults
and minors are brought together to laugh at these obese creatures.

Popular Culture
The obese are commonly treated as a stock of ridicule. Selfishness and bullying are their
characteristics in popular culture. These are shown with such traits in adults’ as well as
children’s movies, books, cartoons and other art forms.

The character Dudley Dursley in British writer Joan Cathlene Rowling’s super
hit book Harry Potter series is a selfish bully. The rock lifting overweight Mr. Flintstones in
the cartoon The Flintstones is made fun of because of his dull head and weight. He is a fool
and enjoys being a fool. We are given obesity related humor in Bustopher Jone’s fat cat in the
musical Cats who rises to fame only because he is a regular visitor of well-known clubs
where heavy dishes are served. And he, already 25-pound, is putting on weight everyday.
Another obese comic cartoon character is Garfield, an idle fat cat, who enjoys eating lasagna
and sleeping.
In Hollywood, an obese actor’s best choice is to play a clown like Drew Carey. He may also
play a funny guy like Lou Costello or a gangster like Victor Buono with 400 pound or pure
menace like Sidney Greenstreet with 357 pound in The Maltese Falcon. In the film Jurassic
Park, the selfish man Denis Nerdy is an obese. He is portrayed as a thief.
In Bollywood, we also see people make fun out of the obesity of a person in hindi movies.
Kumkum, an obese unmarried woman of yesteryears, was a comic female character, the only
one in the hindi film history. She was always shown as a female pining for marriage and
shunned by the man, she chose because of her obesity.
Famous hindi film actor Amjad Khan was a great hit since his debut film Sholay in 1975. But
soon he fell victim of obesity by taking heavy doses of pain killers after suffering an accident.
He lost all chances to act in films. He died at the tender age of 40.
Thus both in reel and real life the obese receive a shabby jests in popular culture. The old
idea has been lost of being a stout and strong man. His or her obesity has made them a joker
in popular art forms.

Effects On Health
An obese person is prey to certain critical health disorders. These disorders include
cardiovascular problems like stroke, diabetes milletus type 2, sleep apnea, depression,
osteoarthiritis, cancer, hormone deficiency, especially a sharp fall in testosterone level in men,
fast ageing and Obesity Hypoventilation Syndrome (OHS).

Obesity raises cholesterol and triglycide levels and lowers HDL good
cholesterol leading to stroke. It also raises the levels of blood pressure and blood sugar. This
combination increases the risk of heart attack.
Obesity also causes osteoarthritis in the hand, hip, back and knee. Obesity issues affect post-
menopausal women by increasing their chances of having breast cancer. Obese men may also
suffer from breast cancer. Increased BMI may cause cancer of the esophagus. A person with
super weight may have endometrial and renal cell cancer particularly for women.
Obesity increases the risk of cardiovascular diseases, carpal tunnel syndrome, chronic venous
insufficiency, gallbladder problems, daytime sleeping, fatigue, gout, hypertension, pancreatic
problems, infertility and low back pain. Obstetric and gynecological complications in women
are also reported.
Other obesity related diseases are abdominal hernias, acanthosis nigricans, endocrine
abnormalities, chronic hypoxia and hypercapnia, dermatological effects, depression,
elephantitis, gastro esophageal reflux, heel spurs, hirsutism, lower extremity edema,
mammegaly (causing considerable problems such as bra strap pain, skin damage, cervical
pain, chronic odors and infections in the skin folds under the breasts, etc.), large anterior
abdominal wall masses (abdominal paniculitis with frequent panniculitis, impeding walking,
causing frequent infections, odors, clothing difficulties, low back pain), musculoskeletal
disease, prostate cancer, pseudo tumor cerebri (or benign intracranial hypertension), and
sliding hiatil hernia.
The cause of Obesity Hypoventilation Syndrome (OHS) is generally unknown, but is likely
related to a combination of a disorder in the brain’s control over breathing and the effects of
obesity on the chest wall. With the excess weight of massive obesity, the muscles of the chest
wall can have difficulty expanding the chest enough to exchange air efficiently. This results in
a decreased ability to oxygenate the blood, and the retention of carbon dioxide. Affected
people suffer from chronic fatigue due to sleep loss; poor sleep quality, and chronic hypoxia
meaning decreased blood oxygen.

Metrics
Body mass index (BMI), developed by Belgian anthropometrist Adolphe Quetelet, is a
widely accepted scale to measure obesity. Its formula is division of the weight of an obese in
kilograms by his height in square metres. Another formula is BMI = weight (lbs.) * 703 /
height (inches)2

Top of Form
Body Mass Index

cm/kg

in/lb
Height:

Weight:

BMI:
Bottom of Form

The following values are commonly accepted:

• A BMI less than 18.5 is underweight
• A BMI of 18.5 – 24.9 is normal weight
• A BMI of 25.0 – 29.9 is overweight
• A BMI of 30.0 – 39.9 is obese
• A BMI of 40.0 or higher is severely (or morbidly) obese
• A BMI of 35.0 or higher in the presence of at least one other significant co morbidity
is also classified by some bodies as morbid obesity.
To interpret BMI, physicians take into account race, ethnicity, lean mass, age, sex and other
similar factors. Although there is no dispute to accept BMI to measure obesity, but it is not
accurate in judging body fact of a very muscular person, for example an athlete or the lost
mass of an old person. It is also not correct in measuring waist circumference as it does not
take into account differing ratios of adipose to lean tissues. BMI also cannot differentiate
between separate types of adiposity, which on many occasions relates to cardiovascular
danger.
There is an alternative way. Scientists and physicians believe that men with over 25 per cent
body fat and women with over 30 per cent body fat are obese. There is, however, difficulty in
precisely measuring excessive fat of a person’s body. Experts suggest that the underwater
weight of a person could be closer to an accurate answer. But underwater measurement is
not generally possible for all the people. It can be conducted in laboratories only.
Another alternative is the skinfold test which is dependable and can be easily conducted. The
bioelectrical impedance analysis is also acceptable to doctors because of its easy
conductibility in medical clinics. Other types of measurement are computed tomography
(CT/CAT scan) and magnetic resonance imaging (MRI/NMR) and dual energy X-ray
absorptiometry (DXA). Measurement of risk factors and diseases associated with
overweight can be judged by clinical analysis. Coronary heart problems diabetes type 2 and
sleep apnea are common ailments for an obese. These are life-threatening diseases.
Smoking, blood pressure, age and family history can multiply the risk factors for disease. So
it is understood that there are several methods to quantify body weight of an obese with each
having its advantages and disadvantages. The physicians resort to methods which are
commonly practiced and can give accurate figures.

Causes Of Obesity
Overeating

Overeating is the main cause of obesity. When the consumption intake

does not match physical expenditure in a single day, obesity begins. The extra fat gained by
the negative subtraction of the tow factors mentioned above allows pockets of fat deposits
accumulate within the human body. A man or a woman of such a high-consumption nature
falls prey to extra fat, bypassing the normal metabolic conditions of a human being.
The extra energy produces fat which is reserved into tissues. This imbalance in energy
conservation leads to overweight over a period of time.
Eating disorders, unscheduled timing of meals and a wide time gap between eating all
increase the chance of being an obese.
Genetic
 Besides overeating there are other reasons for getting weight. Some genetic
disorders, carried by generations lead to overweight. In these cases people are helpless as
they are biologically destined to have super weight. According to a study conducted by the
World Health Organization (WHO), the people of Indian sub-continent are more prone to
diabetes which presupposes an over weight condition.
Some illness like hypothyroidism leads to obesity. Here too things are not in the hands of
the suffering people.
Gender plays an important part to play in causing obesity. On an average, a man has more
muscles than a woman. Since muscles consume more calories than other forms of tissues, a
man uses more calories than a woman even when he is not doing anything.
It proves that women are more vulnerable to obesity than men with same food intake.
Age is also a vital factor. Older people lose more muscles and thereby they tend to get
fatter than the youth. Elderly people thus become obese more than the young generation.
During pregnancy, women get extra weight. This weight gain may lead to obesity. This can
compound with each pregnancy.
Medication and Drugs
Certain medications also lead to overweight. For example taking too many pain killers,
sedatives, anti-depressants and typical antipsychotics cause extra fat to build in an
individual.
People should be very cautious in consuming such drugs. The less you take the better. Over
consumption of alcohols also causes extra fat cells to develop.
Lack of Exercise
Sedentary lifestyle lacking in the realm of manual labor in the day’s schedule also leads to
obesity. Those who do not spend a few hours engrossed in manual works give way to
becoming heavy weight. Lack of physical exercise also leads to the miserable fall out
becoming heavyweight.
Wrong Diet
A high glycemic diet, for example, a diet that consists of meals having high postpandial blood
sugar causes a person to become obese. Heavy consumption of sugary food raises blood
sugar level which in its turn makes one overweight.
A repeated attempt to lose weight by dieting is also risky. Eminent pop singer Carpenter died
by practicing over dieting.
Depression
 Higi level of stress are capable of leading to obesity. In this world of
competition, it is hard not to become anxious, but too much of it is dangerous. Some people
overeat because of depression, hopelessness, anger and boredom, it is not true that obese have
more emotional problems. What we want to say is that emotions force people to take a
particular eating habit that may not be healthy.
Insufficient Sleep
Insufficient sleep may also lead to danger. One should remember that sleep is a food for the
body. Denial of this vital food necessarily leads to complications.
Smoking
Smoking is also extremely bad for a person’s health. It leads to many serious medical
complications. But sudden cessation of smoking may also lead to danger. If a person makes
the healthy decision to quit smoking they should talk to their doctor about their quitting
options.
Ethnic Group
Ethnic diversity plays a part in the growing epidemic of obese people among certain cultural
populations worldwide. It is proven that some ethnic groups are more vulnerable to
becoming obese than others. It depends on the food habit of the ethnic group in question.
People having large adipose reserves are more likely to survive food shortages or famines. On
the other hand, these people are in a disadvantageous position in a society where food
supplies are plentiful.

Treatment For Obesity

1994 is memorable year for the obese. During the year leptin was discovered. With this
discovery, the information about appetite, food intake, storage type of adipose tissues,
hormonal mechanisms, development of insulin resistance etc came to light. This stock of
information has made the treatment of obesity easier.
The knowledge gained dealing with the influence of appetite by leptin and ghrelin hormones
aid in the prevention of obesity. It was noticed that stomach produced ghrelin to meet its
short-term appetite. On the other hand adipose tissues produce leptin hormone for long-term
appetite.
With the discovery of leptin and ghrelin, doctors try to administer these two hormones to the
obese as and when required. Sometimes they work , sometimes they don’t. Doctors
prescribe medicines on the result of these two mediators.
Hunger and satiety were closely studied since the discovery of leptin and ghrelin. The effect
of leptin on arcuate nucleus melanoctrin system is now considered the most substantial part of
the scheduling of feeding and the consequent metabolism.
The function of these two on the hypothalamus, located in brain that controls hunger and
satiety, is known and the treatment based on it is called the neuroscientific method of treating
the obese.
The most effective therapy to cure obesity is to change certain behavior patterns. An obese
individual should lower their food intake, consuming low calorie food, use of a clinically
proven weight loss product, participating in regular physical work and exercise three times a
week or more.
The intake of lesser food amounts and low calorie food at that will automatically generate a
smaller amount of food energy taken-in therefore causes a person to be of a lower weight.
Care should be taken that the diet is still nutritionally balanced. A balance must be struck
between adequate food and luxury dishes.
The obese individual must take great care in learning about food nutrition. A little amount of
nutritional food would make up a huge intake of junk food. Green vegetables play an
important role in the daily meal of an obese. Consumption of green vegetables in place of
starchy food aids in weight loss.
Alcohol should be avoided religiously. All attempts should be made to avoid getting alcoholic
fat cells in the tissues of the body. Nobody is asking someone to practice one-hundred percent
abstinence but a restriction is imperative.
The overzealous use of painkillers, sedatives, tranquilizers, anti-depressants and birth control
pills should be stopped if they can be. These drugs cause immense fat as they increase a
person’s appetite and the need to eat more to ease their increased hunger pains.
A healthy food chart should be maintained so that there isn’t any additional fat added to the
body of an overweight individual. In this effort, help may be sought form a
nutritionist.Weight loss product can be a big help. But with thousands of products out there,
one should only use clinically proven and medically backed with clinical studies
products. The most effective weight loss product used by doctors for treatment of obesity is
Proactol.
Once food intake is properly managed, an effort should be made to reduce the weight of an
obese person through physical labor and exercising. Routine physical labor consumes extra fat
cells therefore causing a noticeable reduction in weight. To add to this endeavor, regular
physical exercises would further the use of stored calories.
Brisk walking for a considerable amount of time a day, would increase the burning of
calories, enabling an obese individual to lose more weight at a quicker pace.
Attention should be directed to the overseeing that a person suffering from obesity has
receives an adequate amount of sleep each night and is not emotionally distressed.
Sleeplessness takes a toll on the health of an obese person. Excessive emotions can also
influence one’s diet and thus jeopardize all their positive efforts to reduce fat cells.

Environmental Factors
Environment plays a major role in people becoming obese. Here the environment stands
for the surroundings an American is born and grows up. The sedentary life style of an
average American is mainly responsible for the citizens becoming obese in such large
quantities. That is why it is so important for parents to instill a love for exercise at an early
age.
An obese parent genetically hands over his fat to the next generation. The cycle thus has
become vicious. The early Americans were British colonialists. These colonists were hard
working and therefore they did not have to deal with the issues and complications of obesity.
With the growth of economy, people find no interest in manual labor and there for have
started the production of a society of people greatly suffering from obesity. History tells us
that since the Second World War, the average weight of Americans increased, but they did not
suffer from such intense obesity.
But things started to take a turn for the worse, once the cost of food products decreased in the
1980’s. People have enough money to buy food, especially sugar and corn products, plus huge
food consumption, such as restaurant portions, combined with little physical labor add to this
perplexing dilemma. These factors have caused people to become thick around the middle.
Some foodstuffs have been subsidized leading to a sharp fall in their prices.
With the opening of economy lead by the Regan administration in the 1980s adults and
children fell prey to seductive advertisements for junk food and cold drinks, which consist of
a large amount of calories that cause a person to become obese. With new gadgets for cooking
and household work appearing on the scene, people, especially women, do less physical work
leading to their becoming obese.
Increasing affluence in society also has caused over consumption of food by Americans. The
elderly population tends to be more obese. The number of elderly people in the USA is
growing since the mortality rate has increased over the years. And with this the number of
obese people in the United States has grown rapidly from year to passing year.
A lack of physical work and exercise also contributes to the formation of a large number of
people becoming obese. Since the service sector is booming in American industry, people are
mostly occupied with cool and comfortable sitting jobs in air-conditioned rooms. This
increases obesity among the average worker.
As for the need for physical exercise, many people have become largely indifferent to this
need. With heavy foods in the stomach, people find no outlet to use up the stored calories.
This causes obesity.
Americans should pay immediate attention to their environment, they should eliminate any
factors that affect their health negatively. They should undertake more manual labor and
physical exercise and teach their children about the importance of these factors to ensure a
healthy body. Since obesity is associated with several fatal diseases, obese Americans will
soon be treated as social outcasts and the USA, as a country of patients.

General Causes of Modern Obesity

Thr risk factors and contributory causes of obesity - a disease of excess body fat
characterised by a body mass index of 30+ - include a range of well-documented genetic
and environmental factors. But the relative effect of these causes on the development of
obesity, remains unclear. Before examining possible causes, note that obesity, especially
severe clinical obesity like morbid or malignant obesity, carries greater risks of morbidity
and premature mortality than simple overweight.

Problem 1: Diagnosing Causes For Sudden Rise in Obesity Levels

Any explanation of the root causes of the current obesity epidemic must account for its
sudden appearance. Six million American adults are now morbidly obese (BMI 40+),
almost twice as high as 1980 severe obesity rates, while another 9.6 million have a BMI
of 35-40. The percentage of overweight children 6-11 has nearly doubled since the early
1980's. (Source: US Census 2000; NHANES III data estimates). Thus genetic causes are
unlikely to be significant. Because while a predisposition to obesity can be inherited, the
fact that obesity has increased so much in the last few decades appears to discount
genetics as a major main cause. Also, the fact that each succeeding generation is heavier
than the last indicates that changes in our environment are playing the key role.
Problem 2: Separating Genetic Causes From Environmental Causes
Obesity tends to run in families, suggesting a genetic link. Yet families also share
common dietary, physical exercise, attitude and lifestyle habits that may also contribute
to obesity. Separating these from purely genetic factors is not an easy statistical or
diagnostic task.
Environmental Causes of Obesity
In view of the sudden rise in weight levels - which is a worldwide trend as reflected in the
new word "globesity" - environmental factors must be the prime cause of modern
obesity.
Overconsumption - A Possible Root Cause
Eating too many calories for our enery needs must be a major candidate for the main
cause of the modern obesity epidemic. According to Dr. Marion Nestle, Professor and
Chair of the Department of Nutrition and Food Studies at New York University, US
agribusiness now produces 3,800 calories of food a day for every American, 500 calories
more than 30 years ago — but at much lower per-calorie costs. Increases in consumption
of calorie-dense foods, as evidenced by the growth of fast-food chains and higher soft
drink consumption, also point to a higher energy-intake.
NOTE: For an explanation of how surplus calories - from dietary fat, protein or
carbohydrate - are stored as body fat, please see: Body Fat/Adipose Tissue - Why
We Gain Fat
Eating Too Many High-Fat or Refined Sugary Foods
The type of food eaten may also play an important role in the rise of obesity.
Researchers continue to discover more metabolic and digestive disorders resulting from
overconsumption of trans-fats and refined white flour carbohydrates, combined with low
fiber intake. These eating patterns are known to interfere with food and energy
metabolism in the body, and cause excessive fat storage. Associated health disorders
include insulin resistance, type 2 diabetes as well as obesity. Incidence of these "modern"
diseases is increasing worldwide.
Reduced Energy Expenditure - A Possible Root Cause
People who eat more calories need to burn more calories, otherwise their calorie surplus
is stored as fat. For example, if we eat 100 more food calories a day than we burn, we
gain about 1 pound in a month. That’s about 10 pounds in a year. Over two decades this
energy surplus causes a weight gain of 200 pounds!
Assessing the contribution of lack of exercise to obesity is hampered by lack of research.
According to existing surveys, only 20 percent of the population are frequent exercisers.
In addition, only a small minority of children (1 in 5) regularly participate in after-school
sports or extra-curricular physical activity. Since 1990, among adults there has been a
per capita decline of 15 percent in frequent exercise activity (100+ days per year in any
one activity). Among teenagers and adolescents aged 12-17, the plunge is 41 percent.
However, data on correlation between BMI and exercise frequency is almost non-
existent, so we are unable to say exactly what effect lack of exercise has on obesity.
What we do know is that severe clinical obesity leads to serious mobility problems caused
by respiratory and musculoskeletal disorders. Thus the fitness capacity of obese
individuals, especially those suffering from morbid obesity, is typically diminished.
Family Influence - A Major Contributory Cause to Obesity
Parental behavioral patterns concerning shopping, cooking, eating and exercise, have an
important influence on a child's energy balance and ultimately their weight. Thus family
diet and lifestyle are important contributory causes to modern child obesity, especially at
a time of rising affluence. Since obese children and adolescents frequently grow up to
become obese adults, it's clear that family influence also extends to adult obesity.
Genetic Causes of Modern Obesity
Genes affect a number of weight-related processes in the body, such as metabolic rate,
blood glucose metabolism, fat-storage, hormones, to name but a few. Also, some studies
of adopted children indicate that adopted children tend to develop weight problems
similar to their biological, rather than adoptive, parents. In addition, infants born to
overweight mothers have been found to be less active and to gain more weight by the
age of three months when compared with infants of normal weight mothers, suggesting a
possible inborn drive to conserve energy. Research has also shown that normal-weight
children of obese parents may have a lower metabolic rate than normal-weight children
of non-obese parents, which can lead to weight problems in adulthood. All of this
suggests that a predisposition to obesity can be inherited.
However, the fact that obesity has increased so much in the last few decades appears to
discount genetics as the main cause. According to Stephen O'Rahilly, professor of clinical
biochemistry and medicine at Cambridge University, the influence of genetics on modern
levels of obesity is insignificant:

What is Obesity?
If someone is obese, it means they are seriously overweight as a result of having too
much body fat. In adults, the exact level of obesity is determined by reference to the
Body Mass Index (BMI). A score of 30+ on the BMI indicates mild obesity. Types of
severe clinical obesity include morbid obesity (BMI 40+) and malignant or super obesity
(BMI 50+). At the extreme end of the scale is super-super obesity (BMI 60+). Child
obesity is measured differently. It is based on BMI-for-age, and is assessed in relation to
the weight of other children of a similar age and gender. Central or abdominal obesity,
now classified as an independent risk factor for some serious diseases, refers to
excessive fat around the stomach, abdomen or middle.

Health Effects of Obesity

Obesity, especially morbid and super obesity, has been linked to raised incidence of
premature death as well as several serious medical conditions, including type 2 diabetes,
insulin resistance, heart disease, high blood cholesterol, high blood pressure, and stroke.
Obesity is also a risk factor in higher rates of certain types of cancer, as well as fatty liver
disease, vascular disorders, thrombosis, obstructive sleep apnea, musculoskeletal
problems and gastroesophageal reflux. Abdominal obesity is associated with insulin
resistance syndrome and cardiovascular disease. But if you are very overweight, do not
despair. Losing even 5-10 per cent of your body weight can cause a significant
improvement in your health.
See also: Weight Loss Guide For Super-Obese.
Obesity in Women
Obese women are more likely than non-obese women to die from cancer of the
gallbladder, breast, uterus, cervix and ovaries. In addition, obesity can lead to an
increased risk of many obstetric and gynecological complications for women. These
include infertility, menstrual abnormality, miscarriage and birth problems for both mother
and child. Before menopause, women suffer less from abdominal obesity because
estrogen levels cause fat to be stored around the hips and thighs. But after menopause,
women tend to store more fat around their middle, with a consequent rise in associated
health risks. See also: Body Fat/Adipose Tissue - Why We Gain Fat
Obesity in Men
Being typically apple-shaped, men have a higher risk for abdominal obesity which is an
independent risk factor for heart disease and type 2 diabetes. Morbidly obese white
males aged 20-30 years old with a body mass index exceeding 45, can shorten their life
expectancy by 13 years. Morbidly obese African American men of similar age and body
mass index can lose up to 20 years of life. Abdominal obesity, characterized by a fat
belly, is more common in men as males typically store fat around their middle. Men
suffering from stress are especially at risk because stress causes the body to produce
cortisol, a hormone which is believed to stimulate the storage of fat around the abdomen.
Abdominal obesity is one of a cluster of interlinked symptoms (including, raised
cholesterol levels, hypertension, insulin insensitivity, raised levels of inflammatory and
clotting components in the blood) that make up 'metabolic syndrome'. This metabolic
disorder has been identified as a serious risk factor for heart disease. Estimates suggest
that up to 1 in 3 of overweight men have metabolic syndrome.
Obesity in Children and Teenagers
According to the Center For Disease Control (CDC), the percentage of overweight
children aged 6-11 years has almost doubled since the early 1980's. The percentage of
overweight adolescents has risen by nearly 300 percent. This is reflected in the increased
prescription of weight loss drugs and the introduction of Lap-Band gastric reduction
surgeries for obese teenagers.
Drug Treatment For Obesity
Mildly obese patients can benefit from diet and exercise treatments, sometimes provided
in conjunction with weight loss medication. FDA-approved obesity drugs like Meridia
(sibutramine) or Xenical (orlistat) can provide some assistance to some obese patients,
although long term results are not encouraging. Clinical studies of weight loss pills show
minimal benefits for obese patients, perhaps because drugs are not yet able to treat the
emotional factors behind disordered eating patterns.
Bariatric Surgery
Patients with morbid obesity, especially those with serious co-morbid conditions, may
qualify for bariatric surgical treatments such as Lap Band or Roux-en-Y gastric bypass.
Gastric reduction surgery is an important treatment option for obese patients with severe
health problems. Initially, it leads to very significant weight loss in the 2 year period
following their gastric bypass or banding operation, but it deals with symptoms (our
excess weight) not causes (why we overeat). As a result, about 2-5 years after their
operation, up to 40 percent of bariatric patients find it too arduous to follow the
recommended dietary guidelines and end up regaining weight.
Recommended Non-Surgical Treatment For Obesity
So what can you do if you're obese? How can you begin to regain control over your
weight and shape? Here are two suggestions: first, get yourself a good incentive to
reduce weight. Next, join a healthy weight loss program. One that allows you
plenty to eat, explains what exercise is necessary, and why, and gives you tons of
personal support to overcome the normal dieting headaches that cause you to quit. If
you need help, then check out Anne Collins Weight Loss Diet Program. It includes a
range of easy diets, great motivation advice, and a really friendly online weight loss
forum with over 10,000 members to help you lose weight and keep it off. It is used by
doctors and obesity clinics, as well as dieters from every state in America, and 20 other
countries worldwide. The program's success in helping obese patients lose up to 170
pounds of body fat, by healthy eating and friendly community support, is astonishing. To
see how effective the diet program is, see Before-and-After Weight Loss Photos.
Energy Balance
For most people, overweight and obesity are caused by not having energy balance. Weight is
balanced by the amount of energy or calories you get from food and drinks (this is called
energy IN) equaling the energy your body uses for things like breathing, digesting, and being
physically active (this is called energy OUT).
Energy balance means that your energy IN equals your energy OUT. To maintain a healthy
weight, your energy IN and OUT don’t have to balance exactly every day. It’s the balance
over time that helps you maintain a healthy weight.
• The same amount of energy IN and energy OUT over time = weight stays
the same
• More IN than OUT over time = weight gain
• More OUT than IN over time = weight loss
Overweight and obesity happen over time when you take in more calories than you use.

Other Causes
Physical Inactivity
Many Americans aren’t very physically active. There are many reasons for this. One reason is
that many people spend hours in front of TVs and computers doing work, schoolwork, and
leisure activities. In fact, more than 2 hours a day of regular TV viewing time has been linked
to overweight and obesity.
Other reasons for not being active include: relying on cars instead of walking to places, fewer
physical demands at work or at home because modern technology and conveniences reduce
the need to burn calories, and lack of physical education classes in schools for children.
People who are inactive are more likely to gain weight because they don’t burn up the calories
that they take in from food and drinks. An inactive lifestyle also raises your risk for heart
disease, high blood pressure, diabetes, colon cancer, and other health problems.
Environment
Our environment doesn’t always help with healthy lifestyle habits; in fact, it encourages
obesity. Some reasons include:
• Lack of neighborhood sidewalks and safe places for recreation. Not having
area parks, trails, sidewalks, and affordable gyms makes it hard for people
to be physically active.
• Work schedules. People often say that they don’t have time to be
physically active given the long hours at work and the time spent
commuting back and forth to work.
 • Oversized food portions. Americans are surrounded by huge food portions
in restaurants, fast food places, gas stations, movie theaters,
supermarkets, and even home. Some of these meals and snacks can feed
two or more people. Eating large portions means too much energy IN. Over
time, this will cause weight gain if it isn’t balanced with physical activity.
• Lack of access to healthy foods. Some people don’t live in neighborhoods
that have supermarkets that sell healthy foods such as fresh fruits and
vegetables. Or if they do, these items are often too costly.
• Food advertising. Americans are surrounded by ads from food companies.
Often children are the targets of advertising for high-calorie, high-fat
snacks and sugary drinks. The goal of these ads is to sway people to buy
these high-calorie foods, and often they do.

Genes and Family History

Studies of identical twins who have been raised apart show that genes have a strong influence
on one’s weight. Overweight and obesity tend to run in families. Your chances of being
overweight are greater if one or both of your parents are overweight or obese. Your genes also
may affect the amount of fat you store in your body and where on your body you carry the
extra fat.
Because families also share food and physical activity habits, there is a link between genes
and the environment. Children adopt the habits of their parents. So, a child with overweight
parents who eat high-calorie foods and are inactive will likely become overweight like the
parents. On the other hand, if a family adopts healthful food and physical activity habits, the
child’s chance of being overweight or obese is reduced.
Health Conditions
Sometimes hormone problems cause overweight and obesity. These problems include:
• Underactive thyroid (also called hypothyroidism). This is a condition in
which the thyroid gland doesn’t make enough thyroid hormone. Lack of
thyroid hormone will slow down your metabolism and cause weight gain.
You’ll also feel tired and weak.
• Cushing’s syndrome. This is a condition in which the body’s adrenal glands
make too much of the hormone cortisol. Cushing’s syndrome also can
happen when people take high levels of medicines such as prednisone for
long periods of time. People with Cushing’s syndrome gain weight, have
upper-body obesity, a rounded face, fat around the neck, and thin arms
and legs.
• Polycystic ovarian syndrome (PCOS). This is a condition that affects about
5 to 10 percent of women of childbearing age. Women with PCOS often are
obese, have excess hair growth, and have reproductive and other health
problems due to high levels of hormones called androgens.

Medicines
Certain medicines such as corticosteroids (for example, prednisone), antidepressants (for
example, Elavil®), and medicines for seizures (for example, Neurontin®) may cause you to
gain weight. These medicines can slow the rate at which your body burns calories, increase
your appetite, or cause your body to hold on to extra water—all of which can lead to weight
gain.
Emotional Factors
Some people eat more than usual when they are bored, angry, or stressed. Over time,
overeating will lead to weight gain and may cause overweight or obesity.
Smoking
Some people gain weight when they stop smoking. One reason is that food often tastes and
smells better. Another reason is because nicotine raises the rate at which your body burns
calories, so you burn fewer calories when you stop smoking. However, smoking is a serious
health risk, and quitting is more important than possible weight gain.
Age
As you get older, you tend to lose muscle, especially if you’re less active. Muscle loss can
slow down the rate at which your body burns calories. If you don’t reduce your calorie intake
as you get older, you may gain weight. Midlife weight gain in women is mainly due to aging
and lifestyle, but menopause also plays a role. Many women gain around 5 pounds during
menopause and have more fat around the waist than they did before.
Pregnancy
During pregnancy, women gain weight so that the baby gets proper nourishment and develops
normally. After giving birth, some women find it hard to lose the weight. This may lead to
overweight or obesity, especially after a few pregnancies.
Lack of Sleep
Studies find that the less people sleep, the more likely they are to be overweight or obese.
People who report sleeping 5 hours a night, for example, are much more likely to become
obese compared to people who sleep 7–8 hours a night.
People who sleep fewer hours also seem to prefer eating foods that are higher in calories and
carbohydrates, which can lead to overeating, weight gain, and obesity over time. Hormones
that are released during sleep control appetite and the body’s use of energy. For example,
insulin controls the rise and fall of blood sugar levels during sleep. People who don’t get
enough sleep have insulin and blood sugar levels that are similar to those in people who are
likely to have diabetes.
Also, people who don’t get enough sleep on a regular basis seem to have high levels of a
hormone called ghrelin (which causes hunger) and low levels of a hormone called leptin
(which normally helps to curb hunger).

What Are the Health Risks of Overweight

and Obesity?
Being overweight or obese isn’t a cosmetic problem. It greatly raises the risk in adults for
many diseases and conditions.
Overweight and Obesity-Related Health Problems in Adults
Heart Disease
This condition occurs when a fatty material called plaque (plak) builds up on the inside walls
of the coronary arteries (the arteries that supply blood and oxygen to your heart). Plaque
narrows the coronary arteries, which reduces blood flow to your heart. Your chances for
having heart disease and a heart attack get higher as your body mass index (BMI) increases.
Obesity also can lead to congestive heart failure, a serious condition in which the heart can’t
pump enough blood to meet your body’s needs.
High Blood Pressure (Hypertension)
This condition occurs when the force of the blood pushing against the walls of the arteries is
too high. Your chances for having high blood pressure are greater if you’re overweight or
obese.
Stroke
Being overweight or obese can lead to a buildup of fatty deposits in your arteries that form a
blood clot. If the clot is close to your brain, it can block the flow of blood and oxygen and
cause a stroke. The risk of having a stroke rises as BMI increases.
Type 2 Diabetes
This is a disease in which blood sugar (glucose) levels are too high. Normally, the body
makes insulin to move the blood sugar into cells where it’s used. In type 2 diabetes, the cells
don’t respond enough to the insulin that’s made. Diabetes is a leading cause of early death,
heart disease, stroke, kidney disease, and blindness. More than 80 percent of people with type
2 diabetes are overweight.
Abnormal Blood Fats
If you’re overweight or obese, you have a greater chance of having abnormal levels of blood
fats. These include high amounts of triglycerides and low-density lipoprotein (LDL)
cholesterol (a fat-like substance often called “bad” cholesterol), and low high-density
lipoprotein (HDL) cholesterol (often called “good” cholesterol). Abnormal levels of these
blood fats are a risk for heart disease.
Metabolic Syndrome
This is the name for a group of risk factors linked to overweight and obesity that raise your
chance for heart disease and other health problems such as diabetes and stroke. A person can
develop any one of these risk factors by itself, but they tend to occur together. Metabolic
syndrome occurs when a person has at least three of these heart disease risk factors:
• A large waistline. This is also called abdominal obesity or “having an apple
shape.” Having extra fat in the waist area is a greater risk factor for heart
disease than having extra fat in other parts of the body, such as on the
hips.
• Abnormal blood fat levels, including high triglycerides and low HDL
cholesterol.
• Higher than normal blood pressure.
• Higher than normal fasting blood sugar levels.
Cancer
Being overweight or obese raises the risk for colon, breast, endometrial, and gallbladder
cancers.
Osteoarthritis
This is a common joint problem of the knees, hips, and lower back. It occurs when the tissue
that protects the joints wears away. Extra weight can put more pressure and wear on joints,
causing pain.
Sleep Apnea
This condition causes a person to stop breathing for short periods during sleep. A person with
sleep apnea may have more fat stored around the neck. This can make the breathing airway
smaller so that it’s hard to breathe.
Reproductive Problems
Obesity can cause menstrual irregularity and infertility in women.
Gallstones
These are hard pieces of stone-like material that form in the gallbladder. They’re mostly made
of cholesterol and can cause abdominal or back pain. People who are overweight or obese
have a greater chance of having gallstones. Also, being overweight may result in an enlarged
gallbladder that may not work properly.

Overweight and Obesity-Related Health Problems in Children

and Teens
Overweight and obesity also increase the health risks for children and teens. Type 2 diabetes
was once rare in American children. Now it accounts for 8 to 45 percent of newly diagnosed
diabetes cases. Also, overweight children are more likely to become overweight or obese as
adults, with the same risks for disease.

Who Is At Risk for Overweight and

Obesity?
Populations Affected
Overweight and obesity affect Americans of all ages, sexes, racial/ethnic groups, and
educational levels. This serious health problem has been growing over the years. In fact,
overweight and obesity in adults have doubled since 1980, and overweight in children and
teens has tripled.

Adults
According to the National Health and Nutrition Examination Survey (NHANES) 2003–2004,
about one-third of adults in the United States are overweight and slightly more than one-third
are obese. The survey also shows differences in overweight and obesity according to
racial/ethnic groups.
• In women, overweight and obesity are highest for non-Hispanic Black
women (about 82 percent), compared to about 75 percent for Mexican
American women and 58 percent for non-Hispanic White women.
 • In men, overweight and obesity also are higher for minority groups.
They’re highest for Mexican American men (about 76 percent), compared
to about 71 percent for non-Hispanic White men and about 69 percent for
non-Hispanic Black men.

Children and Teens

According to NHANES 2003–2004, overweight and the risk for overweight is rising in
children and teens. The survey shows that:
• About 19 percent of school-aged children and about 17 percent of teens
are overweight.
• About 18 percent of school-aged children and about 17 percent of teens
are at risk for overweight.
There are also some differences in overweight according to racial/ethnic groups.
• In male children and teens, overweight is highest for Mexican Americans
(about 22 percent), compared to 17 percent for non-Hispanic Whites and
about 16 percent for non-Hispanic Blacks.
• In female children and teens, overweight is highest for non-Hispanic Blacks
(23 percent), compared to 16 percent for Mexican Americans and about 14
percent for non-Hispanic Whites.

Income
Overweight and obesity are also common in groups with low incomes. Women with low
incomes are about 50 percent more likely to be obese than women with higher incomes.
Among children and teens, overweight in non-Hispanic White teens is related to a lower
family income.
Low-income families also buy more high-calorie, high-fat foods, which may add to the
problem. This is because they tend to cost less than more healthful foods such as fruits and
vegetables.

How Are Overweight and Obesity Treated?

Successful treatments for weight loss include setting goals and making lifestyle changes such
as eating fewer calories and being more physically active. Drug therapy and weight loss
surgery are also options for some people if lifestyle changes don’t work.

Set Realistic (“Do-able”) Goals

Setting the right weight loss goals is an important first step to losing and maintaining weight.
For Adults
• Lose just 5 to 10 percent of your current weight over 6 months. This will
lower your risk for heart disease and other conditions.
• The best way to lose weight is slowly. A weight loss of 1 to 2 pounds a
week is do-able, safe, and will help you keep off the weight. It also will give
you the time to make new, healthy lifestyle changes.
• If you’ve lost 10 percent of your body weight, have kept it off for 6 months,
and are still overweight or obese, you may want to consider further weight
loss.
For Children and Teens
• If your child is overweight or at risk of overweight, the goal is to maintain
his or her current weight and to focus on eating healthy and being
physically active. This should be part of a family effort to make lifestyle
changes.
• If your child is overweight and has a health condition related to overweight
or obesity, your doctor should refer you to a pediatric obesity treatment
center.

Lifestyle Changes
For long-term weight loss success, it’s important for you and your family to make lifestyle
changes:
• Focus on energy IN (calories from food and drinks) and energy OUT
(physical activity)
• Follow a healthy eating plan
• Learn how to adopt more healthful lifestyle habits
Over time, these changes will become part of your everyday life.
Calories
Cutting back on calories (energy IN) will help you lose weight. To lose 1 to 2 pounds a week,
adults should cut back their calorie intake by 500 to 1,000 calories a day.
• In general, 1,000 to 1,200 calories a day will help most women lose weight
safely.
• In general, 1,200 to 1,600 calories a day will help most men lose weight
safely. This calorie range is also suitable for women who weigh 165 pounds
or more or who exercise routinely.
These calorie levels are a guide and may need to be adjusted. If you eat 1,600 calories a day
but don’t lose weight, then you may want to cut back to 1,200 calories. If you’re hungry on
either diet, then you may want to boost your calories by 100 to 200 a day. Very low-calorie
diets of less than 800 calories a day shouldn’t be used unless your doctor is monitoring you.
For overweight children or teens, it’s important to slow the rate of weight gain; however,
reduced-calorie diets aren’t advised before you talk to a health care provider.
Healthy Eating Plan
A healthy eating plan gives your body the nutrients it needs every day. It has enough calories
for good health, but not so many that you gain weight.
A healthy eating plan also will lower your risk for heart disease and other conditions. A plan
low in total, saturated, and trans fat; cholesterol; and sodium (salt) will help to lower your risk
for heart disease. Cutting down on fats and added sugars also can help you eat fewer calories
and lose weight. Healthful foods include:
• Fat-free and low-fat milk and milk products such as low-fat yogurt, cheese,
and milk.
• Lean meat, fish, poultry, cooked beans, and peas.
• Whole grain foods such as whole wheat bread, oatmeal, and brown rice.
Other grain foods like pasta, cereal, bagels, bread, tortillas, couscous, and
crackers.
 • Fruits, which can be canned (in juice or water), fresh, frozen, or dried.
• Vegetables, which can be canned (without salt), fresh, frozen, or dried.
Canola or olive oils and soft margarines made from these oils are heart healthy. They should
be used in small amounts because they’re high in calories. Unsalted nuts, like walnuts and
almonds, also can be built into a healthful diet as long as you watch the amount you eat,
because nuts are high in calories.
The National Heart, Lung, and Blood Institute’s “Aim for a Healthy Weight” patient booklet
provides more information on following a healthy eating plan.
Foods to limit. Foods that are high in saturated and trans fats and cholesterol raise blood
cholesterol levels and also may be high in calories. These fats raise the risk of heart disease,
so they should be limited.
Saturated fat is found mainly in:
• Fatty cuts of meat such as ground beef, sausage, and processed meats
such as bologna, hot dogs, and deli meats
• Poultry with the skin
• High-fat milk and milk products like whole-milk cheeses, whole milk,
cream, butter, and ice cream
• Lard, coconut, and palm oils found in many processed foods
Trans fat is found mainly in:
• Foods with partially hydrogenated oils such as many hard margarines and
shortening
• Baked products and snack foods such as crackers, cookies, doughnuts, and
breads
• Food fried in hydrogenated shortening such as french fries and chicken
Cholesterol is found mainly in:
• Egg yolks
• Organ meats such as liver
• Shrimp
• Whole milk or whole-milk products, including butter, cream, and cheese
Limiting foods and drinks with added sugars, like high-fructose corn syrup, is important.
Added sugars will give you extra calories without nutrients like vitamins and minerals. Added
sugars are found in many desserts, canned fruit packed in syrup, fruit drinks, and nondiet
drinks. Check the nutrition label on food packages for added sugars like high-fructose corn
syrup. Drinks with alcohol also will add calories, so it's a good idea to watch alcohol intake.
Portion size. A portion is the amount of food that you choose to eat for a meal or snack. It's
different from a serving, which is a measured amount of food and is noted on the nutrition
label on food packages.
Anyone who has eaten out lately is likely to notice how big the portions are. In fact, they’re
oversized. These ever-larger portions have changed what we think of as normal.
Cutting back on portion size is a good way to help you eat fewer calories and balance your
energy IN. To quiz yourself on how today's portions compare to those from 20 years ago, visit
the National Heart, Lung, and Blood Institute's Portion Distortion Web pages.
Food weight. Studies have shown that we all tend to eat a constant “weight” of food. Ounce
for ounce, our food intake is fairly constant. Knowing this, you can lose weight if you eat
foods that are lower in calories and fat for a given measure of food. For example, replacing a
full-fat food product that weighs 2 ounces with one that's the same weight but lower in fat
helps you cut back on calories. Another helpful practice is to eat foods that contain a lot of
water like vegetables, fruits, and soups.
Physical Activity
Staying active and eating fewer calories will help you lose weight and keep the weight off
over time. Physical activity also will benefit you in other ways. It will:
• Lower the risk of heart disease, diabetes, and cancers (such as breast,
uterus, and colon)
• Strengthen your lungs and help them to work better
• Strengthen your muscles and keep your joints in good condition
• Slow bone loss
• Give you more energy
• Help you to relax and cope better with stress
• Allow you to fall asleep more quickly and sleep more soundly
• Give you an enjoyable way to share time with friends and family
In general, adults should follow these guidelines in relation to physical activity.
• For overall health and to lower the risk of disease, aim for at least 30
minutes of moderate-intensity physical activity most days of the week.
• To help manage body weight and prevent gradual weight gain, aim for 60
minutes of moderate-to-vigorous intensity physical activity most days of
the week.
• To maintain weight loss, aim for at least 60 to 90 minutes of daily
moderate-intensity physical activity.
In general, children and teens should aim for at least 60 minutes of physical activity on most,
if not all, days of the week.
Many people lead inactive lives and may not be motivated to do more physical activity. Some
people may need help and supervision when they start a physical activity program to avoid
injury.
If you're obese, or if you haven't been active in the past, start physical activity slowly and
build up the intensity a little at a time. When starting out, one way to be active is to do more
"everyday" activities such as taking the stairs instead of the elevator and doing household
chores and yard work. The next step is to start walking, biking, or swimming at a slow pace,
and then build up the amount of time you exercise or the intensity level of the activity.
To lose weight and gain better health, it's important to get moderate-intensity physical
activity. Choose activities that you enjoy and that fit into your daily life. A daily, brisk walk is
an easy way to be more active and improve your health. Use a pedometer to count your daily
steps and keep track of how much you're walking. Try to increase the number of steps you
take each day.
Other examples of moderate-intensity physical activity include dancing, bicycling, gardening,
and swimming. For greater health benefits, try to step up your level of activity or the length of
time you're active. For example, start walking for 10 to 15 minutes three times a week, and
then build up to brisk walking for 60 minutes, 5 days a week. You also can break up the
amount of time that you're physically active into shorter amounts such as 15 minutes at a
time.
Behavioral Changes
Changing your behaviors or habits around food and physical activity is important for losing
weight. The first step is to understand the things that lead you to overeat or have an inactive
lifestyle. The next step is to change these habits.
The list below gives you some simple tips to help build healthier habits.
Change your surroundings. You may be more likely to overeat when watching TV, when
treats are available in the office break room, or when you're with a certain friend. You also
may not be motivated to take the exercise class you signed up for. But you can change these
habits.
• Instead of watching TV, dance to music in your living room or go for a walk.
• Leave the office break room right after you get a cup of coffee.
• Bring a change of clothes to work. Head straight to the exercise class on
the way home from work.
• Put a note on your calendar to remind yourself to take a walk or go to your
activity class.
Keep a record. A record of your food intake and the amount of physical activity that you do
each day will help to inspire you. You also can keep track of your weight. For example, when
the record shows that you've been meeting your goal to be more active, you'll want to keep it
up. A record is also an easy way to track how you're doing, especially if you're working with a
registered dietitian or nutritionist.
Seek support. Ask for help or encouragement from your friends, family, and health care
provider. You can get support in person, through e-mail, or by talking on the phone. You also
can join a support group.
Reward success. Reward your success for meeting your weight loss goals or other
achievements with something you would like to do, not with food. Choose rewards that you'll
enjoy, such as a movie, music CD, an afternoon off from work, a massage, or personal time.

Weight Loss Medicines

Weight loss medicines approved by the Food and Drug Administration (FDA) may be an
option for some people. If you're not successful at losing 1 pound a week after 6 months of
using lifestyle changes, medicines may help. These medicines should be used only as part of a
program that includes diet, physical activity, and behavioral changes.
Weight loss medicines may be suitable for adults who are obese (a BMI of 30 or greater).
People who have BMIs of 27 or greater and a risk for heart disease and other health
conditions also may benefit from medicines.
The FDA has approved two prescription weight loss medicines for long-term use: sibutramine
(Meridia®) and orlistat (Xenical®). These medicines cause a weight loss between 4 and 22
pounds, although some people lose more weight. Most of the weight loss occurs within the
first 6 months of taking the medicine.
• Sibutramine (Meridia). This medicine sends signals to your brain to curb
your appetite. Sibutramine raises blood pressure and pulse. You shouldn't
take it if you have high blood pressure or a history of heart disease or
stroke.
• Orlistat (Xenical). This medicine reduces the absorption of fats, fat calories,
and vitamins A, D, E, and K by the body. Orlistat can result in mild side
effects such as oily and loose stools.
The FDA also has approved Alli™, an over-the-counter weight loss aid for adults. Alli is the
lower dose form of orlistat. It's meant to be used along with a reduced-calorie, low-fat diet
and physical activity. In studies, most people taking Alli lost 5 to 10 pounds over 6 months.
Like orlistat, Alli reduces the absorption of fats, fat calories, and vitamins A, D, E, and K to
promote weight loss. It also has similar side effects to orlistat. If you're taking orlistat or Alli,
you should take a multivitamin at bedtime due to the possible loss of some vitamins. You also
should talk to your doctor before starting Alli if you're taking blood-thinning medicines or
being treated for diabetes or thyroid disease.
Combined with healthy eating and physical activity, these medicines can help people lose
weight. If you think you would benefit from the prescription medicines, sibutramine or
orlistat, talk to your doctor. People taking these medicines need regular checkups with their
doctors, especially in the first year after starting the medicine. During checkups, your doctor
will check your weight, blood pressure, and pulse and order laboratory tests. He or she also
will discuss any medicine side effects and answer your questions.
Other Medicines
Some prescription medicines are used to treat weight loss, but aren't FDA-approved for
treating obesity. They include:
• Drugs to treat depression. Some medicines for depression cause an initial
weight loss and then a regain of weight while taking the medicine.
• Drugs to treat seizures. Two drugs used for seizures, topiramate and
zonisamide, have been shown to cause weight loss. These drugs are being
studied to see whether they will be useful in treating obesity.
• Drugs to treat diabetes. Metformin may cause small amounts of weight
loss in people with obesity and diabetes. It's not known how this drug
causes weight loss, but it has been shown to reduce hunger and food
intake.

Over-the-Counter Products
Over-the-counter (OTC) products often claim that a person taking them will lose weight. The
FDA doesn't regulate these products because they're considered dietary supplements, not
medicines. However, many of these products have serious side effects and aren't generally
recommended. A few OTC products include:
• Ephedra (also called ma-huang). Ephedra comes from plants and has been
sold as a dietary supplement. The active ingredient in the plant is called
ephedrine. Ephedra can cause short-term weight loss. It also has serious
side effects. It causes high blood pressure and stresses the heart. In fact,
because ephedra poses a serious health risk, the FDA has advised people
to stop using dietary supplements that contain it.
• Chromium. This is a mineral that's sold as a dietary supplement to reduce
body fat. While studies haven't found any weight loss benefit from
chromium, there are few serious side effects from taking it.
• Diuretics and herbal laxatives. These products cause you to lose water
weight, not fat. They also can lower your body's potassium levels, which
may cause heart and muscle problems.
• Hoodia. Hoodia is a cactus that is native to Africa. It's sold in pill form as an
appetite suppressant. However, there is no firm evidence that hoodia
works. No large-scale research has been done on humans to show whether
hoodia is effective or safe.
Weight Loss Surgery
Weight loss surgery may be an option for people with extreme obesity (BMI of 40 or greater)
when other treatments have failed. It's also an option for people with a BMI of 35 or greater
who have life-threatening conditions such as:
• Severe sleep apnea (a condition in which your breathing stops or gets very
shallow while you're sleeping)
• Obesity-related cardiomyopathy (diseases of the heart muscle)
• Severe type 2 diabetes
Two common weight loss surgeries include:
• Banded gastroplasty. For this surgery, a band or staples are used to create
a small pouch at the top of your stomach. This surgery limits the amount
of food and liquids the stomach can hold.
• Roux-en-Y gastric bypass. For this surgery, a small stomach pouch is
created with a bypass around part of the small intestine where most of the
calories you eat are absorbed. This surgery limits food intake and reduces
the calories your body absorbs.
Weight loss surgery can improve your health and weight. However, the surgery can be risky
depending on your overall health. There are few long-term side effects with gastroplasty;
however, you must limit your food intake dramatically. Roux-en-Y gastric bypass has more
side effects. These include nausea, bloating, diarrhea, and faintness (which are all part of a
condition called dumping syndrome). After Roux-en-Y gastric bypass, multivitamins and
minerals may be needed to prevent nutrient deficiencies.
Lifelong medical followup is needed after both surgeries. A monitoring program both before
and after surgery also is advised to help you with diet, physical activity, and coping skills.
If you think you would benefit from weight loss surgery, talk to your doctor. Ask whether
you're a candidate for the surgery and discuss the risks, benefits, and what to expect.

Weight Loss Maintenance

Maintaining your weight loss over time can be a challenge. For adults, weight loss is a
success if you lose at least 10 percent of your initial weight and you don't regain more than 6
or 7 pounds in 2 years. You also must keep a lower waist circumference—at least 2 inches
lower than your waist circumference before you lost weight.
After 6 months of keeping off the weight, you can think about losing more if:
• You've already lost 5 to 10 percent of your body weight
• You're still overweight or obese
The key to further weight loss or to maintain your weight loss is to continue with lifestyle
changes. Adopt these changes as a new way of life. However, if you want to lose more
weight, you may need to eat fewer calories and increase your activity level. For example, if
you eat 1,600 calories a day but don't lose weight, you may want to cut back to 1,200 calories.
Adults should aim for 60 to 90 minutes of daily moderate-intensity physical activity. Children
and teens should aim for 60 minutes of physical activity a day.

How Can Overweight and Obesity Be

Prevented?
Staying at a healthy weight and preventing overweight and obesity can be achieved through
living a healthy lifestyle. Because lifetime habits begin in childhood, it’s important for parents
and families to create habits that encourage healthy food choices and physical activity early in
life.
• Follow a healthy eating plan. Make healthful food choices, keep your and your
family’s calorie needs in mind, and focus on the balance of energy IN and energy
OUT.
• Focus on portion size. Watch the size of portions in fast food and other restaurants.
The portions served are often enough for two or three people. Children’s portion sizes
should be smaller than those for adults. Cutting back on portion size is a sure way to
help keep energy IN and energy OUT in balance.
• Be active. Make personal and family time active. Find activities that everyone will
enjoy. For example, go for a brisk walk, bike or rollerblade, or train together for a
walk or run.
• Reduce screen time. Limit the use of TVs, computers, DVDs, and video games,
because they crowd out time for physical activity. Health experts recommend 2 hours
or less a day of screen time that’s not work- or homework-related.
• Keep track of weight and other measurements. Monitor your weight, body mass index,
and waist circumference on a regular basis. Also, keep track of your children’s
growth.
Four Institutes (led by the National Heart, Lung, and Blood Institute) from the National
Institutes of Health have come together to promote We Can!—Ways to Enhance Children’s
Activity & Nutrition. We Can! is a national education program designed for parents and
caregivers to help children 8 to 13 years old stay at a healthy weight.
The evidence-based program offers parents and families tips and fun activities to encourage
healthy eating, increase physical activity, and reduce time spent being inactive. Currently,
more than 140 communities around the country are participating in We Can! programs for
parents and youth. These community groups include hospitals, health departments, clinics,
faith-based organizations, YMCAs, schools, and more.

Key Points
• The terms “overweight” and “obesity” refer to a person’s overall body weight and
where the extra weight comes from. Overweight is having extra body weight from
muscle, bone, fat, and/or water. Obesity is having a high amount of extra body fat.
• Millions of Americans and people worldwide are overweight or obese.
• Being overweight or obese puts you at risk for many diseases and conditions,
including heart disease, high blood pressure, type 2 diabetes, gallbladder disease,
breathing problems, and certain cancers.
• A person’s weight is the result of many factors, including environment, family history
and genetics, metabolism (the way your body changes food and oxygen into energy),
behavior or habits, and other factors.
• For most people, overweight and obesity are caused by not having energy balance.
The amount of calories you get from food and drinks is energy IN. The amount of
energy your body uses daily is energy OUT. To maintain a healthy weight, energy IN
and energy OUT should balance over time.
• Overweight and obesity are calculated using the body mass index (BMI). BMI is an
estimate of body fat and a good gauge of your risk for diseases that occur with more
body fat. Adults can calculate their BMI using the National Heart, Lung, and Blood
Institute’s online calculator, or your health care provider can calculate your BMI.
• Children’s BMI is calculated based on growth charts for their age and sex. This is
called BMI-for-age percentile. For more information, go to the Centers for Disease
Control and Prevention’s BMI-for-age calculator.
• Treatment for overweight and obesity includes lifestyle changes. These changes mean
cutting back on calories, following a healthy eating plan, being physically active, and
making behavioral changes.
• When lifestyle changes aren’t enough, other treatment options for some people are
weight loss medicines and surgery.
• To manage weight and prevent unhealthy weight gain, adults should aim for 60
minutes of moderate-to-vigorous intensity physical activity most days of the week. To
keep up weight loss, aim for 60 to 90 minutes of daily moderate-intensity physical
activity.
• Children and teens should strive for 60 minutes of physical activity a day.
• Overweight and obesity in children and teens can be prevented with healthy food
choices and more physical activity. Parents and families should create habits that
encourage healthful food choices and physical activity early in a child’s life.