Obesity is a term used to describe body weight that is much greater than what is healthy. If you are obese, you also have a much higher amount of body fat than is healthy or desirable.

Adults with a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) between 25 kg/m2 and 30 kg/m2 are considered overweight.

Adults with a BMI greater than or equal to 30 kg/m2 are considered obese.

Anyone who is more than 100 pounds overweight or who has a BMI greater than or equal to 40 kg/m2 is considered morbidly obese.

Morbid obesity; Fat - obese

Taking in more calories than you burn leads to being overweight and, eventually, obesity. The body stores unused calories as fat. Obesity can be the result of:

• Eating more food than your body can use
• Drinking too much alcohol
• Not getting enough exercise

An underactive thyroid (hypothyroidism) may lead to 5 - 10 pounds of weight gain. Some antidepressants and antipsychotic medicines may also contribute to weight gain and obesity. Genetic factors play some part in the development of obesity -- children of obese parents are 10 times more likely to be obese than children with parents of normal weight.

People who are at higher risk for obesity include:

• Lower income groups
• Former smokers
• People with chronic mental illness
• People with disabilities
• People with a sedentary lifestyle

The health care provider will perform a physical exam and ask questions about your medical history, eating habits, and exercise routine.

Skin fold measurements may be taken to check your body fat percentage.

Blood tests may be done to look for thyroid or endocrine problems, which could lead to weight gain.

Regular exercise and a healthy diet are crucial when it comes to controlling your weight. Although there are many programs advertised to help you lose weight, the only method proven safe over the long-term is to burn more calories than you consume.

Exercising and eating right must become as much a part of your routine as bathing and brushing your teeth. Unless you are convinced of the benefits, you will not succeed.

DIET

Most people can lose weight by eating a healthier diet and exercising more. Even modest weight loss can improve your health. Sticking to a weight reduction program is not easy. You will need a lot of support from family and friends.

When dieting, your main goal should be to learn new, healthy ways of eating and make them a part of your everyday routine. Learn to read the nutrition labels and ingredients of all the foods you eat.

Work with your health care provider and dietitian to set realistic, safe daily calorie counts that help you lose weight while staying healthy. Remember that if you drop pounds slowly and steadily, you are more likely to keep them off. Your dietitian can teach you about healthy food choices, portion sizes, and new ways to prepare food.

Extreme diets (fewer than 1,100 calories per day) are not thought to be safe or to work very well.

• These types of diets often do not contain enough vitamins and minerals.
• People who are on these diets may experience symptoms such as fatigue, feeling cold most of the time, hair loss, or dizziness.
• There is a risk for gallbladder stones, changes in menstrual periods, and rarely, dangerous heart rhythms.
• Most people who lose weight this way return to overeating and become obese again.

See also: Sweeteners

Other changes can have an impact on your weight loss success:

• Eat only at the table. No snacking in front of the TV, in bed, while driving, or while standing in front of the open refrigerator.
• Learn about appropriate portion sizes.
• Choose low-calorie snacks, such as raw vegetables.
• Learn new ways to manage stress, rather than snacking. Examples may be meditation, yoga, or exercise.
• Keep a diet and exercise journal. This may help you identify overeating triggers in your life.
• If you are depressed, seek medical treatment rather than eating excessively to help cope with your depression.
• Find a support group or consider psychotherapy to help you achieve your weight loss goal.

EXERCISE

To lose weight, you must burn more calories than you eat. Exercise is a key way to do this. Walking a mile a day for 30 days will help you burn off 1 pound of fat, as long as you don't eat more than usual.

If you have not been active, start slowly and build up over weeks or even months. Walking can be a good exercise to start with. Talk to your health care provider before starting.

Every week, increase the amount of time you spend doing the activity. Do it more often or add a second activity. You can increase the speed or difficulty of the activity (for example, by going up hills).

All adults should get 2 1/2 hours of aerobic exercise each week. Spread the exercise out over the week. Exercise for at least 10 minutes at a time.

Find ways to increase your activity level very day.

• Walk instead of driving. If you have to drive, park several blocks away from your destination.
• Climb stairs instead of using an elevator or escalator.
• Do other house activities, such as gardening.

In addition to burning off extra calories, exercise will also:

• Lift your mood and help with anxiety
• Make your bones stronger
• Reduce your chance of having a heart attack or stroke
• Help you manage high blood pressure and cholesterol

MEDICATIONS AND HERBAL REMEDIES

There are many over-the-counter diet products. These include herbal remedies. Most of these products do not work and some can be dangerous. Before using an over-the-counter or herbal diet remedy, talk to your health care provider.

Several prescription weight loss drugs are available, including sibutramine (Meridia) and orlistat (Xenical). Ask your health care provider if these are right for you.

Usually, you can lose between 5 and 10 pounds by taking these drugs. People usually regain the weight when they stop taking the medication, unless they have made lasting lifestyle changes.

SURGERY

Weight-loss surgery may be done to help you lose weight if you are very obese and have not been able to lose weight with diet and exercise.

Surgery alone is not the answer for weight loss. It can train you to eat less, but you still have to do much of the work. You must be committed to diet and exercise after the surgery.Talk to your doctor to learn if this is a good option for you.

The two most common weight-loss surgeries are:

• Laparoscopic gastric banding -- the surgeon places a band around the upper part of your stomach, creating a small pouch to hold food. The band helps you limit how much food you eat by making you feel full after eating small amounts.
• Gastric bypass surgery -- helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, you will not be able to eat as much as before, and your body will not absorb all the calories and other nutrients from the food you eat.

You may have complications from these surgeries. One problem some people have is throwing up if they eat more than their new small stomach can hold.

Many people find it easier to follow a diet and exercise program if they join a group of people with similar problems.

See: Eating disorders - support group

Obesity is a significant health threat. The extra weight puts added stress on all parts of your body.

Medical problems commonly resulting from untreated obesity and morbid obesity include:

• Type 2 diabetesand metabolic syndrome
• High blood pressure, heart disease, and stroke
• Obstructive sleep apnea and other sleep disorders
• Certain cancers, including breast and colon cancer
• Depression
• Osteoarthritis

Extreme obesity can lead to a gradual decrease in the level of oxygen in your blood, a condition called hypoxemia. Decreased blood oxygen levels and sleep apnea may cause a person to feel sleepy during the day. These conditions may also lead to high blood pressure and pulmonary hypertension. In extreme cases, especially when left untreated, this can lead to right-sided heart failure and ultimately death.

Schedule an appointment with your health care provider if you or your child is obese or gaining weight at an extremely rapid rate. Remember that catching the problem early is much simpler than trying to fix it after the person has gained an excessive amount of weight.

Leslie D, Kellogg TA, Ikramuddin S. Bariatric surgery primer for the internist: keys to the surgical consultation. Med Clin North Am. 2007;91:353-381.

Richards WO, Schirmer BD. Morbid Obesity. In: Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 17.

Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007;297(9):969-977.

Position of the American Dietetic Association: Weight Management. J Am Diet Assoc. 2009;109:330-346.

Thompson WG, Cook DA, Clark MM, et al. Treatment of obesity. Mayo Clin Proc. 2007;82(1):93-101

Svetke, LP, Stevens VJ, Brantley PJ, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA. 2008;299(10):1139-48.

Kaplan LM, Klein S, Boden G, Brenner DA, Gostout CJ, Lavine JE, Popkin BM, Schirmer BD, Seeley RJ, Yanovski SZ, Cominelli F. Report of the American Gastroenterological Association (AGA) Institute Obesity Task Force. Gastroenterology. 2007;132(6):2272-5.

When it comes to losing weight with weight loss surgery, obesity surgeons are supposed to schedule mental health check-ups for every patient that may have a previous issue with anorexia, bulimia or other mental health problem. Mental issues can affect how weight loss patients react to surgery and recovery. Obesity surgeons are not trained to diagnose mental health, so how can family members ensure it is safe for the surgery to be performed?

Why is Mental Health a Problem With Obesity Surgery?

Obesity is thought to be linked to addiction. Addiction to food can lead to extreme weight gain, which is why obesity surgeons are sought in the first place. Addiction, however, is not cured by weight loss. Patients who are addicted to food may become addicted to weight loss leading to severe complications and possible death.

After gastric bypass, one type of weight loss surgery, part of the bowel is removed and a stomach pouch about the size of an egg is left. Patients must eat six to eight times a day, take shots for vitamin deficiency as needed and take vitamins and supplements throughout the day. Dedication to weight loss in a healthy manner is essential to successful weight loss.

Mental health issues can also affect rebound weight gain. There are many cases when obesity surgeons have performed a second of third weight loss surgery on a patient who regained weight after surgery. In many of these cases, mental health consultations, treatment and therapy may have helped to prevent weight regain through mental support.

Signs of Previous Eating Disorder

One of the most common reasons for mental intervention by obesity surgeons is a history of eating disorder. Patients who want to lose weight may not admit to this history to obesity surgeons, but mental health care providers may have more luck getting to the truth of the matter. If eating disorders were suffered in the past, patients seeking obesity surgery may not be approved due to the risk of the eating disorder returning.

More and more obesity surgeons are hiring on staff mental health experts to diagnose and treat potential mental issues before surgery or issues after surgery. If a mental health expert is not part of the physician team, weight loss patients may want to take time to see a professional before surgery to talk about previous mental issues include depression, anxiety and addictive behaviors.

Obesity hypoventilation syndrome (OHS) is a condition that occurs in obese people, in which poor breathing leads to lower oxygen levels and higher carbon dioxide levels in the blood.

Pickwickian syndrome

The exact cause of OHS in unknown. Most (but not all) patients with the syndrome have a form of sleep apnea.

OHS is believed to result from both a defect in the brain's control over breathing, and excessive weight (due to obesity) against the chest wall, which makes it hard for a person to take a deep breath. As a result, the blood has too much carbon dioxide and not enough oxygen. People with OHS are often tired due to sleep loss, poor sleep quality, and chronic hypoxia.

Excess (morbid) obesity is the main risk factor.

See also: Respiratory acidosis

The main symptoms of OHS are due to lack of sleep and include:

• Excessive daytime sleepiness
• Falling asleep during the day
• Increased risk for accidents or mistakes at work
• Depression

Symptoms of low blood oxygen level (chronic hypoxia) can also occur, such as shortness of breath or feeling tired after very little effort.

People with OHS are usually very overweight. Symptoms of OHS include:

• Bluish color in the lips, fingers, toes, or skin (cyanosis)
• Signs of right-side heart failure (cor pulmonale), such as swollen legs or feet, shortness of breath, or feeling tired after little effort
• Reddish complexion
• A short, thick neck and small airway passage in the mouth

Tests to confirm OHS include:

• Sleep study
• Lung (pulmonary) function
• Arterial blood gas

Doctors can tell OHS from obstructive sleep apnea by high carbon dioxide levels in the blood when a person is awake.

The treatment involves breathing assistance using special machines (mechanical ventilation). Options include:

• Non-invasive mechanical ventilation (BiPAP or other modes) through a mask that fits tightly over the nose or nose and mouth (mainly for sleep)
• Mechanical ventilation through an incision in the neck (tracheostomy)
• Oxygen

Other treatments are aimed at weight loss, which can reverse OHS.

Support groups can help patients with OHS, or their family members, adjust to the lifestyle changes needed for treatment to be successful. Also, support groups can offer information about new treatments.

Untreated, it can lead to serious heart and blood vessel problems, severe disability, or death. Chronic sleeping problems may also increase the chance of having a motor vehicle accident.

Complications of OHS have to do with a lack of sleep, such as:

• Increased risk for accidents
• Depression, agitation, irritability
• Sexual dysfunction

OHS can also include heart problems, such as:

• Hypertension
• Right heart failure (cor pulmonale)

Call your health care provider if you are very tired during the day, or have any other symptoms that suggest OHS.

Maintain a healthy weight and avoid obesity.

Murray J, Nadel J. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: W.B. Saunders Company; 2000:2326-2328.

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby, Inc; 2004:221-223.

Obesity means having too much body fat. It is not the same as overweight, which means weighing too much. A person may be overweight from extra muscle, bone, or water, as well as too much fat.

Both terms mean your weight is higher than what is thought to be healthy for your height.

This article discusses obesity in children.

Weight - loss - children; Obese - children

When children eat more than they need, their bodies store the extra calories in fat cells to use for energy later. If this pattern continues over time, and their bodies do not need this stored energy, they develop more fat cells and may develop obesity.

Infants and young children are very good at listening to their bodies' signals of hunger and fullness. They will stop eating as soon as their bodies tell them they have had enough.

But sometimes a well-meaning parent tells them they have to finish everything on their plate. This forces them to ignore their fullness and eat everything that is served to them.

Some people may use food to reward good behavior or seek comfort when sad.

These learned habits lead to eating no matter if we are hungry or full. Many people have a very hard time breaking these habits.

The family, friends, schools, and community resources in a child's environment reinforce lifestyle habits regarding diet and activity. Children are surrounded by many things that make it easy to overeat and harder to be active:

Watching television, gaming, texting, and playing on the computer are activities that require very little energy. They can take up a lot of time and replace physical activity. And, when children watch television, they often crave the unhealthy high-calorie snacks they see on commercials. See: Screen time in children

The term eating disorders refers to a group of medical conditions that have an unhealthy focus on eating, dieting, losing or gaining weight, and body image. Obesity and eating disorders often occur at the same time in teenage girls and young-adult women who may be unhappy with their body image.

Certain medical conditions, such as hormone disorders or low thyroid function, and certain medications, such as steroids or anti-seizure medications, can increase a child's appetite, which over time increases their risk for obesity.

The health care provider will perform a physical exam and ask questions about your child's medical history, eating habits, and exercise routine.

Blood tests may be done to look for thyroid or endocrine problems, which could lead to weight gain.

Child health experts recommend that children be screened for obesity at age 6. Your child's body mass index (BMI) is calculated using height and weight. A health care provider can use BMI to estimate how much body fat your child has.

However, measuring body fat and diagnosing obesity in children is different than measuring these things in adults.

SUPPORTING YOUR CHILD

The first step in helping your child get to a healthy weight is to consult with their doctor. The doctor can help to set healthy goals for weight-loss and help with monitoring and support.

Try to get the whole family to join a weight-loss plan, even if weight loss is not the goal for everyone. Weight-loss plans for children focus on healthy lifestyle habits. A healthy lifestyle is good for everyone.

Having support from friends and family may also help your child lose weight. See: Supporting a child with weight loss

CHANGING YOUR CHILD'S LIFESTYLE

Eating a balanced diet means you child consumes the right types and amounts of foods and drinks to keep their body healthy.

• Know what size portions are child should eat to meet your body's needs for nutrients, without getting too much of some and not enough of others.
• Stock your pantry and refrigerator with healthy foods. See: Healthy grocery shopping
• Choose a variety of healthy foods from each of the food groups and eat foods from each group at every meal.
• Learn more about eating healthy and eating out

Choosing healthy snacks and drinks for your children is important, but can be a challenge. See: Snacks and sweetened drinks-children

• Fruits and vegetables are good choices for healthy snacks. They are full of vitamins and low in calories and fat. Some crackers and cheeses also make good snacks.
• Avoid junk-food snacks like chips, candy, cake, cookies, and ice cream. The best way to keep kids from eating junk food or other unhealthy snacks is to not have these foods in your house.
• Avoid sodas, sport drinks, and flavored waters, especially ones made with sugar or corn syrup. These drinks are full of calories and can lead to weight gain, even in active children. If needed, choose beverages with artificial (manmade) sweeteners.

Children should not watch more than 2 hours of TV a day. This can be difficult because watching TV is part of their daily routine. See: Screen time and children

Children should have many chances to play, run, bike, and play sports during the day. Experts recommend they get 60 minutes of moderate activity every day. Moderate activity means you breathe and your heart beats faster than normal. If your child is not athletic, find ways to motivate your child to be more active. See: Exercise and activity-children

WHAT ELSE TO THINK ABOUT

You may see ads for supplements and herbal remedies that claim they will help with weight loss. But many of these claims are not true, and some of these supplements can have serious side effects. Talk to your health care provider before giving them to your child.

Weight loss drugs are not recommended for children

Bariatric surgery is currently being performed for some children, but only after they've stopped growing. See: Weight loss surgery in children

A child who is overweight or obese is more likely to be overweight or obese as an adult. Obese children are now developing health problems that used to be seen only in adults. When these problems begin in childhood, they often become more severe when the child becomes an adult.

Children with obesity are at risk for developing these health problems:

• High blood glucose (sugar) or diabetes
• High blood pressure (hypertension)
• High blood cholesterol and triglycerides (dyslipidemia or high blood fats)
• Heart attacks due to coronary heart disease, congestive heart failure, and stroke later in life
• Bone and joint problems -- more weight puts pressure on the bones and joints. This can lead to osteoarthritis, a disease that causes joint pain and stiffness.
• Stopping breathing during sleep (sleep apnea). This can cause daytime fatigue or sleepiness, poor attention, and problems at work.

Obese girls are more likely to not have regular menstrual periods.

Obese children often have low self-esteem. They are more likely to be teased or bullied, and they may have a hard time making friends.

United States Department of Agriculture. Dietary Guidelines for Americans, 2010. National Academy Press, Washington, DC, 2000.

Seagle HM, Strain GW, Makris A, Reeves RS; American Dietetic Association. Position of the American Dietetic Association: weight management. J Am Diet Assoc. 2009;109:330-346.

Pratt JS, Lenders CM, Dionne EA, Hoppin AG, Hsu GL, Inge TH, Lawlor DF, MarinoMF, Meyers AF, Rosenblum JL, Sanchez VM. Best practice updates for pediatric/adolescent weight loss surgery. Obesity (Silver Spring). 2009 May;17(5):901-10.

Review Date: 09/21/2011

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine.

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Child Obesity in the Classroom

One in three children are now obese. The epidemic affects every aspect of a child's life, and it is no different in school. Childhood obesity has been on the rise for decades and accommodations must be made for these children which can be seen in subtle and not-so-subtle ways.

Some schools are having to ditch the standard-sized school desk previous generations have grown up with for larger ones. Some are having to use chairs meant for older high school students in grade school classrooms so obese children can be more comfortable.

Furniture companies have seen an increase in sales of the larger student desks in the past five years. Sales have actually surpassed those of the standard desk of years past. For the casual observer, these desks may not look very different in size. However, there is as much as seven inches more room between the student and the desk while seated and an additional six inches of room for the student's legs.

Unfortunately, many obese students are unable to fit into the bigger desks as the chairs are attached and cannot be pushed back. To meet this challenge, many schools have gone to large desks with detached chairs so the students can adjust by moving the chair to accommodate them.

Even more disturbing is the old growth charts that track a child's development are becoming outdated due to the explosion in childhood obesity. Half of overweight kids will remain overweight throughout their development into adulthood.

One suggestion to help combat childhood obesity is to use elevated desks where students will have to stand while in the classroom. Sitting at a desk for up to seven hours a day can impact the health of all students. The human body is not equipped to deal with sitting for that long day after day.

One school on the east coast has implemented a novel way of teaching by having students walk around while learning. This has all but eliminated ADHD and obesity because students are always moving and are better focused on learning. This could be the wave of the future.

Childhood obesity affects both a child's health and ability to learn. Squeezing into small desks can be both humiliating and uncomfortable. Schools now are having to step up to help these kids with the right equipment for better comfort and more activity. It is a problem that can no longer be overlooked.

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