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Weight LossWeight Loss Medications
Orlistat blocks some of the fat that you eat from being absorbed by your body. |
| Obesity definitionOBESITY is a chronic condition defined by an excess amount body fat. A certain amount of body fat is necessary for storing energy, heat insulation, shock absorption, and other functions. The normal amount of body fat (expressed as percentage of body fat) is between 25-30% in women and 18-23% in men. Women with over 30% body fat and men with over 25% body fat are considered obese. Signs and SymptomsMost practitioners use the following BMI ranges as indications that a person is overweight or obese: - BMI 25 to 29.9 (overweight)
- BMI 30 to 39.9 (moderately obese)
- BMI 40 or above (extremely obese)
A high waist to hip ratio (indicating that fat is centered around the waist—also known as central obesity) increases the risk for developing serious, even life-threatening conditions associated with obesity. Physicians consider a very high waist circumference to be greater than 102 cm for men and greater than 88 cm for women. CausesWhile there is no single underlying cause of obesity, the bottom line is that excessive weight reflects an imbalance between energy input and energy output. Both genetic and behavioral factors play a role in the development of excessive weight. For example, an individual's total number of fat cells (which may predispose an individual to weight gain) is determined genetically, but behavioral factors, such as a high-calorie, high-fat diet and lack of physical activity, must be present in order for weight gain to occur. Risk Factors- Being older than 18 years of age in an industrialized country, especially the United States
- Having family members who are overweight or obese
- Lack of physical activity
- Overeating
- Consuming a high-fat diet
- Taking certain prescription medications that may increase the risk for obesity (see Causes section)
- Having a hormone disorder, such as Cushing's syndrome or hypothyroidism (underactive thyroid)
- Being emotionally stressed (from the death of a loved one, for example), which may cause a person to overeat
- Being born with rare disorders associated with obesity (as mentioned in the Causes section)
Factors that increase your risk of being obese: Diet -Regular consumption of high-calorie foods, such as fast foods, contributes to weight gain. High-fat foods are dense in calories. Loading up on soft drinks, candy and desserts also promotes weight gain. Foods and beverages like these are high in sugar and calories. Inactivity - Sedentary people are more likely to gain weight because they don't burn calories through physical activities. Psychological factors - Some people overeat to cope with problems or deal with emotions, such as stress or boredom. Genetics - If one or both of your parents are obese, your chances of being overweight are greater. Your genes may affect the amount of body fat you store and where that fat is distributed. But, your genetic makeup doesn't guarantee that you'll be obese. Age - As you get older, you tend to be less active. In addition, the amount of muscle in your body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs. If you don't decrease your caloric intake as you age, you'll likely gain weight. Cigarette smoking - Smokers tend to gain weight after quitting. This weight gain may be partially due to nicotine's ability to raise the rate at which your body burns calories (metabolic rate). When smokers stop, they burn fewer calories. Smoking also affects taste; quitting smoking makes food taste and smell better. Former smokers often gain weight because they eat more after they quit. However, cigarette smoking is still considered a greater threat to your health than is extra weight. Pregnancy - During pregnancy a woman's weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women. Medications. Corticosteroids and tricyclic antidepressants, in particular, can lead to weight gain. So can some high blood pressure and antipsychotic medications. Medical problems - Uncommonly, obesity can be traced to a medical cause, such as low thyroid function, excess production of hormones by the adrenal glands (Cushing's syndrome) or other hormonal imbalances, such as polycystic ovary syndrome. A low metabolic rate is rarely a cause of obesity. A medical problem, such as arthritis, can also lead to decreased activity, which can result in weight gain. Alcohol. Drinking alcohol adds calories to your diet — just one regular beer is about 150 calories. If you don't cut back somewhere else, adding just one beer daily could cause a weight gain of more than one pound a month.
DiagnosisBMI is used to assess whether or not an individual is overweight or obese. To determine BMI, weight in kilograms is divided by height in meters, squared. The following BMI ranges are most often used as indications that a person is overweight or obese: BMI 25 to 29.9 (overweight)
BMI 30 to 39.9 (moderately obese)
BMI 40 or above (extremely obese)
After assessing BMI, blood pressure and percentage of body fat may be measured, and blood tests performed to evaluate cholesterol levels and determine how well the thyroid is functioning.
Treatment ApproachThe mainstay of treatment for obesity is an energy-limited diet and increased exercise. In studies, diet and exercise programs have consistently produced an average weight loss of approximately 8% of total body mass on average (excluding study drop-outs). While not all dieters will be satisfied with this outcome, studies have shown that a loss of as little as 5% of body mass can create enormous health benefits.
Although a variety of medications are available to help promote weight loss, no drugs cure obesity. Weight loss medications should therefore not be used in isolation—rather, they should be used in addition to diet, exercise, and other lifestyle modifications. Many are available by prescription only and some have serious side effects. For these reasons, weight loss medications should only be used under the direction and supervision of a physician.
PregnancyPregnant women should not take any herbal remedies or over-the-counter or prescription medications for weight loss.
Obese women who become pregnant are at an increased risk for the following: - Gestational diabetes—a diabetic condition that appears during pregnancy and usually goes away after the birth of the baby
- High blood pressure
- Preeclampsia—a potentially fatal condition causing high blood pressure, fluid retention, and protein in the urine; may cause abdominal pain and vomiting
- Abnormally large infants resulting in difficult deliveries
- Caesarean sections as well as complications associated with Caesarean sections
- Fetal distress—a condition in which the baby does not receive enough oxygen
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