Along with smoking, diet, and stress, obesity is considered a major risk factor for serious medical conditions, including heart disease, stroke, diabetes, and cancer.
It’s an epidemic in America, and many other nations as well. Per current statistics, the United States has the 12th highest obesity rate in the world, at 36.2% (https://data.worldobesity.org/). China, India, and Japan are among the lowest, averaging around 21.9%.
In the U.S., according to the Centers for Disease Control (CDC), the obesity prevalence was 39.8% for adults aged 20 to 39 years, 44.3% among adults 40 to 59 years, and 41.5% among adults aged 60 and older. From 1999 through March 2020, the U.S. obesity prevalence increased from 30.5% to 41.9%.
Screening for obesity is typically based on body mass index, or BMI. Body Mass Index is the ratio of weight to height. A high BMI can indicate high body fat. To calculate your BMI, use the BMI calculator at www.smartbmicalculator.com, which accounts for age and gender, then see the findings, which can be underweight, healthy, overweight, or obese.
• A BMI less than 18.5 falls within the underweight range
• A BMI of 18.5 to <25 falls within the healthy weight range
• A BMI of 25.0 to <30 falls within the overweight range
• A BMI is 30.0 or higher falls within the obesity range
African American adults, at 49.9%, had the highest age-adjusted prevalence of obesity, followed by Hispanic adults (45.6%), non-Hispanic White adults (41.4%), and non-Hispanic Asian adults (16.1%).
In addition to its association with serious medical complications, the prevalence of obesity has a dramatic financial impact. According to the CDC, the estimated annual medical cost of obesity in the U.S. was nearly $173 billion dollars (based on 2019 data).
Obesity often begins in childhood, putting children and adolescents at risk for chronic health problems. Unfortunately, the prevalence of obesity among children and adolescents remains high. For children and adolescents aged 2-19, from 2017-2020, the prevalence of obesity was 19.7%, affecting about 14.7 million children and adolescents. Obesity-related conditions in children include high blood pressure, high cholesterol, type-2 diabetes, asthma, and sleep apnea.
According to CDC.gov, men and women with college degrees had lower obesity prevalence compared to those with less education. These statistics indicate a high correlation between obesity and formal education.
Managing the Epidemic
Whether you are obese or overweight, there is no simple solution, and it’s a certainty that every person will require a plan targeted to their needs. For some individuals, an established and reputable diet plan like Weight Watchers may be sufficient, while others may require medical supervision, especially when managing other comorbidities, such as cardiac disease or diabetes. Getting educated on the serious effects of obesity is a good place to start.
Experts recommend a progression of interactions to treat and manage unhealthy weight gain and obesity. The recommended progression is:
1. Diet and exercise
2. Medical evaluation, possible drug regimen, and/or behavioral health counselling
3. Bariatric surgery
For many people, a commitment to diet and exercise, over a prolonged period, such as six months to a year, may be sufficient. If that’s not successful, a full medical exam by your physician may be indicated to rule out any metabolic or endocrinologic conditions. Your physician will likely review your weight history, physical activity, eating patterns, and other health conditions. In addition to taking your BMI, measuring the circumference of your waist helps assess visceral fat, which can increase the risk of heart disease and diabetes.
You may be referred to other health professionals, including a dietitian, counsellor, and an obesity specialist. A mental health specialist is important to help identify unhealthy eating habits that may be rooted in a psychological or lifestyle issue. Depending on where you reside, there are specialty centers where you can access all the professionals dedicated to weight loss under one roof.
Finally, you may require weight-loss medications and, if necessary, bariatric surgery. Current procedures include gastric bypass, sleeve gastrectomy, and biliopancreatic diversion. Most experts prefer to exhaust all the non-surgical options first, due to the inherent risks of surgery. In addition, there are minimally invasive Endoscopic Procedures that can aid weight loss.
The Messenger reached out to Mandi Li, a Dietitian and the Clinical Nutrition Manager at St. Catherine of Siena Hospital, in Smithtown. Ms. Li and the other dietitians meet with as many admitted patients as possible to assess their dietary needs in accordance with their medical history. Obesity is one of the medical concerns that can be addressed nutritionally, although Ms. Li pointed out the hospital emphasizes a multi-disciplinary approach to obesity, as well as other medical conditions. Diets can also be tailored to address fat, salt, as well as calories.
Dr. Nirav Desai is the Director of Bariatric Surgery at St. Catherine of Siena Hospital. Dr. Desai agreed that a commitment to diet and exercise is a good place to start. However, for many people, “a medically supervised program, including a team approach, possible drug therapy, and timely follow up care may be necessary.”
Dr. Desai also pointed out it’s important to see a physician who specializes in the treatment of obesity, as these physicians are certified by the American Board of Obesity Medicine. While Dr. Desai feels the newer obesity drugs show promise, researchers are still collecting data to study the long-term effects. Patients typically remain on a drug regimen indefinitely, or risk regaining the weight they’ve lost. Therefore, it’s important to study the long-term effects, says Dr. Desai. Meanwhile, patients should continue their commitment to a healthy lifestyle, including diet and exercise.
There is some anecdotal evidence to suggest people are simply too busy to eat healthily. When discussing this issue, Ms. Li emphasized that preparing simple, yet healthy, home-cooked meals need not be time-consuming.
“It’s a great way for families to spend time together, with each family member contributing,” stated Li.
Li also emphasized the need to consume sufficient vegetables, recommending three cups per day.
Around the globe, some countries focus their resources on children, knowing that the link between childhood obesity and adult obesity is very strong, and it’s easier for children to lose weight and adapt to a healthy lifestyle, than for adults. For example, in France, an intervention program was rolled out nationally which involves free dietary, psychological, and physical activity for three to 12-year-olds at risk for obesity. France will now study the effectiveness of the program, which was rolled out last year.
Other nations are also making progress with children. In 2019, the World Economic Forum found that Japan had fewer overweight children than any other developed nation, “in part due to healthy school lunches.” All school lunches are dietitian-supervised in Japan, an initiative it adopted a few years back.
There is no question that weight gain and obesity remain serious health issues in the U.S., including in children. Being overweight or obese poses a risk of other serious medical conditions, including stroke, diabetes, joint pain, and cancer. There are multiple medical specialists who are dedicated to helping overweight patients, but people must be willing and motivated to comply over the long haul.
It’s a “lifestyle commitment,” emphasized both Desai and Li.
Always consult your healthcare professional before starting any program or treatment on your own.