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Obesity

The definition of overweight and obesity

Medical scientists and policy makers around the world have produced a number of different ways in which to measure bodies and Obesity assess risks to health among those people who are carrying more weight than usual. If people are considered "at risk", they can be advised to eat a more healthy diet, exercise more and use medications such as phentermine to reduce their weight. The international standard is called the Body Mass Index (BMI). This is a number calculated from a person's weight and height to indicate the degree of "fatness" in that person

The BMI is not intended as a direct measure of body fat, but is an inexpensive and easy-to-perform method of screening for weight categories that may lead to health problems. It is not a diagnostic tool — physical measuring devices and procedures are used to assess an individual’s weight. Even though someone may have a high BMI, a physician would have to review the individual's medical history and perform detailed tests to decide whether the excessive weight is a health risk. If risks are found, the physician will usually prescribe phentermine or an equivalent to help the patient reduce the level of danger to his or her health.

The role of the BMI is often misunderstood. Consequently, people classified as “fat” are often resentful or hurt. They feel they have been wrongly classified and attack the validity of the system. They point to the facts that:

• the BMI results change with age — what may appear excessive in a growing child may become a "normal" weight as adulthood approaches;
• older people may accumulate more weight than young adults;
• the age profile of weight distribution changes depending on whether it is applied to men or women — treating both the same in a single index can appear to give unfair results particularly because shorter women will always be given a higher BMI than taller women (or men);
• there are racial and ethnic characteristics that may affect the body's composition; and
• athletes may train and achieve higher BMIs, but they will not be "fat" in the clinical sense.

For all the potential difficulties, the BMI is used by the World Health Organisation (WHO)1 and national organisations to classify individuals at risk. Adults with a BMI of 25 or more are considered "overweight". A BMI of 30 or more is considered "obese". The formula is:

(weight in pounds / height in inches2) x 703
So if you weigh 160lb and are 5'6" (66") tall
Calculation: (160/662) x 703 = 25.82

An alternative way of assessing risk is to arrive at an average (or ideal) body weight for age by gender. A person is considered obese if his or her weight is at least 20% more than his or her ideal weight. An excess of weight between 20 - 40% is considered mildly obese, and in the range 40 - 100% moderately obese. Anything more than 100% would be severe or morbid, being likely to cause death. Unfortunately, there is no international agreement on a scale of "ideal" weights.

Obesity often leads to Diabetes

The are a number of studies demonstrating a direct link between obesity and the onset of Type 2 Diabetes in both adults and children. In this form of Diabetes, the body continues to produce insulin, but the body becomes resistant to it and does not use it effectively to prevent blood glucose levels from rising. Although the precise cause and effect of the relationship remains unclear, about 80% of those diagnosed with Type 2 Diabetes are obese. There are three theories, namely that:

• the lipid metabolism changes to prevent the insulin receptors in cells from responding to the insulin;
• an increase in tumor necrosis factor-a (TNF-a) circulating in the blood stream may contribute to insulin resistance in patients with Type 2 Diabetes and interferes with intracellular signalling in insulin-responsive cells2 ;
• adipose tissue, first thought only to be a storage system, is actually a more active system. There is now active research to determine whether adiponectin and other adipocytokines account for the relationship between fat and diabetes3. The adipose tissue appears to be acting as a kind of endocrine gland, releasing hormones and other signalling molecules (adipocytokines) which may disrupt the response to insulin, particularly in older patients4.

To help reduce the threat of Diabetes, physicians will usually prescribe phentermine in conjunction with a change to diet and the introduction of physical exercise. There are many studies that show even a small reduction in weight (usually between 10 and 20 pounds depending on the starting weight) can significant reduce the likelihood of late onset Diabetes.

Problems due to obesity

Ignoring the physical problems of finding clothes to fit and chairs that are comfortable to sit in, and the social problems of stigmatisation and discrimination, people who are or overweight or obese are more likely to develop non-fatal, but debilitating health problems:

• skin problems;
• dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
• osteoarthritis and other chronic musculoskeletal problems;
• sleep apnoea and respiratory problems; and
• infertility.

The more life-threatening problems fall into the following areas:

• the cardiovascular diseases including hypertension, stroke and coronary heart disease;
• Type 2 Diabetes;
• fatty liver disease
• certain types of cancers, especially the hormonally related endometrial and breast, and cancers of the colon and large bowel; and
• gallbladder disease.

The greater the excess of weight, the more likely it is that health problems will occur. Weight loss of not less than 5% reduces the chances of developing these health problems. Among children there is an increased risk of contracting the diseases usually seen in adulthood. It also can cause psychological distress through bullying, damaging self-confidence and self-esteem, and leading to isolation and depression. Although phentermine has a good track record of promoting weight loss in adults, it cannot be prescribed for children under the age of sixteen years. Different approaches are required to help children lose weight.

Obesity tougher on men

A recent study5 finds that men who are obese are less efficient than comparable women in processing carbohydrates. The inability to metabolise the sugar found in carbohydrates is associated with a build up of fat deposits on muscle tissue. This is the first step to gaining weight and, eventually, impairs physical endurance. If not remedied, it can result in a drop in fitness levels and the onset of metabolic disorders. The results emerge from the pre-surgery screening of individuals with a BMI in excess of 40, due to have bariatric surgery: 59% of men had Diabetes or were carbohydrate intolerant, as compared to 35% of women. Decreased physical fitness may indicate the presence of metabolic syndrome and make bariatric surgery more necessary. But, in tests to ensure sufficient fitness to sustain an anaesthetic, women performed better on exercise endurance and related lung capacity tests. The authors of the study point to the difference in the distribution of fat. Men tend to deposit more fat on the upper body, whereas women tend to deposit more fat on the lower body. As a result, men may have less usable lung capacity, and so experience more difficulty in breathing.

Even though the study quoted refers to people with a high BMI, the general principle applies to any man classified as “obese” on the BMI scale and physicians will usually advise the use of phentermine or an equivalent in conjunction with better eating habits and some physical exercise, to reduce the adverse effects from any weight considered excessive.

1. World Health Organisation. Preventing and Managing the Global Epidemic of Obesity. Report of the World Health Organisation Consultation of Obesity. WHO, Geneva, June 1997.

2. Engebretson S, Chertog R, Nichols A, Hey-Hadavi J, Celenti R, Grbic J. Plasma levels of tumour necrosis factor-a in patients with chronic periodontitis and type 2 diabetes. J Clin Periodontol 2007; 34: 18–24.

3. Alka M. Kanaya, MD; Christina Wassel Fyr, MS; Eric Vittinghoff, PhD; Tamara B. Harris, MD; Seok Won Park, PhD; Bret H. Goodpaster, PhD; Fran Tylavsky, PhD; Steven R. Cummings, MD. Adipocytokines and Incident Diabetes Mellitus in Older Adults. Arch Intern Med. 2006;166:350-356.

4. A M. Kanaya; T Harris; B H. Goodpaster; F Tylavsky; S R. Cummings. Adipocytokines attenuate the association between visceral adiposity and diabetes in older adults. Diabetes Care, Vol. 27, 2004; 1375-1380.

5. Jacqueline G. Dolfing; Emile F. Dubois; Bruce H.R. Wolffenbuttel; Nienke M. ten Hoor-Aukema; Dave H. Schweitzer. Different Cycle Ergometer Outcomes in Severely Obese Men and Women Without Documented Cardiopulmonary Morbidities Before Bariatric Surgery. Chest, Jul 2005; 128: 256 – 262