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Obesity

Obesity is a serious problem in the developed countries of the world. During the past 20 years, obesity among adults has risen significantly in the United States. The latest data from the National Center for Health Statistics show that 30 percent of U.S. adults 20 years of age and older—over 60 million people—are obese.This increase is not limited to adults. The percentage of young people who are overweight has more than tripled since 1980. Among children and teens aged 6–19 years, 16 percent (over 9 million young people) are considered overweight.

What are the health concerns for those who are overweight or obese? Being overweight or obese increases the risk of many diseases and health conditions, including the following.

• Hypertension
• Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Gallbladder disease
• Osteoarthritis
• Sleep apnea and respiratory problems
• Some cancers (endometrial, breast, and colon)

Although one of the national health objectives for the year 2010 is to reduce the prevalence of obesity among adults to less than 15%, current data indicate that the situation is worsening rather than improving.

What is the difference between being overweight and being obese? Overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. The terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems.

For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the “body mass index” (BMI). BMI is used because, for most people, it correlates with their amount of body fat.

An adult who has a BMI between 25 and 29.9 is considered overweight.
An adult who has a BMI of 30 or higher is considered obese.
See the following table for an example

Weight RangeConsidered

Height	Weight Range	BMI	Considered
5’ 9”	124 lbs or less	Below 18.5	Underweight
	125 lbs to 168 lbs	18.5 to 24.9	Healthy weight
	169 lbs to 202 lbs	25.0 to 29.9	Overweight
	203 lbs or more	30 or higher	Obese

It is important to remember that although BMI correlates with the amount of body fat, BMI does not directly measure body fat. As a result, some people, such as athletes, may have a BMI that identifies them as overweight even though they do not have excess body fat.

Overweight and obesity are a result of energy imbalance over a long period of time. The cause of energy imbalance for each individual may be due to a combination of several factors. This involves eating too many calories and not getting enough physical activity. Body weight is the result of genes, metabolism, behavior, environment, culture, and socioeconomic status.

Energy imbalance - When the number of calories consumed is not equal to the number of calories used. Energy Balance is like a scale. When calories consumed are greater than calories used weight gain results.

Weight Gain: Calories Consumed > Calories Used

Weight Loss: Calories Consumed < Calories Used

No Weight Change: Calories Consumed = Calories Used
Genetics and the environment may increase the risk of personal weight gain. However, the choices a person makes in eating and physical activity also contributes to overweight and obesity. Behavior can increase a person’s risk for gaining weight.

Looking back at the energy balance scale, weight gain is a result of extra calorie consumption, decreased calories used (reduced physical activity) or both. Personal choices concerning calorie consumption and physical activity can lead to energy imbalance.

Calorie Consumption - In America, a changing environment has broadened food options and eating habits. Grocery stores stock their shelves with a greater selection of products. Pre-packaged foods, fast food restaurants, and soft drinks are also more accessible. While such foods are fast and convenient they also tend to be high in fat, sugar, and calories. Choosing many foods from these areas may contribute to an excessive calorie intake. Some foods are marketed as healthy, low fat, or fat-free, but may contain more calories than the fat containing food they are designed to replace. It is important to read food labels for nutritional information and to eat in moderation.

Portion size has also increased. People may be eating more during a meal or snack because of larger portion sizes. This results in increased calorie consumption. If the body does not burn off the extra calories consumed from larger portions, fast food, or soft drinks, weight gain can occur.

Calories Used - Our bodies need calories for daily functions such as breathing, digestion, and daily activities. Weight gain occurs when calories consumed exceed this need. Physical activity plays a key role in energy balance because it uses up calories consumed.

Physical activity is any bodily movement produced by skeletal muscles that results in an expenditure of energy with a range of activities such as Occupational work - Carpentry, construction work, waiting tables, farming Household chores -Washing floors or windows, gardening or yard work Leisure time activities -Walking, skating, biking, swimming, playing Frisbee, dancing Structured sports or exercise Softball, tennis, football, aerobics

Regular physical activity is good for overall health. Physical activity decreases the risk for colon cancer, diabetes, and high blood pressure. It also helps to control weight, contributes to healthy bones, muscles, and joints; reduces falls among the elderly; and helps to relieve the pain of arthritis. Physical activity does not have to be strenuous to be beneficial. Moderate physical activity, such as 30 minutes of brisk walking five or more times a week, also has health benefits.

Despite all the benefits of being physically active, most Americans are sedentary. Technology has created many time and labor saving products. Some examples include cars, elevators, computers, dishwashers, and televisions. Cars are used to run short distance errands instead of people walking or riding a bicycle. As a result, these recent lifestyle changes have reduced the overall amount of energy expended in our daily lives.

The belief that physical activity is limited to exercise or sports, may keep people from being active. Another myth is that physical activity must be vigorous to achieve health benefits. Physical activity is any bodily movement that results in an expenditure of energy. Moderate-intensity activities such as household chores, gardening, and walking can also provide health benefits. Confidence in one’s ability to be active will help people make choices to adopt a physically active lifestyle.

The obesity epidemic covered on TV and in the newspapers did not occur overnight. Obesity and overweight are chronic conditions. Overall there are a variety of factors that play a role in obesity. This makes it a complex health issue to address. This section will address how behavior, environment, and genetic factors may have an effect in causing people to be overweight and obese.

What contributes to overweight and obesity?

Behavior and environment play a large role causing people to be overweight and obese. These are the greatest areas for prevention and treatment actions. Genetics and the environment may increase the risk of personal weight gain. However, the choices a person makes in eating and physical activity also contributes to overweight and obesity. Behavior can increase a person’s risk for gaining weight.

Environment
People may make decisions based on their environment or community. For example, a person may choose not to walk to the store or to work because of a lack of sidewalks. Communities, homes, and workplaces can all influence people's health decisions. Because of this influence, it is important to create environments in these locations that make it easier to engage in physical activity and to eat a healthy diet. The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity identified action steps for several locations that may help prevent and decrease obesity and overweight. The following table provides some examples of these steps.

Location	Steps to Help Prevent and Decrease Overweight and Obesity
Home	Reduce time spent watching television and in other sedentary behaviors Build physical activity into regular routines
Schools	Ensure that the school breakfast and lunch programs meet nutrition standards Provide food options that are low in fat, calories, and added sugars Provide all children, from prekindergarten through grade 12, with quality daily physical education
Work	Create more opportunities for physical activity at work sites
Community	Promote healthier choices including at least 5 servings of fruits and vegetables a day, and reasonable portion sizes Encourage the food industry to provide reasonable food and beverage portion sizes  Encourage food outlets to increase the availability of low-calorie, nutritious food items Create opportunities for physical activity in communities

 How do genes affect obesity? Science shows that genetics plays a role in obesity. Genes can directly cause obesity in disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome.

However genes do not always predict future health. Genes and behavior may both be needed for a person to be overweight. In some cases multiple genes may increase one’s susceptibility for obesity and require outside factors; such as abundant food supply or little physical activity.

Other Factors? Some illnesses may lead to obesity or weight gain. These may include Cushing's disease, and polycystic ovary syndrome. Drugs such as steroids and some antidepressants may also cause weight gain. A doctor is the best source to tell you whether illnesses, medications, or psychological factors are contributing to weight gain or making weight loss hard.

Childhood Obesity - Doctors and other health care professionals are the best people to determine whether your child or adolescent's weight is healthy, and they can help rule out rare medical problems as the cause of unhealthy weight.
A Body Mass Index (BMI) can be calculated from measurements of height and weight. Health professionals often use a BMI "growth chart" to help them assess whether a child or adolescent is overweight. A physician will also consider your child or adolescent's age and growth patterns to determine whether his or her weight is healthy.

What are factors that contribute to a child obesity?

1. lack of regular exercise
2. sedentary behavior (high frequency of watching tv, computer use, and similar behavior that takes up time that can be used for physical activity)
3. Socioeconomic Status/"SES" (Low family incomes and non-working parents)
4. eating habits (over-eating high calorie foods, eating patterns that have been associated with this behavior are eating when not hungry, eating while watching TV or doing homework)
5. environment (such as over-exposure to advertising of foods that promote high-calorie foods and lack of recreational facilities)
6. genetics (a greater risk of obesity has been found in children of obese and overweight parents)

General suggestions

• Let your child know he or she is loved and appreciated whatever his or her weight. An overweight child probably knows better than anyone else that he or she has a weight problem. Overweight children need support, acceptance, and encouragement from their parents.
• Focus on your child's health and positive qualities, not your child's weight.
• Try not to make your child feel different if he or she is overweight but focus on gradually changing your family's physical activity and eating habits.
• Be a good role model for your child. If your child sees you enjoying healthy foods and physical activity, he or she is more likely to do the same now and for the rest of his or her life.
• Realize that an appropriate goal for many overweight children is to maintain their current weight while growing normally in height.

Suggestions for physical activity for childern

• Be physically active. It is recommended that Americans accumulate at least 30 minutes (adults) or 60 minutes (children) of moderate physical activity most days of the week. Even greater amounts of physical activity may be necessary for the prevention of weight gain, for weight loss, or for sustaining weight loss.
• Plan family activities that provide everyone with exercise and enjoyment.
• Provide a safe environment for your children and their friends to play actively; encourage swimming, biking, skating, ball sports, and other fun activities.
• Reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games. Limit TV time to less than 2 hours a day.
  

Suggestions for eating healthy

• Follow the Dietary Guidelines for healthy eating (www.health.gov/dietaryguidelines).
• Guide your family's choices rather than dictate foods.
• Encourage your child to eat when hungry and to eat slowly.
• Eat meals together as a family as often as possible.
• Carefully cut down on the amount of fat and calories in your family's diet.
• Don't place your child on a restrictive diet.
• Avoid the use of food as a reward.
• Avoid withholding food as punishment.
• Children should be encouraged to drink water and to limit intake of beverages with added sugars, such as soft drinks, fruit juice drinks, and sports drinks.
• Plan for healthy snacks.
• Stock the refrigerator with fat-free or low-fat milk, fresh fruit, and vegetables instead of soft drinks or snacks that are high in fat, calories, or added sugars and low in essential nutrients.
• Aim to eat at least 5 servings of fruits and vegetables each day.
• Discourage eating meals or snacks while watching TV.
• Eating a healthy breakfast is a good way to start the day and may be important in achieving and maintaining a healthy weight.

If your child is overweight

• Many overweight children who are still growing will not need to lose weight, but can reduce their rate of weight gain so that they can "grow into" their weight.
• Your child's diet should be safe and nutritious. It should include all of the Recommended Dietary Allowances (RDAs) for vitamins, minerals, and protein and contain the foods from the major Food Guide Pyramid groups. Any weight-loss diet should be low in calories (energy) only, not in essential nutrients.
• Even with extremely overweight children, weight loss should be gradual.
• Crash diets and diet pills can compromise growth and are not recommended by many health care professionals.
• Weight lost during a diet is frequently regained unless children are motivated to change their eating habits and activity levels for a lifetime.
• Weight control must be considered a lifelong effort.
• Any weight management program for children should be supervised by a physician.