Obesity Health Article

Diagnosis

Diagnosis of obesity is made by observation and by comparing the patient's weight to ideal weight charts. Many doctors and obesity researchers refer to the body mass index (BMI), which uses a height-weight relationship to calculate an individual's ideal weight and personal risk of developing obesity-related health problems.

Since this method can be misleading, due to its failure to account for body composition and muscle mass, physicians may also obtain direct measurements of an individual's body fat content by using calipers to measure skin-fold thickness at the back of the upper arm and other sites. The most accurate means of measuring body fat content involves hydrostatic weighing, or having a person let as much air as possible out of his lungs, immersing him in water and measuring relative displacement; however, this method is very unpleasant and impractical, and is usually only used in scientific studies requiring very specific assessments. Women whose body fat exceeds 32% and men whose body fat exceeds 27% are generally considered obese.

Doctors may also note how a person carries excess weight on his or her body. Studies have shown that this factor may indicate whether or not an individual has a predisposition to develop certain diseases or conditions that may accompany obesity. "Apple-shaped" individuals who store most of their weight around the waist and abdomen are at greater risk for cancer, heart disease, stroke, and diabetes than "pear-shaped" people whose extra pounds settle primarily in their hips and thighs.

Treatment

Treatment of obesity depends primarily on how overweight a person is and his or her overall health. However, to be successful, any treatment must affect lifelong behavioral changes rather than short-term weight loss. A report issued by the National Institutes of Health-sponsored group, the National Heart, Lung, and Blood Institute, The Practical Guide to Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, recommends a combination of diet modification, increased physical activity, and behavior therapy as the means most likely to prove effective.

"Yo-yo" dieting, in which weight is repeatedly lost and regained, has been shown to increase a person's liklihood of developing fatal health problems more than if the weight had been lost gradually or not lost at all. Behavior-focused treatment should concentrate on:

• What and how much a person eats. This aspect may involve keeping a food diary and developing a better understanding of the nutritional value and fat content of foods. It may also involve changing grocery-shopping habits (e.g. buying only what is on a prepared list and only going on a certain day), timing of meals (to prevent feelings of hunger, a person may plan frequent, small meals), and actually slowing down the rate at which a person eats.
• How a person responds to food. This may involve understanding what psychological issues underlie a person's eating habits. For example, one person may binge eat when under stress, while another may always use food as a reward. In recognizing these psychological triggers, an individual can develop alternative coping mechanisms that do not focus on food.
• How they spend their time. Making activity and exercise an integrated part of everyday life is a key to achieving and maintaining weight loss. Starting slowly and building endurance keeps individuals from becoming discouraged. Varying routines and trying new activities also keeps interest high.

For most individuals who are mildly obese, these behavior modifications entail life-style changes they can make independently while being supervised by a family physician. Other mildly obese persons may seek the help of a commercial weight-loss program (e.g. Weight Watchers). The effectiveness of these programs is difficult to assess, since programs vary widely, drop-out rates are high, and few employ members of the medical community. However, programs that emphasize realistic goals, gradual progress, sensible eating, and exercise can be very helpful and are recommended by many doctors. Programs that promise instant weight loss or feature severely restricted diets are not effective and, in some cases, can be dangerous.

For individuals who are moderately obese, medically supervised behavior modification and weight loss are required. While doctors will put most moderately obese patients on a balanced, low-calorie diet (1200–1500 calories a day), they may recommend that certain individuals follow a very-low-calorie liquid protein diet (400–700 calories) for as long as three months. This therapy, however, should not be confused with commercial liquid protein diets or commercial weight-loss shakes and drinks. Doctors tailor these diets to specific patients, monitor patients carefully, and use them for only a short period of time.

In addition to reducing the amount and type of calories consumed by the patient, doctors will recommend professional therapists or psychiatrists who can help the individual effectively change his or her behavior in regard to eating. For individuals who are severely obese, dietary changes and behavior modification may be accompanied by surgery to reduce or bypass portions of the stomach or small intestine. Such obesity surgery, however, can be risky, and it is only performed on patients for whom other strategies have failed and whose obesity seriously threatens their health. Other surgical procedures are not recommended, including liposuction, a purely cosmetic procedure in which a suction device is used to remove fat from beneath the skin, and jaw wiring, which can damage gums and teeth and cause painful muscle spasms.

Appetite-suppressant drugs are sometimes prescribed to aid in weight loss. These drugs work by increasing levels of serotonin or catecholamine, which are brain chemicals that control feelings of fullness. Appetite suppressants, though, are not considered truly effective, since most of the weight lost while taking them is usually regained after stopping them. Also, suppressants containing amphetamines can be potentially abused by patients.

While most of the immediate side-effects of these drugs are harmless, the long-term effects of these drugs, in many cases, is unknown. Two drugs, dexfenfluramine hydrochloride (Redux) and fenfluramine (Pondimin) as well as a combination fenfluramine-phentermine (Fen/Phen) drug, were taken off the market when they were shown to cause potentially fatal heart defects.

Other weight-loss medications available with a doctor's prescription include: sibutramine (Meridia), diethylpropion (Tenuate, Tenuate dospan) mazindol (Mazanor, Sanorex) phendimetrazine (Bontril, Plegine, Prelu-2, XTrozine) and phentermine (Adipex-P, Fastin, Ionamin, Oby-trim).

Phenylpropanolamine (Acutrim, Dextarim) is the only nonprescription weight-loss drug approved by the FDA, but in November, 2000, the FDA announced that it was considering withdrawing its approval. These over-the-counter diet aids have been found to increase the risk of hemorrhagic stroke (bleeding into the brain or into tissue surrounding the brain) in women, and men may also be at risk.

Combined with diet and exercise and used only with a doctor's approval, prescription anti-obesity medications enable some patients to lose 10% more weight than they otherwise would. Most patients regain lost weight after discontinuing use of either prescription medications or nonprescription weight-loss products. Prescription medications or over-the-counter weight-loss products can cause: constipation, dry mouth, headache, irritability, nausea, nervousness, and sweating. None of them should be used by patients taking monoamine oxidase inhibitors (MAO inhibitors).

Doctors sometimes prescribe fluoxetine (Prozac), an antidepressant that can increase weight loss by about 10%. Weight loss may be temporary and side effects of this medication include diarrhea, fatigue, insomnia, nausea, and thirst.

Weight-loss drugs currently being developed or tested include ones that can prevent fat absorption or digestion; reduce the desire for food and prompt the body to burn calories more quickly; and regulate the activity of substances that control eating habits and stimulate overeating.

In April, 1999, the U.S. Food and Drug Administration (FDA) approved Xenical (orlistat), which works in the intestines, where it blocks some fat from being absorbed. This undigested fat is then eliminated in the patient's bowel movements. Available only with a doctor's prescription, many gastrointestinal side-effects can occur with Xenical. This medication should not be used by patients who have problems absorbing food or have gallbladder problems.

The Chinese herb ephedra (Ephedra sinica), combined with caffeine, exercise, and a low-fat diet in physician-supervised weight-loss programs, can cause at least temporary weight loss. However, the large doses of ephedra required to achieve the desired result can also produce serious side effects including chest pain, myocardial infarction, hepatitis, stroke, seizures, psychosis, and death. Mixing this with caffeine (a diuretic) also promotes dehydration, which can cause a number of other health problems. Ephedra should not be used by anyone with a history of diabetes, heart disease, or thyroid problems.

Getting the correct ratios of protein, carbohydrates, and good-quality fats can help in weight loss via enhancement of the metabolism. Support groups that are informed about healthy, nutritious, and balanced diets can offer an individual the support he or she needs to maintain this type of eating regimen.