Overweight

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Overweight
Classification and external resources
Body mass index chart.svg
The overweight range according to the Body Mass Index (BMI) is the area on the chart where BMI > 25.
ICD-10E66
ICD-9278.02
MedlinePlus003101
MeSHD050177
 
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Overweight
Classification and external resources
Body mass index chart.svg
The overweight range according to the Body Mass Index (BMI) is the area on the chart where BMI > 25.
ICD-10E66
ICD-9278.02
MedlinePlus003101
MeSHD050177

Overweight is generally defined as having more body fat than is optimally healthy. Being overweight is a common condition, especially where food supplies are plentiful and lifestyles are sedentary.

Excess weight has reached epidemic proportions globally, with more than 1 billion adults being either overweight or obese.[1] Increases have been observed across all age groups.

A healthy body requires a minimum amount of fat for the proper functioning of the hormonal, reproductive, and immune systems, as thermal insulation, as shock absorption for sensitive areas, and as energy for future use. But the accumulation of too much storage fat can impair movement and flexibility, and can alter the appearance of the body.

Classification

The degree to which a person is overweight is generally described by body mass index (BMI). Overweight is defined as a BMI of 25 or more, thus it includes pre-obesity defined as a BMI between 25 and 30 and obesity as defined by a BMI of 30 or more.[2][3] Pre obese and overweight however are often used interchangeably thus giving overweight a common definition of a BMI of between 25 -30. There are however several other common ways to measure the amount of adiposity or fat present in an individual's body.

The body mass index (BMI) is a measure of a person's weight taking into account their height. It is given by the formula: BMI equals a person's weight (mass) in kilograms divided by the square of the person's height in metres. The units therefore are kg/m2 but BMI measures are typically used and written without units.
BMI provides a significantly more accurate representation of body fat content than simply measuring a person's weight. It is only moderately correlated with both body fat percentage and body fat mass (R2 of 0.68).[4] It does not take into account certain factors such as pregnancy or bodybuilding; however, the BMI is an accurate reflection of fat percentage in the majority of the adult population.
The body volume index (BVI) was devised in 2000 as a computer, rather than manual, measurement of the human body for obesity and an alternative to the BMI
Body volume index uses 3D software to create an accurate 3D image of a person so BVI can differentiate between people with the same BMI rating, but who have a different shape and different weight distribution.
An obese man on a motorcycle
Belly of an overweight teenage boy.
Children with varying levels of body fat
BVI measures where a person’s weight and the fat are located on the body, rather than total weight or total fat content and places emphasis on the weight carried around the abdomen, commonly known as central obesity. There has been an acceptance in recent years that abdominal fat and weight around the abdomen constitute a greater health risk.[5]
The person's weight is measured and compared to an estimated ideal weight. This is the easiest and most common method, but by far the least accurate, as it only measures one quantity (weight) and often does not take into account many factors such as height, body type, and relative amount of muscle mass.
The skin at several specific points on the body is pinched and the thickness of the resulting fold is measured. This measures the thickness of the layers of fat located under the skin, from which a general measurement of total amount of fat in the body is calculated. This method can be reasonably accurate for many people, but it assumes particular fat distribution patterns over the body—which may not apply to all individuals, and does not account for fat deposits not directly under the skin. Also, as the measurement and analysis generally involves a high degree of practice and interpretation, an accurate result requires that a professional perform it. It cannot generally be done by patients themselves.
A small electrical current is passed through the body to measure its electrical resistance. As fat and muscle conduct electricity differently, this method can provide a direct measurement of the body fat percentage, in relation to muscle mass. In the past, this technique could only be performed reliably by trained professionals with specialized equipment, but it is now possible to buy home testing kits that let people do this themselves with a minimum of training. Despite the improved simplicity of this process over the years, however, a number of factors can affect the results, including hydration and body temperature, so it still needs some care when taking the test to ensure that the results are accurate.
Considered one of the more accurate methods of measuring body fat, this technique involves complete submersion of a person in water, with special equipment to measure the person's weight while submerged. This weight is then compared with "dry weight" as recorded outside the water to determine overall body density. As fat is less dense than muscle, careful application of this technique can provide a reasonably close estimate of fat content in the body. This technique does, however, require expensive specialized equipment and trained professionals to administer it properly.
Originally developed to measure bone density, DEXA imaging is also used to precisely determine body fat content by using the density of various body tissues to identify which portions of the body are fat. This test is generally considered very accurate, but requires a great deal of expensive medical equipment and trained professionals to perform.

The most common method for discussing this subject and the one used primarily by researchers and advisory institutions is BMI. Definitions of what is considered overweight vary by ethnicity. The current definition proposed by the US National Institutes of Health (NIH) and the World Health Organization (WHO) designates whites, Hispanics and blacks with a BMI of 25 or more as overweight. For Asians, overweight is a BMI between 23 and 29.9 and obesity for all groups is a BMI of 30 or more.

BMI, however, does not account extremes of muscle mass, some rare genetic factors, the very young, and a few other individual variations. Thus it is possible for an individuals with a BMI of less than 25 to have excess body fat, while others may have a BMI that is significantly higher without falling into this category.[6] Some of the above methods for determining body fat are more accurate than BMI but come with added complexity.

If an individual is overweight and has excess body fat it could, but won't always, create or lead to health risks. Reports are surfacing, however, that being mildly overweight to slightly obese – BMI being between 24 and 31.9 – may be actually beneficial and that people with BMI between 24 and 31.9 could actually live longer than normal weight or underweight persons.[7][8]

Health-related implications

Animals can suffer from obesity as well. This German Shepherd dog is noticeably overweight.

While the negative health outcomes associated with obesity are accepted within the medical community, the health implications of the overweight category are more controversial. The generally accepted view is that being overweight causes similar health problems to obesity, but to a lesser degree. Adams et al. estimated that the risk of death increases by 20 to 40 percent among overweight people,[9] and the Framingham heart study found that being overweight at age 40 reduced life expectancy by three years.[10] A review in 2013 came to the result that being overweight significantly increases the risk of oligospermia and azoospermia in men.[11]

Flegal et al., however, found that the mortality rate for individuals who are classified as overweight (BMI 25 to 30) may actually be lower than for those with an "ideal" weight (BMI 18.5 to 25).[12][13]

Being overweight has been identified as a cause of cancer, and is projected to overtake smoking as the primary cause of cancer in developed countries as cases of cancer linked to smoking dwindle.[14]

Psychological well-being is also at risk in the overweight individual due to social discrimination. However, children under the age of eight are normally not affected.[15]

Being overweight does not increase mortality in older people.[16]

Prevalence per country

As much as 64% of the United States adult population is considered either overweight or obese, and this percentage has increased over the last four decades.[17]

Causes

Being overweight is generally caused by the intake of more calories (by eating) than are expended by the body (by exercise and everyday living). Factors that may contribute to this imbalance include:

People who have insulin dependant diabetes and chronically overdose insulin may gain weight, while people who already are overweight may develop insulin tolerance, and in the long run type II diabetes.

Treatment

The etiology and the difficulty of one's overweight condition or level of obesity may be different for different reasons. Treatment must be suited to the nature of an individual's body anatomy and physiology with a focus on contributing factors.

The physician or dietitian may perform a BMI calculation, sampling fat percentage of the body, measuring posterior, arm, or stomach. The clinician may recommend tests for hormonal and other biochemical abnormalities in glucose, insulin, cholesterol, thyroid hormones, sex hormones, SHBG and other proteins, cortisol (associated with Cushing's syndrome), triglycerides, HCG, and in acute cases ghrelin (also known as the "hunger" hormone) and leptin (sometimes known as the "satiety hormone") though satiety is associated with some other major factors that aren't necessarily hormonal or molecular.

Some evidence suggests that for merely overweight patients, the health effects of attempting to lose weight may actually be more detrimental than simply remaining overweight.[18]

General treatment in cases of overweight

With the accumulation of knowledge about its neuroendocrine, gastroenterological, nutritional, and psychological (mainly cognitive and behavioral), and environmental causes, obesity, at least in its acute versions, is no longer understood as a problem solely dependent on the obese. It is now known that independent factors, genetic and epigenetic alike, resemble an infrastructure of a decent number of obesity cases, in such a way that the obese have little control whatsoever of their condition. In cases of mild obesity, or overweight, most cases are more easily self-regulated, so that self-care is easier to instill, and in most cases efficient, if implemented correctly.

General treatments are a proper diet, and tailored exercise program (in cases of ability), and sometimes some supplements such as orlistat (lipase inhibitor), caffeine, or others, usually given by a physician, or a dietitian.

In the case of extreme diets, the body goes into an emergency regimen and lowers its metabolic rate, with the result that after the diet, it uses fewer calories for energy production and gathers more to form fat in ddipocytes. Extreme diet usually ends with the individual falling back to previous eating habits and weight, almost always in a repetitive form—a phenomenon known as the yo-yo effect. Dietitians generally recommend eating several balanced meals dispersed through the day, with a combination of progressive, primarily aerobic, physical exercise. Also it should be mentioned that non-overweight people have a higher chance to stay as such, because of higher levels of hormones such as Adiponectin,[19] which is considered to play a positive role in fatty-acid metabolism.

Because these general treatments are trivial and could actually help almost any case of obesity, they are common in all its levels, and resemble the most basic form of treat even in worst cases that demands more progressive medical intervention, as described later.

Specific causes for overweight

Inability to make efficient aerobic exercise

Besides diet, overweight (tendency to gain weight, BMI: 25.0 – 29.9) in an allegedly healthy man could be agitated or worsened by the inability (which is treatable in most cases) to make efficient aerobic exercise. A common cause for this is a chronic pathology or the accumulation (or multiplicative effect) of several associated pathologies in the lower respiratory tract or upper respiratory tract that aren't necessarily fatal. ?These cause an inability to breathe efficiently from the nose in normal conditions and especially during exercise. So much so, that an individual who runs for more than a few minutes experiences a suffocating feeling in the throat, or even lactic acidosis in the legs. Little nasal airflow could be derived from pathologies as turbinate hyperthrophy and nasal septum deviation,[20][21] allergic, and vasomotor rhinitis, asthma,[22] especially exertion asthma, and exercise-induced bronchospasm.[23] Such pathologies are easily diagnosed at an otolaryngologist or pulmonologist, respectively. It is important to note that such problems themselves could induce another problem: lactic acidosis.[24] In this case, one who experiences relatively low intake of oxygen because of problematic breathing during aerobic exercise might not have enough of it to cause lactic acid oxidation, and therefore, would have symptoms[25] such as a feeling of general or specific abnormal (muscle) pain,[25] hyperventilation,[25] fatigue,[25] weakness,[25] and heart irregularities[25] while doing their aerobic activity in cases in which inability to do efficient aerobic exercise (from the aforementioned cases for example) is the main reason for gaining weight (from fat storage), whereas treating it could relieve overweight.

It should be noted that the upper and lower respiratory system pathologies could play a role or worsen more severe obesity cases.

Metabolic or Hormonal pathology or idiopathy

An Endocrine disorder or mild hormonal problem can lead to a person being overweight or obese. If circumstances allow, treatment of such conditions by hormone replacement therapy may help.

Some who are considered healthy by conventional standards might have, for yet unknown reasons, a metabolic pattern that lets them store more fat than normal weight people (BMI 18.5 – 24.9). The popular solution for this problem is a carefully planned and sophisticated diet and exercise program, under the supervision of a licensed dietitian. Some might acquire cognitive and or behavioral therapy from a medical psychologist.

Environment change

There are many environmental factors that could lead to weight gain.

A lack or money or time to devote to exercise due to other commitments, such as work or family, or an inability to exercise, due to living in an environment away from public parks, gyms, or a supportive network of people.

There may also be cultural or religious reasons for not exercising.

A job that involves working with food (especially fast food could also contribute to weight gain.

Liposuction

Some particular manifestations of overweight, such as lipomastia or waist or belly fat, are treated with targeted liposuction. Such a treatment is useful only in cases of overweight, and not in cases of obesity.

Obesity

In obese people (who generally have more complicated issues), the frequency of hormonal or metabolic failings is higher. In relatively mild cases of obesity, which are still harder than regular overweight, specific obesity medication, or HRT could be useful for the patients. In extreme cases bariatric surgery is considered. The NIH recommends to perform such surgery only those with BMI above 40, or above 35.0 if they suffer from a serious co-morbid condition such as diabetes.[26] Indeed, even in progressive obesity, many cases would demand a diet as balanced as possible, alongside the medical treatment.

Psychological help

Those who are overweight or obese often consult psychologists (such as medical and sport psychologists, and maybe others), to provide them with psychological and practical advice in order to lose weight. Supervised learning and implementation of cognitive and behavioral techniques may help to reduce as much as possible the likelihood of failing in the weight-loss process.

Treatment Importance

Being overweight could bring emotional distress, harassment, and impair the intimate functioning in some cases, if not many, thus detracting some of the joy and opportunities of the individual and endanger them and mentally and physically (albeit, not harshly as in severe forms of obesity).

Sometimes treatment of overweight could indeed be demanding, and require considerable mental and financial resources just for the potentially exhausting investigation into the factors causing the overweight, especially when it involves bureaucratic and systematic obstacles to name a few.

For all opinions, it is of utmost importance to lower fat percentage[27] to a decent level.

Understanding the importance of treating obesity may itself play a contributing variable to the success of the process of removing individual excessive amount of body fat and increase the chances of achieving that target.

See also

References

  1. ^ "Obesity and overweight". World Health Organization. 2003. Retrieved 2009-04-27. 
  2. ^ "Obesity: preventing and managing the global epidemic. Report of a WHO convention". World Health Organization technical report series (Geneva: World Health Organization) 894: i–xii, 1–253. 1999. PMID 11234459. 
  3. ^ "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report" (PDF). National Institutes of Health. September 1998. Retrieved 2009-04-27. 
  4. ^ Gray, D. S.; Fujioka, K. J. (1991). "Use of relative weight and Body Mass Index for the determination of adiposity". Journal of Clinical Epidemiology 44 (6): 545–50. doi:10.1016/0895-4356(91)90218-X. PMID 2037859. 
  5. ^ Craver, R. (10 September 2008). "Location, not volume, of fat found to be key". Journalnow.com. Retrieved 2008-10-09. 
  6. ^ Gallagher, Dympna; Heymsfield, S. B.; Heo, M.; Jebb, S. A.; Murgatroyd, Y.; Sakamoto, Y. (1 September 2000). "Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index". The American Journal of Clinical Nutrition 72 (3): 694–701. PMID 10966886. 
  7. ^ "Being Overweight may be Good for Your Health". Statesman. Retrieved November 26, 2009. [dead link]
  8. ^ McFadden, Maureen (January 7, 2009). "Experts say being moderately overweight may be good for you". WNDU.com (WNDU-TV). Retrieved September 24, 2011. 
  9. ^ Adams, K. F.; Schatzkin, A.; Harris, T. B.; Kipnis, V.; Mouw, T.; Ballard-Barbash, R. et al. (2006). "Overweight, Obesity, and Mortality in a Large Prospective Cohort of Persons 50 to 71 Years Old". The New England Journal of Medicine 355 (8): 763–788. doi:10.1056/NEJMoa055643. PMID 16926275.  open access publication - free to read
  10. ^ Peeters, A.; Barendregt, J. J.; Willekens, F.; MacKenbach, J. P.; Al Mamun, A.; Bonneux, L. (January 2003). "Obesity in adulthood and its consequences for life expectancy: a life-table analysis". NEDCOM, the Netherlands Epidemiology and Demography Compression of Morbidity Research Group. Ann. Intern. Med. 138 (1): 24–32. doi:10.7326/0003-4819-138-1-200301070-00008. PMID 12513041. 
  11. ^ Sermondade, N.; Faure, C.; Fezeu, L. et al. (2012). "BMI in relation to sperm count: An updated systematic review and collaborative meta-analysis". Human Reproduction Update 19 (3): 221–231. doi:10.1093/humupd/dms050. PMC 3621293. PMID 23242914.  edit
  12. ^ Flegal, K. M.; Graubard, B. I.; Williamson, D. F.; Gail, M. H. (2005). "Excess Deaths Associated With Underweight, Overweight, and Obesity". JAMA 293 (15): 1861–1867. doi:10.1001/jama.293.15.1861. PMID 15840860.  open access publication - free to read
  13. ^ Kolata, Gina (7 November 2007). "Causes of Death Are Linked to a Person's Weight". New York Times. Retrieved 2009-04-27. 
  14. ^ Wanjek, Christopher (19 February 2008). "Scientists Agree: Obesity Causes Cancer". LiveScience. Retrieved 2009-04-27. 
  15. ^ Kirschenbaum, Daniel S. (2006). "Effect of Obesity or Being Overweight on Self-Esteem". My Overweight Child. Retrieved 2009-05-20. 
  16. ^ Flicker, L.; McCaul, K. A.; Hankey, G. J.; Jamrozik, K.; Brown, W. J.; Byles, J. E. et al. (February 2010). "Body mass index and survival in men and women aged 70 to 75". J Am Geriatr Soc 58 (2): 234–41. doi:10.1111/j.1532-5415.2009.02677.x. PMID 20370857. 
  17. ^ Flegal, K. M.; Carroll, M. D.; Ogden, C. L.; Johnson, C. L. (2002). "Prevalence and Trends in Obesity Among US Adults, 1999–2000". JAMA 288 (14): 1723–1727. doi:10.1001/jama.288.14.1723. PMID 12365955. 
  18. ^ Sørensen, T. I.,; Rissanen, A.; Korkeila, M.; Kaprio, J. (2005). "Intention to Lose Weight, Weight Changes, and 18-y Mortality in Overweight Individuals without Co-Morbidities". Public Library of Science 2 (6): e171. doi:10.1371/journal.pmed.0020171. PMC 1160579. PMID 15971946. 
  19. ^ Díez, J. J.; Iglesias, P. (March 2003). "The role of the novel adipocyte-derived hormone adiponectin in human disease". Eur. J. Endocrinol. 148 (3): 293–300. doi:10.1530/eje.0.1480293. PMID 12611609. 
  20. ^ "The Effects of Partial Turbinectomy on Patients Undergoing Rhinoplasty" (PDF). Iranian Journal of Otorhinolaryngology. 64 23 (3). Summer 2011. 
  21. ^ "Objective Assessment of the Breathe-Right Device During Exercise In Adult Males". 
  22. ^ Cypcar, D.; Lemanske, R. F., Jr (June 1994). "Asthma and exercise". Clinics in chest medicine 15 (2): 351–68. PMID 8088098. 
  23. ^ Sinha, T.; David, A. K. (Feb 15, 2003). "Recognition and management of Exercise-induced bronchospasm". American family physician 67 (4): 769–74, 675. PMID 12613731. 
  24. ^ Luft, F. C. (February 1, 2001). "Lactic acidosis update for critical care clinicians". Journal of the American Society of Nephrology (American Society of Nephrology) 12 (Suppl. 17): 15–19. PMID 11251027. Retrieved 2008-05-28. 
  25. ^ a b c d e f "Lactic Acidosis: Symptoms". Better Medicine. Retrieved 4 April 2011. 
  26. ^ Robinson, M. K. (July 2009). "Editorial: Surgical treatment of Obesity—weighing the facts". N. Engl. J. Med. 361 (5): 520–1. doi:10.1056/NEJMe0904837. PMID 19641209. (subscription required (help)). 
  27. ^ See for example: "What are the guidelines for percentage of body fat loss?". Ask the Expert Blog. American Council on Exercise (ACE). December 2, 2009. 

External links