Obesity results from the excessive accumulation of fat that
exceeds the body's skeletal and physical standards. According
to the National Institutes of Health (NIH), an increase in 20
percent or more above your ideal body weight is the point at
which excess weight becomes a health risk. Today 97 million
Americans, more than one-third of the adult population, are
overweight or obese. An estimated 5 to 10 million of those are
considered morbidly obese.
Obesity becomes "morbid" when it reaches
the point of significantly increasing the risk of one or more
obesity-related health conditions or serious diseases (also
known as co-morbidities) that result either in significant
physical disability or even death. As you read about morbid
obesity you may also see the term "clinically severe
obesity" used. Both are descriptions of the same condition
and can be used interchangeably. Morbid obesity is typically
defined as being 100 lbs. or more over ideal body weight or
having a Body Mass Index of 40 or higher. According to the
National Institutes of Health Consensus Report, morbid obesity
is a serious disease and must be treated as such. It is a
chronic disease, meaning that its symptoms build slowly over
an extended period of time.
The reasons for obesity are multiple and complex.
Despite conventional wisdom, it is not simply a result of
overeating. Research has shown that in many cases a significant,
underlying cause of morbid obesity is genetic. Studies have
demonstrated that once the problem is established, efforts
such as dieting and exercise programs have a limited ability
to provide effective long-term relief.
Science continues to search for answers.
But until the disease is better understood, the control of
excess weight is something patients must work at for their
entire lives. That is why it is very important to understand
that all current medical interventions, including weight loss
surgery, should not be considered medical cures. Rather they
are attempts to reduce the effects of excessive weight and
alleviate the serious physical, emotional and social consequences
of the disease.
Contributing
Factors
Genetic Factors
The Pima Paradox
Environmental Factors
Metabolism
Eating Disorders &
Medical Conditions
The underlying causes of severe obesity are not known. There
are many factors that contribute to the development of obesity
including genetic, hereditary, environmental, metabolic and
eating disorders. There are also certain medical conditions
that may result in obesity like intake of steroids and hypothyroidism.
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Numerous scientific studies have established that your genes
play an important role in your tendency to gain excess weight.
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The body weight of
adopted children shows no correlation with the body weight
of their adoptive parents, who feed them and teach them
how to eat. Their weight does have an 80 percent correlation
with their genetic parents, whom they have never met. |
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Identical twins, with the same genes, show a much higher
similarity of body weights than do fraternal twins, who
have different genes. |
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Certain groups of people, such as the Pima Indian tribe
in Arizona, have a very high incidence of severe obesity.
They also have significantly higher rates of diabetes
and heart disease than other ethnic groups. |
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We probably have a number of genes directly related to weight.
Just as some genes determine eye color or height, others affect
our appetite, our ability to feel full or satisfied, our metabolism,
our fat-storing ability, and even our natural activity levels.
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The Pima Indians are known in scientific circles as one of
the heaviest groups of people in the world. In fact, National
Institutes of Health researchers have been studying them for
more than 35 years. Some adults weigh more than 500 pounds,
and many obese teenagers are suffering from diabetes, the
disease most frequently associated with obesity.
But here's a really interesting fact
- a group of Pima Indians living in Sierra Madre, Mexico,
does not have a problem with obesity and its related diseases.
Why not?
The leading theory states that after
many generations of living in the desert, often confronting
famine, the most successful Pima were those with genes that
helped them store as much fat as possible during times when
food was available. Now those fat-storing genes work against
them.
Though both populations consume a similar
number of calories each day, the Mexican Pima still live much
like their ancestors did. They put in 23 hours of physical
labor each week and eat a traditional diet that's very low
in fat. The Arizona Pima live like most other modern Americans,
eating a diet consisting of around 40 percent fat and engaging
in physical activity for only two hours a week.
The Pima apparently have a genetic
predisposition to gain weight. And the environment in which
they live - the environment in which most of us live - makes
it nearly impossible for the Arizona Pima to maintain a normal,
healthy body weight.
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Environmental and genetic factors are
obviously closely intertwined. If you have a genetic predisposition
toward obesity, then the modern American lifestyle and environment
may make controlling weight more difficult.
Fast food, long days sitting at a desk, and suburban neighborhoods
that require cars all magnify hereditary factors such as metabolism
and efficient fat storage.
For those suffering from morbid obesity, anything less than
a total change in environment usually results in failure to
reach and maintain a healthy body weight.
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We used to think of weight gain or loss as only a function
of calories ingested and then burned. Take in more calories
than you burn, gain weight; burn more calories than you ingest,
lose weight. But now we know the equation isn't that simple.
Obesity researchers now talk about
a theory called the "set point," a sort of thermostat
in the brain that makes people resistant to either weight
gain or loss. If you try to override the set point by drastically
cutting your calorie intake, your brain responds by lowering
metabolism and slowing activity. You then gain back any weight
you lost.
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Eating Disorders
& Medical Conditions
Weight loss surgery is not a cure for eating disorders. And
there are medical conditions, such as hypothyroidism, that
can also cause weight gain. That's why it's important that
you work with your doctor to make sure you do not have a condition
that should be treated with medication and counseling.
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Morbid obesity brings with it an increased
risk for a shorter life expectancy. For individuals whose weight
exceeds twice their ideal body weight (that's about 2-6% of
the U.S. population), the risk of an early death is doubled
compared to non-obese individuals. The risk of death from diabetes
or heart attack is five to seven times greater. Even beyond
the issue of obesity-related health conditions, weight gain
alone can lead to a condition known as "end-stage"
obesity where, for the most part, no treatment options are available.
Yet an early death is not the only potential consequence. Social,
psychological and economic effects of morbid obesity, however
unfair, are real and can be especially difficult.
Obesity-related health conditions are
health conditions that, whether alone or in combination, can
significantly reduce your life expectancy. A partial list of
some of the more common conditions follows. Your doctor can
provide you with a more detailed and complete list:
Type 2 Diabetes. Obese individuals develop
a resistance to insulin, which regulates blood sugar levels.
Over time, the resulting high blood sugar can cause serious
damage to the body.
High blood pressure/Heart disease. Excess
body weight strains the ability of the heart to function properly.
The resulting hypertension (high blood pressure) can result
in strokes, as well as inflict significant heart and kidney
damage.
Osteoarthritis of weight-bearing joints.
The additional weight placed on joints, particularly knees
and hips, results in rapid wear and tear, along with pain
caused by inflammation. Similarly, bones and muscles of the
back are constantly strained, resulting in disk problems,
pain and decreased mobility.
Sleep apnea/Respiratory problems. Fat deposits
in the tongue and neck can cause intermittent obstruction
of the air passage. Because the obstruction is increased when
sleeping on your back, you may find yourself waking frequently
to reposition yourself. The resulting loss of sleep often
results in daytime drowsiness and headaches.
Gastroesophageal reflux/Heartburn. Acid
belongs in the stomach and seldom causes any problem when
it stays there. When acid escapes into the esophagus through
a weak or overloaded valve at the top of the stomach, the
result is called gastroesophageal reflux, and "heartburn"
and acid indigestion are common symptoms. Approximately 10-15%
of patients with even mild sporadic symptoms of heartburn
will develop a condition called Barrett's esophagus, which
is a pre-malignant change in the lining membrane of the esophagus,
a cause of esophageal cancer.
Depression. Seriously overweight persons
face constant challenges to their emotions: repeated failure
with dieting, disapproval from family and friends, sneers
and remarks from strangers. They often experience discrimination
at work, cannot fit comfortably in theatre seats, or ride
in a bus or plane.
Infertility. The inability or diminished
ability to produce offspring.
Urinary stress incontinence. A large, heavy
abdomen and relaxation of the pelvic muscles, especially associated
with the effects of childbirth, may cause the valve on the
urinary bladder to be weakened, leading to leakage of urine
with coughing, sneezing, or laughing.
Menstrual irregularities. Morbidly obese
individuals often experience disruptions of the menstrual
cycle, including interruption of the menstrual cycle, abnormal
menstrual flow and increased pain associated with the menstrual
cycle.
Cancer. Certain cancers are more prevalent
with morbid obesity including breast, colon and prostate.
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