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Clinical Definition of Obesity

morbid obesity defintion, obesity definition bmi

Obesity has been recently recognized as a disease by the American Medical Association. Obesity and health problems go hand in hand and as such, they appear to be a number of different health risks that are associated with being obese. A typical clinical definition of obesity does not exist but has been defined by different groups in a number of different ways. In this article, we should take a brief look at what the clinical definition of obesity is and what the associated health problems are.

What is the definition of obesity?

The word ‘obesity’ is a term that is widely utilised to describe an individual who has a weight over and above what is considered to be normal for that age and sex. There are different ways of classifying obesity but primarily it is done so through a measure known as the ‘body mass index’, also called ‘BMI’. The BMI is measured using the weight and height of the individual and is charted against what is considered to be normal as per the laid out standards.

In Caucasian populations, a BMI that lies between 18.5 and 24.9 is considered to be healthy body weight. According to the Centres for Disease Control and Prevention, a BMI of over 25 is classed as overweight and over 30 is classed as obese. Individuals with a BMI of over 40 are classed as being morbidly obese.

Obesity and health problems

The health risks of obesity are many. A variety of symptoms can occur from obesity affecting different vital organs. For example, obese individuals are at a higher risk of developing cardiovascular diseases such as heart attacks and strokes. Joint pains such as knee problems, hip problems and back problems are extremely common. Obese individuals can develop skin problems such as acne as well.

Morbid obesity is associated with more problems than just what obese people experience. Other than cardiovascular disease, the inability to mobilize because of the body weight can result in a further increase in body weight, ultimately making the individual completely sedentary and dependent on others. Type II diabetes is a well-recognized clinical condition that accompanies obesity. In women, breast cancer incidence can increase in obese patients.

Due to an alteration in the quality of life of obese individuals, they could develop psychological problems such as high-stress levels and depression. Some clinical reports have suggested an increased incidence of bowel cancer as well. Carrying a great deal of weight around can cause a degree of breathlessness as well. Clinical conditions such as excessive snoring and sleep apnoea are well recognized as health problems associated with obesity.

How to Treat Obesity

“Obesity is a well recognized public health problem that affects millions of Americans. It is accompanied by a number of different clinical illnesses such as cardiovascular disease, diabetes, high blood pressure, joint pains and stroke, to name but a few conditions.”

The Obesity Problem in America
The American obesity problem is huge, with over 34% of individuals in the United States falling into the obese category, according to the Centers for Disease Control and Prevention. This has a significant impact on health care expenditure, running into billions of dollars.

The CDC estimates that over $147 billion was spent on treating and managing obese patients in the year 2008, and with the rising incidence, this amount is only likely to get bigger. Typically individuals between the ages of 40 and 60 tend to have a higher incidence, and non-hispanic blacks tend to be the most obese.

But obesity is not just a problem associated with adults. Childhood obesity is a rising concern, with nearly 17% of children i.e. 12.5 million children and adolescents aged between 2 to 19 years classed as obese. Clearly, these numbers are of concern and measures have to be taken to try and control obesity. Obesity guidelines do not exist per se but measures are now in place to target obesity and weight loss.

Obesity Treatment

Obesity is a public health problem that has been recently recognized as a disease by the American Medical Association. The treatment options for obesity are vast and include a variety of different approaches.  Another medical association, the IAPAM, has seen physicians struggle to find a weight loss program that actually works and therefore added a medically supervised weight loss training program to help healthcare providers offer an effective solution to their patients.

General approach
A good first step in controlling obesity is to calculate your body mass index. If your body mass index lies above 25, then you may be either overweight or obese. Once an individual has calculated his/her body mass index, steps can be taken to try and reduce the weight if it falls above 25.

The primary strategies to control obesity include diet and exercise. Reducing overall calorie intake and burning more calories than what is consumed can help bring down the weight.

Reducing carbohydrate intake and fat intake is also strongly recommended. A diet rich in fresh fruits and vegetables and lean meat is extremely beneficial.

Any form of exercise must be run past a registered medical practitioner before an individual commences a new program…just to ensure that it is safe for them to do so.

In a large number of cases, the above treatments for obesity tend not to work and patients require additional interventions. Weight loss programs are useful and can be tailor-made to the individual based on his or her needs. Many individuals prefer to join a gym and hire a personal trainer to encourage them towards reaching their goals. Some people prefer to have a friend or partner to join them in their weight loss journey.

Drug therapy
In some patients, despite their best efforts to lose weight through diet and exercise, weight loss can be an impossible task. Medications and surgical treatments are now available. Obesity medications commonly used include Orlistat and Lorcaserin. Topiramate has also been used with some success in adults. The choice of medication depends upon the individual requirements and the degree of obesity.

While patients may lose a small amount of body weight, it appears that stopping the drug can immediately result in weight gain yet again. Furthermore, drugs are associated with side-effects and this must be borne in mind before treatment is commenced. As such, there are no clear obesity treatment guidelines when it comes to pharmacological treatment.

Exercise
It is strongly recommended that all patients who wish to embark on an exercise program for weight loss must get themselves checked out by the physician’s first for the presence of any underlying medical conditions.

“Once they have been given the all-clear, aerobic exercises of moderate intensity are recommended.”

As such, isotonic exercise appears to be the most beneficial and performing at least 60 minutes of exercise three to five times a week can help bring down the bodyweight effectively. Weight training does not appear to be particularly effective.

Behavioral modification
When it comes to different strategies on how to treat obesity, behavioral modification can play a rather important role. Altering the way an individual manages their day-to-day activities can be the difference between weight loss and weight gain. For example, individuals who do not get enough sleep tend to be overweight compared to those who get a good night’s rest every night.

Surgical treatments
Surgical treatment is offered primarily as a morbid obesity treatment. In individuals who have failed to lose weight despite diet and exercise, Gastric banding surgery, sleeve resectomy and gastric bypass operations have been offered to patients with a great deal of success. However, this is not in any way the solution to control obesity and is, in fact, a treatment offered in extreme cases only following detailed clinical examination and diet and exercise plan reviews.

Obesity and Health Problems

The health risks of obesity are many. A variety of symptoms can occur from obesity affecting different vital organs. For example, obese individuals are at a higher risk of developing a cardiovascular disease such as heart attacks and strokes. Joint pains such as knee problems, hip problems and back problems are extremely common. Obese individuals can develop skin problems such as acne as well.

Morbid obesity is associated with additional problems. Other than cardiovascular disease, the inability to mobilize because of the bodyweight can result in further increases in body weight, ultimately making the individual completely sedentary and dependent on others. Type II diabetes is a well-recognized clinical condition that accompanies obesity. In women, breast cancer incidence can increase in obese patients.

Due to an alteration in the quality of life of obese individuals, they could develop psychological problems such as high-stress levels and depression. Some clinical reports have suggested an increased incidence of bowel cancer as well. Carrying a great deal of weight around can cause a degree of breathlessness as well. Clinical conditions such as excessive snoring and sleep apnoea are well recognized as health problems associated with obesity.

Is Obesity a Disease?

A recent panel of the American Medical Association recognized obesity as a disease, which may not sound like much to the lay public, but actually has a string of advantages. Firstly, recognizing obesity as a disease now means that a great deal of focus will now be paid towards managing the condition. Higher scientific research grants may now be offered to look at finding a complete cure. Given the high incidence of diseases from obesity such as diabetes mellitus, this would translate into increased research in the etiology and connection between obesity and these conditions.

But the question remains – is obesity a disease? There are times when obesity does result from negligent food habits and an unhealthy lifestyle. People who are fully aware of the harms of consuming junk foods and foods high in saturated fats continue to do so, and this over time results in one becoming obese. Calling such individuals as suffering from disease would be ethically and morally wrong. On the other hand, those with genetic obesity, calling obesity a disease can have certain advantages.

Advantages
It is likely that now that obesity is a disease, the approach to its management will be changed. From a doctor’s point of view, treatment options will now need to be explored and rather than just offer advice about weight loss, more active strategies such as pharmacological therapy and even surgical treatments will be offered to patients sooner rather than later.

Tied in with this, insurance companies may now take into account that obesity is a disease and might require covering if a patient requires surgical intervention (i.e. weight loss surgery). This previously had been removed from the Medicare list which could probably now change. From a patient’s point of view, the fact that obesity is a disease may create a need to get treatment for it. Exercise plans and diets may be taken a little more seriously.

Of course, this new designation has not been without opposition. Many believe that calling obesity a disease could cause a degree of social stigma to it, which may be detrimental to a patient’s mental well being. Others state that by calling obesity a disease, a large proportion of the American population would be considered to have a new disease. What impact this could have on the healthcare system is unpredictable.

The Financial Cost of Obesity

The costs of obesity can be classified into a number of different aspects.

1. Direct medical costs

These costs are the ones that occur due to the multitude of health problems that accompany obesity. This includes, and is not limited to, heart disease, diabetes, hypertension and stroke. The costs are incurred not just from the treatment of these conditions, but also from the various investigations that are needed to reach a diagnosis. Studies have shown that a one-unit increase in BMI increases the overall cost of care by nearly 2%1. In fact, the overall increase in cost incurred is almost 20% when compared to healthy individuals2.  The estimated costs from cohort studies reveal in excess cost of $53 million over 25 years, which is no doubt significant. However, it is believed that some of this cost may be offset by the fact that the various illnesses can result in early mortality.

2. Additional transportation costs

The increase in body weight would increase the fuel expenses, as the added weight would increase fuel consumption. In addition, overweight people may require larger vehicles for transportation, and many of these are gas guzzlers. But the added costs have not just affected cars and motor vehicles. Airlines also require a large amount of fuel, with the additional costs going up by millions of dollars in the last few years.

3. Productivity costs

Due to the various health problems that accompany obesity, individuals may take more sick days from work. Research has confirmed this, with links established between high rates of absenteeism from work and obesity. The contrary also has a negative effect – being present at work and being obese can result in reduced productivity as well. Finally, costs such as disability allowances and payments are also high, adding to the costs.

Conclusion

The obesity definition is not well carved out but is dependent on an individual’s height and weight and their calculated BMI. Unfortunately, obesity is associated with a number of different health risks and steps must be taken to keep the bodyweight under control. Obesity costs are increased due to a number of reasons. Clearly, it is time to tackle this problem head-on so that valuable resources can be redirected to other causes.

 

Reference
Relationship between modifiable health risks and short-term health care charges. Pronk NP, Goodman MJ, O’Connor PJ, Martinson BC JAMA. 1999 Dec 15; 282(23):2235-9.
Body mass index and future healthcare costs: a retrospective cohort study. Thompson D, Brown JB, Nichols GA, Elmer PJ, Oster G Obes Res. 2001 Mar; 9(3):210-8.
https://www.cdc.gov/obesity/adult/defining.html