HealthLine: Do You Really Need That Extra Cream Puff?

Obesity is on the rise and considered a leading preventable cause of death worldwide.  A person is considered obese when her or his weight is 20% or more above their “normal” weight, the best measure being the Body Mass Index (BMI). The US customary and imperial BMI measurement = lb*703/in2 where “lb” is the subject’s weight in pounds and “in” is the subject’s height in inches.  Persons with their BMI between 25.0 and 29.9 are overweight, those with BMI between 30.0 and 39.9 are considered obese and a BMI greater than 40.0 is classified as morbidly obese.

Obesity is associated with various medical illnesses such as cardiovascular disease, diabetes, sleep apnea, certain types of cancers; breast, reproductive, gastrointestinal, prostate and osteoarthritis.  Life expectancy is reduced in obese patients by six to seven years, and in patients with severe obesity (BMI > 40) their life expectancy is reduced by up to 10 years.  One of the strongest links between obesity and illness is type 2 diabetes mellitus, where an excess of body fat underlies 64% of cases of diabetes in males and 77% of cases in females.

Obesity affects health in two ways.  The first being the effect of increased fat mass, as seen in osteoarthritis, obstructive sleep apnea and social stigmatization and the other due to the increased number of fat cells, as seen in diabetes, cancer, cardiovascular disease and non-alcoholic fatty liver disease.  The rise in body fat alters the body’s ability to respond to insulin, leading to insulin resistance and diabetes.

Many factors play a role in obesity. Age reduces one’s metabolism while women have a lower resting metabolic rate than men.  Thinness tends to run in families, but one’s environment and attitude towards food and exercise while growing up will impact their weight in later years. 

Lack of physical activity is the biggest factor in the industrialized era which has impacted weight control, with the advent of the automobile, television and computers.  Psychological factors will influence caloric intake if eating occurs out of boredom, sadness or anger.  30% of patients who seek treatment for weight problems suffer from binge eating.  A low thyroid, depression and certain neurological disorders will spur overeating, while long term steroid use is associated with excessive weight gain.

Childhood obesity rates in the US have rapidly risen in the past 30 years.  Between 1980 and 2008, the rate of obesity in children between the ages of 6 to 11 years rose from 6.5% to 19.6% and in adolescents between the ages of 12 to 19 years it rose from 5.0% to 18.1%.  In one population study of 5 to 17 year olds, 70% of obese youth had at least one risk factor for cardiovascular disease.

Obese youth suffer a greater risk for bone and joint problems, sleep apnea and social and psychological problems such as low self-esteem, stereotyping and depression.  Obese children face discrimination at school with a greater risk of being bullied and feelings of shame and rejection.

The cornerstone of treating obesity is diet and exercise.  Portion control with regular physical activity must become a permanent part of the individual’s lifestyle.  Medication management should only be discussed with one’s physician.  The most effective treatment for obesity is bariatric surgery and is associated with long term weight loss and decreased overall mortality.  Surgery is most invasive and is not without risks.

If the sun ever decides to show its face around here, grab a friend and go for a hike, bike ride, swim or just go out and walk the dog.  You will be adding years to your life.

Dr. Ballard is a Board Certified Internist and Geriatrician with a special interest in Women’s Health.  She practices in Enumclaw, 360-825-1389.  Dr. Ballard’s comments are informational only and not to be construed as medical advice.  Consult your personal physician for any medical issues.