Obesity

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An individual who is overweight is generally defined as having more body fat than is healthy for optimum well being. 

Overview

The most common measure of fat percentage within the body is body mass index (BMI). Obesity is defined by an excess of total body fat which is 20 per cent or more above normal weight. In BMI terms a person is considered as obese if their BMI is between 30 and 39.9. Anything above this is classed as morbidly obese, which means the percentage of fat in the body can significantly interfere with health and everyday functioning.

According to figures taken from the 2002 Health Survey for England and the 2004 Health Select Committee Report on Obesity, back in 1980 only 6 per cent of men and 8 per cent of women were classed as obese. Since then the UK obesity rate has grown at an alarming pace, and in 2002 22.1 per cent of men and 22.8 per cent of women were recorded as being obese and 43.4 per cent of men and 33.7 per cent of women were recorded as being overweight.

Being overweight or obese increases a persons chances of developing various health concerns over time such as heart disease, high blood pressure, high cholesterol, type 2 diabetes and psychological issues and can result in a reduction in overall life expectancy.

Despite current headlines focussing heavily on the nation becoming unhealthier, there is mounting evidence showing that whilst a larger number of us are becoming overweight, the number of people meeting the guideline on physical activity and eating the recommended five portions of fruit and vegetables a day is also on the rise. This clear effort in many individuals to lead healthier and more active lifestyles is a small but positive step in the right direction and perhaps an indication that awareness of the current obesity crisis is growing.

Am I overweight or obese?

What is BMI?

As discussed in the above, one of the most accurate methods of checking if you lie within a healthy weight range is to calculate your BMI. Though weighing yourself is a good method of tracking your weight, generally scales do not take into account your height or your build and thus will not be able to determine whether your weight is healthy.

BMI is used by healthcare professionals to assess the weight of patients against their height to check if a persons percentage of body fat is putting them at risk. If you own scales and know your height then calculating your BMI is a simple process which you can work out yourself using a simple formula. Alternatively there are plenty of online BMI calculators which will do the hard work for you and If you don't have a set of scales at home then your practice nurse will be able weigh you, measure your height, and calculate your BMI.

Though BMI is an accurate measurement of body fat in most cases, it is important to note that because muscle weighs more than fat, someone who is extremely fit, healthy and muscular may find their BMI is very high when in actual fact they have a proportionally low and healthy percentage of body fat.

Waist circumference

Measuring your waist circumference may help you to gain a further insight into your weight because individuals who carry excess fat around their waist as opposed to on the hips and thighs are at a greater risk of developing certain health problems.

The simplest way of measuring your waist is to place a tape measure around your body at belly button level. Once you have your measurement you can use the following rules to help interpret them:

Men

  • A waist measurement of 94cm or above poses an increased risk to health.
  • A waist measurement of 102cm or above poses an even higher risk to health.

Women

  • A waist measurement of 80cm or above poses an increased risk to health.
  • A waist measurement of 88cm or above poses an even higher risk to health.

Is my weight already impacting my health?

If you have established that you are overweight or obese then your first port of call should be your doctor or practice nurse so they can ascertain whether or not your weight has already started to affect your health.

At this stage they may start by asking about any symptoms of coronary heart disease, osteoarthritis and sleep apnea etc before moving on to screen for any health problems which may be linked to your weight. Tests may include a blood pressure check and blood tests to establish type 2 diabetes, high blood pressure, cholesterol levels, thyroid or liver problems.

In addition to the physical issues caused by excess weight, many people are also affected on a psychological level. Self image plays a hugely important role in our confidence and self esteem levels and ultimately in our over all sense of mental well-being. It is not uncommon for individuals who are overweight or obese to develop mental health issues and it is for this reason your doctor or nurse may ask questions to see if there are any signs of these.

Health risks

If you are overweight or obese this means that over time you will have an increased risk of developing a range of different health problems. In addition to this you may also find it is a struggle to carry out certain basic activities which should be manageable but instead cause either some or all of the following side effects:

  • excess sweating
  • joint pain which affects mobility
  • skin irritations
  • snoring
  • tiredness and a lack of energy
  • problem breathing including inability to run short distances and shortness of breath when moving around
  • problem sleeping.

Individuals who are overweight or obese also have an increased risk of developing the following health concerns:

Coronary heart disease

This condition see's a build-up of fatty substance in the coronary arteries which blocks or slows the heart's blood supply. Over time an increase in build up of fatty deposits within the arteries will mean that they are narrowed, resulting in blood flow to the heart either slowing down or stopping, sometimes leading to angina or a heart attack.

High Blood Pressure

Overweight and obese individuals both carry more body fat, meaning there are a high number of fatty molecules in the blood vessels. These fats will constrict the vessels meaning that the heart will struggle to push the blood through them. As your blood moves through your arteries, it puts pressure onto their walls and this is what determines your blood pressure. High blood pressure is when your blood moves through the arteries at a higher pressure than normal resulting in the heart having to work harder to pump larger amounts of blood and to push the blood through the vessels.

High cholesterol or triglyceride levels

Cholesterol and triglycerides are two different types of lipids that circulate in your blood. Cholesterol helps to maintain your cells and certain hormones, whilst triglycerides store any unused calories and provide energy to the body.

Both cholesterol and triglyceride's are essential in order for the body to function. However, when the blood levels of either become elevated, the risk of developing cardiovascular disease is significantly increased.

High levels of LDL cholesterol (otherwise known as bad cholesterol) have been linked to an increased risk of both heart attacks and stroke. It is thought that this risk is caused by LDL lipoprotein sticking to the lining of blood vessels which stimulates atherosclerosis (fatty material collecting along the artery walls).

Sleep apnoea

This condition is closely linked to being overweight and is characterised by the walls of the throat coming together during sleep and blocking off the upper airway. This results in the breathing of the individual stopping for a short period of time until the brain recognises the oxygen deficiency and sends a wake up call. This issue is particularly common in overweight and obese people because weight gain can lead to the narrowing of the upper airways. Weight loss will ultimately help to reverse this risk.

Type 2 diabetes

This condition is caused by fat, liver and muscle cells not responding properly to insulin which means that blood sugar is unable to get into cells to be stored for energy. When the sugar is unable to enter the cells this results in an large build up of sugar in the blood, an effect known as hyperglycaemia. High blood sugar can trigger the pancreas to produce more insulin but this will not be enough to meet the demands of the body. Type 2 diabetes is more common among those who are overweight and obese, because fat prohibits the body's ability to use insulin.

Some individuals will display no obvious symptoms, others may experience blurred vision, erectile dysfunction, increased urination, fatigue and increased thirst and appetite.

Other

Being overweight or obese has also been linked to an increased risk of the following – cancer (colon, breast and womb), fatty liver, fertility issues, gallstones, gout, impaired glucose tolerance (pre-diabetes), pregnancy issues, stress incontinence, stroke and overall life expectancy.

In addition to standing an increased risk of developing physical ill health, overweight and obese individuals may also face a range of psychological problems.

Self-esteem, self-confidence and self-image often suffer fatal blows when individuals either gain weight or have been overweight for a period of time. In turn this can lead to a decreased quality of life, reduced social mobility and feeling as though they are not socially accepted. Commonly overweight and obese people feel hopelessness, anger, isolation and boredom which not only can result in further over eating for comfort, but also can lead to serious mental health concerns such as anxiety and depression.

The best chance of reducing the increased health risks featured above is to lose weight and keep the weight off.

What are the causes of being overweight and obese?

Though there are of course additional factors, simply put your weight is determined by how much energy you absorb from the calories in food and drink, and how much of it is used by the body. This process will lead to one of three scenarios:

  1. If the amount of calories consumed is equal to the amount of calories burned, your weight will remain stable.
  2. If the amount of calories consumed is more than your body is able to burn, the excess will be converted to fat and stored in the body resulting in weight gain.
  3. If the amount of calories consumed are fewer than you burn, your body will have to revert to using your fat stores to obtain the extra energy. This will result in weight loss.

Your metabolic rate is the amount of energy or calories your body needs to burn in order to carry out its vital functions. There is a common misconception that overweight and and obese individuals have a low metabolic rate, when in actual fact those who are overweight or obese more often than not have a normal to high metabolic rate as more energy is used to carry the extra fat.

Listed below are the various reasons as to why the amount of energy consumed may not balance evenly with the amount of energy used, possibly leading to weight gain:

Food and drink

One of the primary and most obvious reasons people gain weight is because they eat and drink more than their body needs.

When we are eating food our body does attempt to send signals which indicate it has had enough, though this feeling can be easily ignored if we are in the midst of eating something tasty.

Recent decades have seen the arrival of numerous processed foods and ready meals on the supermarket shelves, many of which are far more calorie laden than a meal cooked from scratch using fresh produce. In addition, special offers and discount vouchers for eating out also mean that many individuals are eating out far more regularly than ever before, again resulting in the consumption of calorie heavy meals.

Drinks are also often not taken into consideration when it comes to daily calorie intake, with many individuals consuming sugar laden fizzy drinks, fruit juices and hot drinks with added sugar throughout the day. Alcohol also contains a lot of calories and can make up a significant proportion of your daily calorie intake if you drink too much.

Physical activity

The World Health Organisation's Global Recommendations on Physical Activity for Health suggest that adults aged between 18-64 should do at least 150 minutes of moderate intensity aerobic physical activity per week, or at least 75 minutes of vigorous intensity aerobic physical activity each week. Though it would be ideal to manage that amount of exercise each week, the unfortunate reality is that many people are either too busy or unwilling to incorporate it into their daily routines.

An increase in labour-saving devices, technology and cars etc also mean that as a generation we are far less active than those before us.

Physical activity helps us to burn off any unused energy which will not only help us to maintain a healthy weight but also to keep our bodies in optimum condition.

Genetics

Though it is not yet fully understood how genetics are a contributing factor to obesity, it has been found that those with either one or both obese parents stand a higher risk of becoming obese themselves.

This could be partly attributed to children picking up unhealthy eating habits from their parents but it is thought that certain individuals do inherit a tendency to overeat which is thought to have something to do with appetite control. When we eat food, our brain will send a signal to let us know when we have had enough. However, for some people appetite control may not be as good as it is in others.

Medical problems

There are very few individuals out there who can attribute their weight to a medical cause. In women, polycystic ovary syndrome can result weight gain as can rare cases of cushing's syndrome and an under active thyroid. Some individuals may also find that medication for a health concern is causing them to put on weight.

Benefits of losing weight

If you are overweight or obese then you will experience huge benefits from losing weight. Even a modest amount of weight loss can help to reduce the risk of certain health issues as well as helping to improve energy levels, self-esteem and general quality of life.

According to Patient UK, an individual with a BMI between 25 and 35 can experience a myriad of health benefits from losing 5-10 per cent of their original weight. In doing this, those who suffer from high blood pressure, high cholesterol, diabetes and other weight related conditions are likely to see an improvement, and those who are not affected by problems such as these will be less likely to develop them.

Individuals with a BMI over 35 are already likely to be affected by health problems related to their weight and in these cases it is recommended that individuals try to lose between 15 and 20 per cent of their weight in order to experience the optimum level of improvement.

Treatment options

If you are committed to losing weight then you first have to accept that there are no magic weight loss pills, diet plans or weight loss tips which are going to mean you lose weight fast. Successful weight loss requires commitment to a healthy diet and lifestyle on a long term basis.

Strict diets can help individuals to lose weight in a short period of time but are often not sustainable for long periods and can sometimes be tricky to fit into an everyday lifestyle. Whats more is that when a diet ends and normal eating resumes once again it is highly likely that the weight will go straight back on. This is why losing weight should be about more than just dieting, it needs to involve a significant change in lifestyle indefinitely.

However you intend to lose weight it is important to consider the following points before beginning:

  • Are you motivated? - Not even the best nutritionist or weight loss plan in the world can help you to lose weight if you are not motivated and committed. When things are difficult always try to keep in mind your desired end goal and your reasons for wanting to get there.
  • Be realistic – Be realistic about your goals and timescale and don't aim to lose weight too fast because disappointment will only cast negativity over your progression. An average of about 1-2 1b per week is an attainable and safe goal. Also bear in mind that for many people weight loss is more dramatic in the early stages, and as time progresses this may slow slightly.
  • Record your current food intake – Try keeping a record of everything you eat and drink for a week or two prior to starting your new regime. This will tell you some interesting things about your eating habits, for instance if you seem to eat more at certain times of the day, or how much you snack. If your are considering consulting a nutritionist or health practitioner then they may find a food diary a really useful to get an idea of your current eating habits.

Listed below are a range of treatments and approaches often used to help individuals lose weight:

Bariatric Surgery

Bariatric surgery is the blanket term which is used to describe operations intended to induce weight loss. Though weight loss surgery is one of the most effective treatment options in terms of clinical efficacy and cost, the procedures are extremely specialist and invasive.

Generally a patient will not be considered for surgery unless they have tried other weight loss methods such as dieting, increasing physical activity and medication etc to no avail. The exception to this rule is patients with a BMI of over 50, whom the National Institute for Clinical Excellence have recommended be first in line for bariatric surgeries, ahead of diet and lifestyle measures.

Primary Care Trusts are required to provide funding for surgery. However, despite the prospect of significant financial savings in the future, the short term expenditure means many primary care trusts actually try to ban procedures.

Bariatric surgical procedures are all aimed at reducing a patients intake of calories and the various forms all carry potential complications. It is paramount that surgery is carried out in a specialist centre and follow-up appointments are essential.

Listed below are a few of the various forms of bariatric surgery:

  • Gastric bypass: Gastric bypass surgery involves reducing the stomach size and shortening the length of the small intestine. This means that the food will bypass the majority of the stomach and some of the intestine so that less food is required to satisfy the patients appetite.
  • Intragastric ballon: This endoscopic procedure is sometimes used for pre-surgery weight loss in morbidly obese patients to reduce the surgical risk, or in obese patients who have failed to lose weight using other methods but do not qualify for surgery. The process involves placing a silicone balloon filled with liquid into the stomach. The balloon will partially fill the stomach, creating the feeling of fullness so that patients feel less hungry and are able to learn to moderate food intake. The balloon is only intended to be temporary and the maximum time it can be left in place before removal is 6 months.
  • Laparoscopic adjustable gastric banding: More commonly referred to as 'gastric band surgery' this involves a ring being placed around the stomach, below the gastro-oesphageal junction. This band incorporates an inflatable balloon which will adjust to the size of the ring in order to regulate the intake of food. The procedure is adjustable which means you and your healthcare provider are able to control the weight loss. The band is put in place laparoscopicically meaning the procedure is not too invasive and the recovery period is minimal. In addition, the procedure is reversible so if it needs to be removed in the future this can be done without damage to the stomach.
  • Sleeve gastrectomy: This operation involves stapling the stomach along its length to reduce it's size by about 75%. Unlike a gastric bypass which sees the food entering a small pouch before it passes into the bowel, a sleeve gastrectomy allows the food to follow the same path as it did before surgery as it is divided vertically from top to bottom and the stomach function remains unaltered. Because the stomach is now smaller it is unable to hold as much meaning that patients will eat less and will feel full and satisfied more quickly.

Medication

Either drugs prescribed by your healthcare provider or alternative over the counter medications could be an option for those trying to lose weight. However, there is no wonder drug which will help to individuals to safely lose weight fast and these drugs are designed to be used in combination with an improved diet and increased physical activity.

Adjusting eating habits

The first step for anyone overweight or obese wishing to lose weight should be a re-evaluation of eating habits and physical activity levels. Though some individuals may feel that they have enough information and motivation to lose weight on their own, others will require professional help. There are various avenues of help which are designed to help with weight loss, from consulting your practice nurse through to weight-loss groups and dieticians.

Consulting a qualified nutritionist is an option which many people choose to explore and they will work with the patient to help them achieve a healthier lifestyle. A nutritionist will take into consideration aspects such as personal preferences, lifestyle and goals before creating a personalised nutrition programme. The ultimate goal of a nutritionist is not simply to achieve short term weight loss which will be difficult to maintain, but to actually integrate positive changes into your lifestyle so they can continue indefinitely.

How can a nutritionist help?

A nutritionist will usually begin by compiling a detailed case history of your diet, lifestyle and any previous and current health issues. The starting point for this case history may involve you creating a food diary to bring with you to the initial consultation as this will give your practitioner an idea of how, when and why you eat. In your food diary you may be asked to include what foods you eat, when you eat them, what the portion sizes are, if you are alone or with others when you eat, what kind of mood you are in when you eat and how frequently your bowel movements occur. All of this information will contribute towards building a picture of your current eating habits.

At this stage certain tests may be taken where appropriate and your nutritionist will discuss with you issues which may factor into your nutrition programme such as any special dietary requirements or health conditions which need to be considered. Other points for consideration may include the following:

Physical activity levels: Though eating less and eating healthily are key to weight-loss, increasing physical activity is also paramount for both losing the initial weight and keeping it off. Nutrition programmes often incorporate exercise regimes or will at least include physical activity advice. If you really dislike certain physical activities or there are some activities you can't participate in for health reasons then be sure to discuss this with your nutritionist so they can make suitable recommendations which you will enjoy and more importantly, that you will keep up. If you are not used to physical activity this can be built up gradually over time.

Enjoyment: As mentioned previously a nutrition programme hopes to teach you a way of eating which you will maintain for the rest of your life, so though at first it may be a struggle to adjust your eating habits it is important that there are foods in there which you can enjoy. Ultimately if you are given a list of foods to stick to which you don't enjoy and find boring then the chances of you sticking to it are slim to none.

Flexibility: Leading on from the previous point, a nutrition programme will need to include a variety of foods from a variety of food groups in order to keep things interesting.

After the above have been considered your practitioner will put together a realistic and achievable programme which may include ideas for meals, shopping lists, suggested supplements, lifestyle changes and a fitness regime.

Monitoring your progress

As well as giving you that initial boost and motivation, a nutritionist is there to offer you ongoing support and advice. Regular consultations will enable your practitioner to make sure you stay committed, motivated and on the path that leads you towards your goals. They may ask you to keep a record of what you are eating and your physical activity as this way they can advise you on where you may be going astray and how you could further improve your diet and fitness.

Monitoring your progress will of course include weigh in's to ensure you are progressing towards your goal of reaching and maintaining a healthy weight. It is important to note that weight loss may slow after the first couple of months, and because our weight tends to fluctuate from day-to-day, weighing yourself daily can reveal minor increases, levelling off or small losses which can be discouraging. Instead, most diet experts recommend a once weekly weigh in as this provides a more accurate reflection of your true weight.

Maintaining a healthy weight

A nutritionist is not just there to help you shed unwanted pounds, but also to help you maintain your desired healthy weight once you have achieved it. Unfortunately, many people who have lost weight tend to put it back on again once they have ceased their diet which is largely due to many diets being nothing more than a temporary change to an unhealthy lifestyle.

A nutritionist on the other hand, will help to ensure these changes are permanent by integrating them into your daily life so they become the 'norm'.

Along the way you may experience hiccups where you find you are not enjoying your food as much or you are too tired to exercise one particular week but your nutritionist will help to iron out these creases and make suitable adjustments where necessary.

When you have reached your target weight your nutritionist may suggest you continue to see them for a few more weeks or once monthly to ensure you stay on the right track and have reached a point where you feel comfortable continuing your healthy lifestyle without that extra support.

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All content displayed on Nutritionist Resource is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional. Whilst some people have benefited from nutritional therapy, no claims can be made to treat, cure or heal specific conditions, and we strongly advise individuals with any health problem to seek independent medical advice from their GP before considering nutritional therapy.