Obesity Epidemic

Despite increased awareness of obesity in recent years, the number of those diagnosed with this disease continues to rise in both the U.S. and worldwide. Around 70% of the U.S. population is currently considered either overweight or obese. Obesity is classified by a person’s body mass index (BMI), the value derived from the mass and height of an individual. Nearly 30% of the population is considered overweight, meaning their BMI is above 24 and below 29.9. Those categorized as obese have a BMI of more than 29.9 and account for 40% of the population. High rates of inactivity, easy access to high calorie-dense food, and changes in behavior all contribute to this growing trend.

“The greatest challenge as a primary care provider often comes when consulting patients,” said family medicine physician, Ebtehal Abdelaal, MD, of TPMG Peninsula Medical Associates. “Oftentimes, patients say they are not ready to discuss the issue, and we’re unable to help resolve some of the underlying medical conditions associated with obesity.”

5A’s Model

Health care professionals use the 5A’s model as a framework to guide the conversation on obesity management.

• Ask permission to discuss weight
• Assess the class and stage, drivers, complications, and barriers
• Advise on risks, explain benefits, discuss treatment options
• Agree on weight-loss expectations, agree on a treatment plan
• Assist by providing education and resources

Overview

The World Health Organization defines obesity as “abnormal or excessive fat accumulation that presents a risk to health.”  Although the public’s perception is shifting, many still assume obesity is an individual’s fault for overeating and moving too little. However, in 2013, the American Medical Association (AMA) recognized obesity as a disease caused by genetics, nutrition, hormones, environment, and other factors.

Contributing Factors:

• Genetics – Studies suggest genetics contribute to 40-70% of obesity in individuals.
• Nutrition – Not all calories are created equal, refined carbohydrates, unhealthy saturated fats, and high caloric fast food have heavily impacted obesity levels.
• Hormones – Insulin resistance, which causes the body to process sugar improperly, has led to obesity.
• Medication – Some prescription medications are associated with weight gain, including antidepressants, steroids, antipsychotics, epilepsy medications, and blood pressure medications.

Medical Conditions Associated with Obesity

As weight goes up, so does the risk for many severe health conditions, including diabetes, high blood pressure, heart disease, sleep apnea, and 232 other comorbidities. Over 85% of individuals with Type 2 diabetes also suffer from obesity. According to the Obesity Medicine Association, an increase in body fat affects lipid levels and blood pressure. With higher blood pressure, the heart has to pump harder. Over time, the heart muscle thickens, increasing the risk of heart failure.

According to the American Academy of Sleep Medicine, it is estimated that 26% of Americans between the ages of 30 and 70 have sleep apnea, most likely due to the obesity epidemic. Common signs include snoring and choking, gasping for breath, or breathing pauses during sleep. By losing at least 10% of your overall body weight, you can improve obstructive sleep apnea and improve other chronic conditions associated with obesity. Additionally, mortality rates increase by 30% for every 1 BMI increase. For those who are at 45 BMI, the median survival decreases by 7-10 years. If you add smoking, that’s 13-14 years fewer.

Prevention

Regardless of the number on the scale, improving your weight can help you start living a healthier lifestyle. Obesity prevention and weight management can be achieved by taking a few simple measures.

Dietary Modifications:

• Don’t drink your calories: soda and other sugar-sweetened drinks have been linked to obesity and Type 2 diabetes.
• Use smaller plates: this helps control portion size and curb overeating.
• Eat more fruits and vegetables: the recommended amount is 5-8 servings. By filling half your plate with vegetables and fruit, you can increase your daily intake and cut back on higher-calorie food.
• Drink more water: having a glass of water before a meal may help you feel more satisfied.
• Enjoy your food: eat without distractions such as watching TV, reading a book, or using your phone and computer. Your environment plays a massive role in how much you eat.
• Limit eating out: these foods are often filled with extra sodium, saturated fats, and sugar.
• Modify how you cook food: bake, steam, or poach food for a healthier option than frying.

Activity Modifications:

• Increased physical activity improves a person’s total energy expenditure, as long as you don’t eat more to compensate for the extra calories burned.
• Break a sweat for at least 30 minutes or more a day. Breaking a sweat may include walking a mile, weeding the garden, going on a bike ride, or going up and down a few flights of stairs.
• Weightlift a few times a week. Muscle-strengthening activities build muscle mass, increasing the energy the body burns throughout the day.
• Find an activity to do with a friend. This activity can be a Zumba class, jogging, swimming, or team sport you can play once a week. By having a friend, you’re more accountable for that activity.

Benefits

According to the CDC, modest weight loss, as few as five to 10% of your total body weight can produce significant improvements in blood pressure, blood cholesterol, and blood sugars. This includes an increase in “HDL cholesterol,” otherwise known as good cholesterol, by five points, lowering the risk of developing heart disease. Another condition seen with weight gain is insulin resistance, where the pancreas produces larger than normal levels of the hormone, insulin. According to the Obesity Action Coalition, modest weight-loss was found to decrease insulin levels and helping to reverse this condition.

Successful weight loss strategies include realistic and sustainable goals. Obesity management is more than reducing the number on the scale, but improvements in overall health. Navigating the best way to shed the pounds can be challenging, but your primary care provider can help you discover the best weight loss options.