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FAQ's
What is Obesity? Obesity used to be understood in fairly simple terms: excess body weight resulting from eating too much and exercising too little, due in large part to a lack of willpower or self-restraint. Fortunately for the millions of American adults who are overweight, obesity is now regarded as a chronic medical disease with serious health implications caused by a complex set of factors. Obesity results from a complex interaction of genetic, behavioral and environmental factors causing an imbalance between energy intake and energy expenditure. According to the National Institutes of Health, an increase in body weight of 20 percent or more above desirable weight is the point at which excess weight becomes an established health hazard. Lower levels of excess weight can also constitute a health risk, particularly in the presence of other disorders like diabetes, hypertension and heart disease. How Are Overweight and Obesity Defined? The body mass index (BMI) is a commonly used measurement tool to define a healthy weight, overweight and obesity. BMI is calculated by multiplying weight (in pounds) by 703, and then dividing by the height (in inches squared), approximately kg/m2. The following classifications for BMI were recommended by the National Heart Lung and Blood Institute: Underweight - BMI lower than 18.5 BMI does not actually measure body fat, but generally correlates well with the degree of obesity. According to a BMI table, a person 5' 6" tall weighing 140 pounds would have a BMI of 23, well out of the range of risk. That same 5' 6" person weighing 190 pounds would have a BMI of 31, in the range of Grade 2 obesity. A BMI of 27 or higher is associated with increased morbidity and mortality; this is generally considered the point at which some form of treatment for obesity is required. A BMI between 25 and 27 is considered a warning sign and may warrant intervention, especially in the presence of additional risk factors. Currently, several other measures are used to evaluate a patient’s weight status and potential health risk. A measurement used to determine the risk of heart attack and other obesity-related disease is reached by dividing the circumference of your waist by your hips. A healthy waist-to-hip ratio for women should be no more than 0.8. A healthy waist-to-hip ratio for men should be no more than 0.95. However, a complete evaluation includes assessments of a person’s age, height, weight, fat composition and distribution, and the presence or absence of other health problems and risk factors. Often, a 10 to 15% reduction in an obese person’s body weight can bring about a significant reduction in their health risk from obesity. An individual’s “healthy” weight loss goal does not always equate with their “cosmetic” weight loss goal. Although they have been in use since 1959, height-weight tables indicating “ideal” weight have their shortcomings. What is a Bariatrician? Bariatric physicians, or bariatricians, specialize in the medical treatment of obesity and related disorders. These licensed physicians (Doctor of Medicine [MD] or Doctor of Osteopathy [DO]) have received special training in Bariatric Medicine: the art and science of medical weight management. Bariatricians treat overweight and obese patients with a comprehensive program of diet and nutrition, exercise, behavioral therapy and, when necessary, the prescription of appetite suppressants and other appropriate medications. (The word bariatric stems from the Greek root “baro” meaning heavy or large.) A physician-supervised medical weight loss program may be the safest and wisest way to lose weight and maintain the loss. Overweight and obesity are frequently accompanied by other medical conditions which might go undetected and untreated in a non-medical weight loss program. The cost of participating in a medically supervised weight loss program is comparable to the cost of weight loss programs that do not have a physician on site. Health insurance companies may cover some or all of your bariatric treatment if you have heart disease, metabolic syndrome, diabetes or a pre-diabetic condition. How Prevalent is Obesity? Obesity is a chronic, debilitating and potentially fatal disease that requires treatment by a physician trained in bariatric medicine. It is marked by an excess accumulation of body fat sufficient to endanger health. The United States is currently suffering an obesity epidemic contributing to the premature death, sickness and suffering of millions of Americans. More than one-third of U.S. adults -– over 72 million people -- were obese in 2005-2006. This includes 33.3 percent of men and 35.3 percent of women. (Centers for Disease Control and Prevention) The latest study based on a nationally representative sample of U.S. adults, estimates that about 112,000 deaths are associated with obesity each year in the United States. (Centers for Disease Control and Prevention) Adults aged 40-59 had the highest obesity prevalence compared with other age groups. Approximately 40 percent of men in this age group were obese, compared with 28 percent of men aged 20-39, and 32 percent of men aged 60 and older. Among women, 41 percent of those aged 40-59 were obese compared with 30.5 percent of women aged 20-39. Women aged 65 and older had obesity prevalence rates comparable with women in the 20 to 39 age group. (Centers for Disease Control and Prevention’s National Center for Health Statistics) There were large race-ethnic disparities in obesity prevalence among women. Approximately 53 percent of non-Hispanic black women and 51 percent of Mexican-American women aged 40-59 were obese compared with about 39 percent of non-Hispanic white women of the same age. Among women 60 and older, 61 percent of non-Hispanic black women were obese compared with 37 percent of Mexican-American women and 32 percent of non-Hispanic white women. (Centers for Disease Control and Prevention’s National Center for Health Statistics) Maintaining weight loss over the long term is exceedingly difficult. Most people regain as much as two-thirds of weight lost within one year and regain all of it within five years. What Costs are Associated with Obesity? The World Bank estimated that roughly 12 percent of the U.S. health care budget is spent on obesity treatment. The cost of obesity in the United States in 2000 was more than $117 billion ($61 billion direct and $56 billion indirect). (The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity) Direct medical costs include preventive, diagnostic, and treatment services related to obesity. Indirect costs relate to morbidity and mortality costs. Morbidity costs are defined as the value of income lost from decreased productivity, restricted activity, absenteeism, and bed days. Mortality costs are the value of future income lost by premature death. Is Childhood Obesity a Growing Problem? Overweight is a serious health concern for children and adolescents. Data from two National Health and Nutrition Examination (NHANES) surveys (1976–1980 and 2003–2004) show that the prevalence of overweight is increasing: for children aged 2–5 years, prevalence increased from 5.0% to 13.9%; for those aged 6–11 years, prevalence increased from 6.5% to 18.8%; and for those aged 12–19 years, prevalence increased from 5.0% to 17.4%. Changes in the Western lifestyle have led to significant reductions in energy expenditure of children and have encouraged “super-sizing” of calorie-dense, high-fat foods and snacks. (Journal of Pediatrics (Editorial) 2000;136(6)) Physical inactivity, “junk” food diets (including high calorie soft drinks and fruit beverages), increased television watching accompanied by snacking, increased time playing video and computer games all contribute to increased obesity among the young. What are the Health Implications of Obesity? Diseases and conditions related to obesity include: Type 2 diabetes How do Bariatricians Treat Obesity? ASBP developed Bariatric Practice Guidelines to assure quality bariatric care. ASBP member physicians are encouraged to conform to these guidelines. Physicians perform an initial patient work-up to determine treatment based on each patient’s history, physical examination, laboratory work and electrocardiogram (ECG). Co- morbidities are assessed and physicians determine if patients are ready and motivated to lose weight. 1. Dietary status, weight history and history of mental status is recorded. 2. Height, weight and waist circumference measurements are recorded. These measurements help determine BMI, or Body Mass Index. Additional exams of the head, neck, thyroid, heart, lungs, abdomen and extremities may be performed. 3. Laboratory tests usually include thyroid function testing, ECG and other body composition testing. Physicians provide counseling and follow-up on proper eating habits, exercise, behavior modification and other aspects of weight loss throughout a weight loss program. Your physician will recommend a diet and set physical activity goals which must be recorded regularly. Physicians will review the potential benefits and risks of any medications that may used during treatment. In addition to medical journals and ASBP’s Anorectic Usage Guidelines, physicians rely on their education, training and experience. Any dispensed medications should be packaged and labeled according to applicable laws. Physicians develop an individual weight loss maintenance program for each patient after weight loss goals are achieved. What About Medications and Special Diets? Risks and side effects are associated with anti-obesity medications, however these side effects are minimal and of short duration for most people. Bariatricians are properly trained in prescribing these drugs and monitoring their patients’ use. Physicians must decide whether to prescribe anti-obesity medication after carefully weighing the medication’s risks vs. the patient’s risks of remaining obese. Bariatricians frequently prescribe low calorie diets or very low calorie diets (VLCD) along with vitamins and nutritional supplements, exercise and lifestyle changes to bring about a relatively rapid loss of weight. The VLCD should only be used under the careful supervision and monitoring of a physician or other health care professional trained in its use. What are the Different Categories of Diet Medications? Always consult a licensed physician before taking any medication. Common side effects of appetite suppressants include dryness of the mouth, dizziness, abdominal pain, diarrhea or constipation, nausea, difficulty sleeping, nervousness, increased blood pressure and headache. Most of these drugs affect the body’s nervous system. While they generally suppress appetite, some may also alter the way the body burns calories. The best-known medications include: Amphetamines (amphetamine, dextroamphetamine, methamphetamine) are strong stimulants that are no longer recommended by most authorities for weight control because they are highly addictive. Potential side effects include heart palpitations, elevation of blood pressure, gastrointestinal disturbances and insomnia. Amphetamines are prescribed for problems other than obesity, for example attention deficit disorder and narcolepsy. Non-Amphetamine Appetite Suppressants — Phentermine was first approved by the Food and Drug Administration in 1959 as a “short term (a few weeks) adjunct in a regimen of weight reduction based on caloric restriction.” It is sold under the brand names Ionamin, Adipex, Fastin, Banobese, Obenix and Zantryl. Among other drugs of this type are phendimetrizine and diethylpropion. The newest prescription appetite suppressant called Sibutramine is being marketed as Meridia. It became available in February, 1997. Orlistat, marketed as Xenical, became available in the US in May, 1999. Not an appetite suppressant, Orlistat is a lipase inhibitor or “fat blocker” drug. It prevents the absorption of about 30 percent of dietary fat by the digestive tract. It is meant to be used in conjunction with a reduced-calorie diet. Side effects which are generally mild and transient may include oily spotting, flatulence with discharge, fecal urgency, oily evacuation and fecal incontinence. Maintaining a diet of no more than 30 percent of calories from fat may minimize these side effects. The medication also reduces the absorption of fat-soluble vitamins; therefore patients are advised to take a daily supplement containing vitamins A, D, E and K as well as beta-carotene. A lower dose form of Orlistat is marketed under the name ALLI. When used as part of a comprehensive program including diet and nutrition changes, exercise, and lifestyle modification, prescription anti-obesity medications can be a useful adjunct to a medical weight loss program. Medication alone will not lead to successful weight loss and maintenance. Many of the appetite suppressants and other medications available today have a long history of safe and successful use. New medications are being researched and become available after clinical testing and Food and Drug Administration approval. FAQ's taken from www.asbp.org. |
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