Excess Weight And Obesity

It is estimated that more than 2 out of every 3 adults in the United States are overweight or obese.  Problems with food, eating, and weight control are endemic in the U.S.

What you eat as well as how and why you eat is affected by many factors including your activity level, overall health, body chemistry, biological makeup and appetite, family training, friends, cultural issues and your psychological makeup.  However, in the end, being overweight is the result of taking in more calories from food than you need to sustain life and physical activity. 

An eating problem reflects itself as a preoccupation with, and/or a problem with, body weight, shape and diet. Typically, if you have an eating disorder, you'll have unhealthy eating behavior. This may include eating foods that are not good for your body and overeating or an extreme and unhealthy reduction of the amount of food you eat. Either way, the person feels bad about their eating, body shape, weight, or all three.

The main types of eating disorders, as defined by the DSM 1V-TR of the American Psychiatric Association, are obesity and excess weight, anorexia and bulimia nervosa, and binge-eating. Most often, eating problems develop during the childhood and teenage years, but many people do not experience these problems until adulthood. Eating disorders frequently show up along with other mental health issues, such as depression, alcohol abuse, drug abuse, and anxiety disorders.  People who suffer from eating disorders also risk serious, and sometimes fatal, health complications.

Given the large number of people with obesity and the serious health risks that come with it, understanding its causes and treatment is crucial. 

Measuring your level of body fat is complicated, so in order to simplify the process many health care professionals use height-weight tables that have a range of acceptable weights for a person of a given height. 

"Overweight" and "obesity": The terms "overweight" and "obesity" refer to an excessive amount of body weight that includes muscle, bone, fat, and water. The term "obesity" is typically used when your weight is approximately 20%-30% or more above normal weight for a person of your age, height, and bone density. 

Since women typically have more body fat than men, most health care professionals say that a man with more than 25% body fat and a woman with more than 30% body fat are obese.  The term "morbidly obese" is used when a person is 50% or more over normal weight, more than 100 pounds over normal weight, has a Body Mass Index (BMI) of 40 or higher, or is overweight to the degree that the weight severely interferes with health or normal function.

How is obesity measured?

Measuring the exact amount of a person's body fat is not easy. The most accurate measures are to weigh a person underwater or in a chamber that uses air displacement to measure body volume, or to use an X-ray test known as DEXA. These methods are not practical for the average person, and are done only in research centers with special equipment.

Because measuring a person's body fat is difficult, health care professionals often rely on weight-for-height tables, used for decades, have a range of acceptable weights for a person of a given height. One problem with these tables is that there are many versions, all with different weight ranges. Another problem is that they do not distinguish between excess fat and muscle. According to the tables, a very muscular person may be classified obese when he or she is not.

The Body Mass Index (BMI) is less likely to misidentify a person's appropriate weight-for-height range.  The BMI is a tool used to assess overweight and obesity and monitor changes in body weight. Like the weight-for-height tables, BMI has its limitations because it does not measure body fat or muscle directly.

Obesity occurs when a person consumes more calories from food than he or she burns. Our bodies need calories to sustain life and be physically active, but to maintain weight we need to balance the energy we eat with the energy we use. When a person eats more calories than he or she burns, the energy balance is tipped toward weight gain and obesity. This imbalance between calories-in and calories-out may differ from one person to another. Genetic, environmental, and other factors may all play a part.

Mental health professionals do not know exactly why some people move beyond normal eating behavior. We do know that this is a complex process, and usually no one factor is the cause or reason. We also know that eating disorders, like obesity, anorexia, bulimia, and binge eating, are real problems that are treatable.

We do not know exactly why some people move beyond normal eating behavior and weight, but we know that this is a complex process and usually no one factor is the cause.

Genetic, environmental, and other factors all appear to play a role. Although genes are an important factor in many cases of obesity, environmental factors including lifestyle also play a critical role.  For example, since the 1980's our genetic make-up has not changed but our environment and lifestyle has and this reflects itself in the current "overweight" problem.  Most people now eat out too often, consume high-fat foods, put convenience ahead of nutrition, and have become more sedentary.

Looking at some Genetic Causal Factors

Obesity tends to run in families, suggesting a genetic cause. However, families also share diet and lifestyle habits that may contribute to obesity. Separating genetic from other influences on obesity is often difficult. Even so, science does show a link between obesity and heredity but many people genetically predisposed to obesity do not become obese or are able to lose weight and keep it off.

Another biological factor is that as you get older, your body's ability to metabolize food slows down and you do not require as many calories to maintain your weight. This is why people note that they eat the same and do the same activities as they did when they were 20 years old, but at age 40, gain weight.

Women tend to be more overweight than men. Men have a higher resting metabolic rate (meaning they burn more energy at rest) than women, so men require more calories to maintain their body weight. Additionally, when women become postmenopausal, their metabolic rate decreases. That is partly why many women gain weight after menopause.

Looking at some Environmental and Social Causal Factors

Environmental factors include lifestyle behaviors such as what a person eats and how active he or she is.  Consider that most people in the United States alive today were also alive in 1980, when obesity rates were lower. Since this time, our genetic make-up has not changed, but our environment has.

Too often Americans eat out, consume large meals and high-fat foods, and put taste and convenience ahead of nutrition. Also, most people in the United States do not get enough physical activity.  Active individuals require more calories than less active ones to maintain their weight. Additionally, physical activity tends to decrease appetite in obese individuals while increasing the body's ability to preferentially metabolize fat as an energy source. Much of the increase in obesity in the last 20 years is thought to have resulted from the decreased level of daily physical activity.

Today, more people drive long distances to work instead of walking, tend to eat out or get “take out” instead of cooking, or have vending machines with high-calorie, high-fat snacks at their workplace.

Although you cannot change your genetic makeup, you can work on changing your eating habits, levels of physical activity, and other environmental factors.

Looking at some Psychological  and Emotional Causal Factors

One of the most painful aspects of obesity may be the emotional suffering it causes. American society places great emphasis on physical appearance, often equating attractiveness with slimness or muscularity. In addition, many obese people face prejudice at work, school, at a job, and in social situations. Feelings of rejection, shame, or depression are common in people who are overweight or obese.

Many people eat in response to negative emotions such as boredom, sadness, or anger. While most overweight people have no more psychological disturbances than people at their normal weight, about 30% of people who seek treatment for serious weight problems have difficulties with binge-eating.

Looking at Illness and Drug Factors

Although not as common as many believe, there are many illnesses that are linked to obesity. These include hormone problems such as hypothyroidism, depression, Cushing's syndrome, polycystic ovary syndrome, and many other diseases.  A doctor can tell whether there are underlying medical conditions that are causing weight gain or making weight loss difficult.

Lack of sleep may also contribute to obesity. Recent studies suggest that people with sleep problems may gain weight over time.

Certain drugs such as steroids, some antidepressants, and some medications for psychiatric conditions or seizure disorders may cause weight gain. These drugs may slow the rate at which the body burns calories, stimulate appetite, or cause the body to hold on to extra water.

Over the years, I have found that the type of treatment that is be best for my clients depends on several variables including your motivation to lose weight, your level of obesity, your overall health condition, what you have tried so far, and your personality and temperament. Treatment may include a combination of cognitive therapy, reality therapy, diet, exercise, behavioral therapy, nutritional counseling, weight control strategies, and weight-loss related drugs. In some cases of extreme obesity, surgery may be considered.

Remember, weight control is a life-long effort, and having realistic expectations about weight loss is an important consideration. Eating a healthful diet and getting at least 30 minutes of moderate-intensity physical activity on most days of the week have important health benefits. Although many adults do not need to see their healthcare professional before starting a moderate-intensity physical activity program, checking with your health care provider before starting a physical activity program is always a good idea.

Remember, to be a truly effective effort, you not only need to lose weight but you need to keep this weight off.  Weight control is a life-long endeavor. If your overweight or obese condition reflects a true eating disorder, treatment can be expected to be more complex and take longer to resolve.

For more information about anorexia nervosa, bulimia nervosa, eating problems, and weight control issues, please visit the websites listed below and the glossary that follows.

If you really want help dealing with your feelings and emotions, changing your behavior, and improving your life and the approach and office hours of typical therapists and counselors do not fit your life style or personal needs, I may have a solution.

By using very flexible office appointments, telephone consultations, email, teleconferences, and the willingness to travel and meet with you personally in your home, office, or other location, I can be available to help you anytime and anywhere.

Feel free to contact me now for your free initial consultation. Once you become an existing client, you will be given a pager number where you can reach me whenever you need.

Below is an Obesity, physical activity, and weight control glossary adapted from the U.S. government"s National Institutes of Health website. 

A

Adipose tissue (add-ih-POS-e) Fat tissue in the body.

B

Bariatric surgery (bear-ee-AT-ric) Surgery on the stomach and/or intestines to help the patient with extreme obesity lose weight. Bariatric surgery is a weight-loss method used for people who have a body mass index (BMI) above 40. Surgery may also be an option for people with a BMI between 35 and 40 who have health problems like heart disease or type 2 diabetes.

Bioelectrical impedance analysis (BIA) (im-PEE-dance) A way to estimate the amount of body weight that is fat and nonfat. Nonfat weight comes from bone, muscle, body water, organs, and other body tissues. BIA works by measuring how difficult it is for a harmless electrical current to move through the body. The more fat a person has, the harder it is for electricity to flow through the body. The less fat a person has, the easier it is for electricity to flow through the body. By measuring the flow of electricity, one can estimate body fat percent.

Body mass index (BMI) A measure of body weight relative to height. BMI can be used to determine if people are at a healthy weight, overweight, or obese. To figure out BMI, use the following formula: A body mass index (BMI) of 18.5 up to 25 refers to a healthy weight, a BMI of 25 up to 30 refers to overweight and a BMI of 30 or higher refers to obese.

C

Calorie (CAL-or-ee) A unit of energy in food. Foods have carbohydrates, proteins, and fats. Some beverages have alcohol. Carbohydrates have 4 calories per gram. Proteins have 4 calories per gram. Alcohol has 7 calories per gram. Fat has 9 calories per gram.

Carbohydrate (kar-bow-HIGH-drate) A major source of energy in the diet. There are two kinds of carbohydrates @ simple carbohydrates and complex carbohydrates. Simple carbohydrates are sugars and complex carbohydrates include both starches and fiber. Carbohydrates have 4 calories per gram. They are found naturally in foods such as breads, cereals, fruits, vegetables, and milk and dairy products. Foods such as sugar cereals, soft drinks, fruit drinks, fruit punch, lemonade, cakes, cookies, pies, ice cream, and candy are very rich in sugars.

Cholesterol (ko-LES-te-rol) A fat-like substance that is made by the body and is found naturally in animal foods such as meat, fish, poultry, eggs, and dairy products. Foods high in cholesterol include liver and organ meats, egg yolks, and dairy fats. Cholesterol is carried in the blood. When cholesterol levels are too high, some of the cholesterol is deposited on the walls of the blood vessels. Over time, the deposits can build up causing the blood vessels to narrow and blood flow to decrease. The cholesterol in food, like saturated fat, tends to raise blood cholesterol, which increases the risk for heart disease. Total blood cholesterol levels above 240 mg/dl are considered high. Levels between 200-239 mg/dl are considered borderline high. Levels under 200 mg/dl are considered desirable.

D

Diabetes Mellitus (dye-uh-BEE-teez) A disease that occurs when the body is not able to use blood glucose (sugar). Blood sugar levels are controlled by insulin, a hormone in the body that helps move glucose (sugar) from the blood to muscles and other tissues. Diabetes occurs when the pancreas does not make enough insulin or the body does not respond to the insulin that is made. There are two main types of diabetes mellitus: type 1 diabetes and type 2 diabetes. [See definitions]

Diet What a person eats and drinks. Any type of eating plan.

E

Energy expenditure The amount of energy, measured in calories, that a person uses. Calories are used by people to breath, circulate blood, digest food, and be physically active.

F

Fat A major source of energy in the diet. All food fats have 9 calories per gram. Fat helps the body absorb fat-soluble vitamins, such as vitamins A, D, E, and K, and carotenoids. Some kinds of fats, especially saturated fats, [see definition] may cause blood cholesterol to increase and increase the risk for heart disease. Other fats, such as unsaturated fats [see definition] do not increase blood cholesterol. Fats that are in foods are combinations of monounsaturated, polyunsaturated, and saturated fatty acids.

G

Gastrointestinal surgery (to treat obesity) See bariatric surgery.

Gestational diabetes (jest-AY-shun-ul) (dye-ah-BEE-teez) A type of diabetes mellitus that can occur when a woman is pregnant. In the second half of her pregnancy, a woman may have glucose (sugar) in her blood at a higher than normal level. In about 95 percent of cases, blood sugar returns to normal after the pregnancy is over. Women who develop gestational diabetes, however, are at risk for developing type 2 diabetes later in life.

Glucose (GLU-kos) A building block for most carbohydrates. Digestion causes carbohydrates to break down into glucose. After digestion, glucose is carried in the blood and goes to body cells where it is used for energy or stored.

H

HDL See high-density lipoprotein.

Healthy weight Compared to overweight or obese, a body weight that is less likely to be linked with any weight-related health problems such as type 2 diabetes, heart disease, high blood pressure, high blood cholesterol, or others. A body mass index (BMI) of 18.5 up to 25 refers to a healthy weight, though not all individuals with a BMI in this range may be at a healthy level of body fat; they may have more body fat tissue and less muscle. A BMI of 25 up to 30 refers to overweight and a BMI of 30 or higher refers to obese.

High blood pressure Another word for “hypertension.” Blood pressure rises and falls throughout the day. An optimal blood pressure is less than 120/80 mmHg. When blood pressure stays high, greater than or equal to 140/90 mmHg, then it is considered high blood pressure. High blood pressure increases the risk for heart disease and stroke.

High-density lipoprotein (HDL) (lip-o-PRO-teen) A form of cholesterol that circulates in the blood. Commonly called “good” cholesterol. High HDL lowers the risk of heart disease. An HDL of 60 mg/dl or greater is considered high and is protective against heart disease. An HDL less than 40 mg/dl is considered low and increases the risk for developing heart disease.

Hydrogenation (high-dro-jen-AY-shun) A chemical way to turn liquid fat (oil) into solid fat. This process creates a new fat called trans fatty acids. Trans fatty acids are found in margarine, shortening, and some commercial baked foods like cookies, crackers, muffins, and cereals. Eating a large amount of trans fatty acids may raise heart disease risk.

I

Insulin (IN-sah-lin) A hormone in the body that helps move glucose (sugar) from the blood to muscles and other tissues. Insulin controls blood sugar levels.

L

LDL See low-density lipoprotein.

Lipoprotein (lip-o-PRO-teen) Compounds of protein that carry fats and fat-like substances, such as cholesterol, in the blood.

Low-density lipoprotein (LDL) (lip-o-PRO-teen) A form of cholesterol that circulates in the blood. Commonly called “bad” cholesterol. High LDL increases the risk of heart disease. An LDL less than 100 mg/dl is considered optimal, 100-129 mg/dl is considered near or above optimal, 130-159 mg/dl is considered borderline high, 160-189 mg/dl is considered high, and 190 mg/dl or greater is considered very high.

M

Metabolism (meh-TAB-o-liszm) All of the processes that occur in the body that turn the food you eat into energy your body can use.

Monounsaturated fat (mono-un-SATCH-er-ay-ted) Fats that are in foods are combinations of monounsaturated, polyunsaturated, and saturated fatty acids. Monounsaturated fat is found in canola oil, olives and olive oil, nuts, seeds, and avocados. Eating food that has more monounsaturated fat instead of saturated fat may help lower cholesterol and reduce heart disease risk. However, it has the same number of calories as other types of fat, and may still contribute to weight gain if eaten in excess.

N

Nutrition (new-TRISH-un) (1) The process of the body using food to sustain life. (2) The study of food and diet.

O

Obesity (oh-BEE-si-tee) Having a high amount of body fat. A person is considered obese if he or she has a body mass index (BMI) of 30 kg/m2 or greater.

Overweight Being too heavy for one’s height. It is defined as a body mass index (BMI) of 25 up to 30 kg/m2. Body weight comes from fat, muscle, bone, and body water. Overweight does not always mean over fat.

P

Pancreas (PAN-kree-as) A gland that makes enzymes that help the body break down and use nutrients in food. It also produces the hormone insulin [see definition] and releases it into the bloodstream to help the body control blood sugar levels.

Physical activity Any form of exercise or movement. Physical activity may include planned activity such as walking, running, basketball, or other sports. Physical activity may also include other daily activities such as household chores, yard work, walking the dog, etc. It is recommended that adults get at least 30 minutes and children get at least 60 minutes of moderate physical activity most days of the week. Moderate physical activity is any activity that requires about as much energy as walking two miles in 30 minutes.

Polyunsaturated fat (poly-un-SATCH-er-ay-ted) A highly unsaturated fat that is liquid at room temperature. Fats that are in foods are combinations of monounsaturated, polyunsaturated, and saturated fatty acids. Polyunsaturated fats are found in greatest amounts in corn, soybean, and safflower oils, and many types of nuts. They have the same number of calories as other types of fat, and may still contribute to weight gain if eaten in excess.

Protein (PRO-teen) One of the three nutrients that provides calories to the body. Protein is an essential nutrient that helps build many parts of the body, including muscle, bone, skin, and blood. Protein provides 4 calories per gram and is found in foods like meat, fish, poultry, eggs, dairy products, beans, nuts, and tofu.

R

Registered Dietitian (R.D.) A health professional who is a food and nutrition expert. A person who has studied diet and nutrition at an American Dietetic Association (ADA) approved college program and passed an exam to become a registered dietitian.

S

Saturated fat (SATCH-er-ay-ted) A fat that is solid at room temperature. Fats that are in foods are combinations of monounsaturated, polyunsaturated, and saturated fatty acids. Saturated fat is found in high-fat dairy products (like cheese, whole milk, cream, butter, and regular ice cream), fatty fresh and processed meats, the skin and fat of chicken and turkey, lard, palm oil, and coconut oil. They have the same number of calories as other types of fat, and may contribute to weight gain if eaten in excess. Eating a diet high in saturated fat also raises blood cholesterol and risk of heart disease.

T

Trans fatty acids A fat that is produced when liquid fat (oil) is turned into solid fat through a chemical process called hydrogenation (See definition). Eating a large amount of trans fatty acids also raises blood cholesterol and risk of heart disease.

Type 1 diabetes (dye-uh-BEET-eez) Previously known as “insulin-dependent diabetes mellitus,” (IDDM) or “juvenile diabetes.” Type 1 diabetes is a life-long condition in which the pancreas stops making insulin. Without insulin, the body is not able to use glucose (blood sugar) for energy. To treat the disease, a person must inject insulin, follow a diet plan, exercise daily, and test blood sugar several times a day. Type 1 diabetes usually begins before the age of 30.

Type 2 diabetes (dye-uh-BEET-eez) Previously known as “noninsulin-dependent diabetes mellitus” (NIDDM) or “adult-onset diabetes.” Type 2 diabetes is the most common form of diabetes mellitus. About 90 to 95 percent of people who have diabetes have type 2 diabetes. People with type 2 diabetes produce insulin, but either do not make enough insulin or their bodies do not use the insulin they make. Most of the people who have this type of diabetes are overweight. Therefore, people with type 2 diabetes may be able to control their condition by losing weight through diet and exercise. They may also need to inject insulin or take medicine along with continuing to follow a healthy program of diet and exercise. Although type 2 diabetes commonly occurs in adults, an increasing number of children and adolescents who are overweight are also developing type 2 diabetes.

U

Underwater weighing A research method for estimating body fat. A person is placed in a tank, underwater, and weighed. By comparing weight underwater with weight on land, one can get a very good measure of body fat.

Unsaturated fat (un-SATCH-er-ay-ted) A fat that is liquid at room temperature. Vegetable oils are unsaturated fats. Unsaturated fats include polyunsaturated fats, and monounsaturated fats. They include most nuts, olives, avocados, and fatty fish, like salmon. [See definitions]

V

Very-low calorie diet Also called “VLCD.” A person following a VLCD eats or drinks a commercially prepared formula that has 800 calories or less, instead of eating food. A VLCD can allow a person to lose weight more quickly than is usually possible with low-calorie diets, but should only be used under the supervision of a health care provider.

W

Waist circumference A measurement of the waist. Fat around the waist increases the risk of obesity-related health problems. Women with a waist measurement of more than 35 inches or men with a waist measurement of more than 40 inches have a higher risk of developing obesity-related health problems, such as diabetes, high blood pressure, and heart disease.

Weight control Achieving and maintaining a healthy weight by eating well and getting regular physical activity.

Weight-cycle Losing and gaining weight over and over again. Commonly called “yo-yo” dieting.