Overweight and Obesity Podcast Transcript
Welcome to the National Heart, Lung, and Blood
Institute podcast on overweight and obesity. This podcast will discuss what
overweight and obesity are and the causes, health risks, risk factors, and
signs and symptoms of overweight and obesity. It also will discuss how
overweight and obesity are diagnosed and treated, and how they can be
prevented.
More information, including Aim for a Healthy
Weight, is available on the NHLBI Web site at
www.nhlbi.nih.gov or by calling the
NHLBI Health Information Center at 3015928573.
What Are Overweight and Obesity?
The terms "overweight" and "obesity" refer to a
person's overall body weight and where the extra weight comes from. Overweight
is having extra body weight from muscle, bone, fat, and/or water. Obesity is
having a high amount of extra body fat.
The most useful measure of overweight and obesity is
the body mass index, or BMI. BMI is based on height and weight and is used for
adults, children, and teens. BMI will be explained in greater detail later in
the podcast when diagnosis is discussed.
Millions of Americans and people worldwide are
overweight or obese. Being overweight or obese puts you at risk for many
diseases and conditions. The more body fat that you carry around and the more
you weigh, the more likely you are to develop heart disease, high blood
pressure, type 2 diabetes, gallstones, breathing problems, and certain cancers.
A person's weight is a result of many factors,
including environment; family history and genetics; metabolism, which is the
way your body changes food and oxygen into energy; behavior or habits; and
other factors.
Certain things, like family history, can't be
changed. However, other thingslike a person's lifestyle habitscan
be changed. You can help prevent or treat overweight and obesity if you:
- Follow a healthful diet, while keeping your
calorie needs in mind,
- Are physically active, and
- Limit the time you spend being inactive.
Weight loss medicines and surgery also are options
for some people who need to lose weight if lifestyle changes don't work.
Reaching and staying at a healthy weight is a
long-term challenge for people who are overweight or obese. But it also can be
a chance to lower your risk of other serious health problems. With the right
treatment and motivation, it's possible to lose weight and lower your long-term
disease risk.
What Causes Overweight and Obesity?
For most people, overweight and obesity are caused
by not having energy balance. Weight is balanced by the amount of energy or
calories you get from food and drinkscalled energy INequaling the
energy your body uses for things like breathing, digesting, and being
physically activecalled energy OUT.
Energy balance means that your energy IN equals your
energy OUT. To maintain a healthy weight, your energy IN and OUT don't have to
balance exactly every day. It's the balance over time that helps you maintain a
healthy weight.
If your energy IN equals your energy out over time,
your weight will stay the same. If you have more energy IN than energy OUT over
time, you will gain weight. Likewise, if you have more energy OUT than energy
IN over time, you will lose weight.
Overweight and obesity happen over time when you
take in more calories than you use.
Other factors also can contribute to overweight and
obesity.
Many Americans aren't very physically active, and
there are many reasons for this. One reason is that many people spend hours in
front of TVs and computers doing work, schoolwork, and leisure activities. In
fact, more than 2 hours a day of regular TV viewing time has been linked to
overweight and obesity.
Other reasons for not being active include: relying
on cars instead of walking to places, fewer physical demands at work or at home
because modern technology and conveniences reduce the need to burn calories,
and lack of physical education classes in schools.
People who are inactive are more likely to gain
weight because they don't burn up the calories that they take in from food and
drinks. An inactive lifestyle also raises your risk for heart disease, high
blood pressure, diabetes, colon cancer, and other health problems.
Environment also can play a part in overweight and
obesity. Our environment doesn't always help with healthy lifestyle habits; in
fact, it encourages obesity. Some reasons include:
- Lack of neighborhood sidewalks and safe places
for recreation. Not having area parks, trails, sidewalks, and affordable gyms
makes it hard for people to be physically active.
- Work schedules that don't allow people enough
time for physical activity because of long hours or time commuting.
- Oversized food portions in restaurants, fast food
places, gas stations, movie theaters, supermarkets, and even home. Some of
these meals and snacks can feed two or more people. Eating large portions means
too much energy IN. Over time, this will cause weight gain if it isn't balanced
with physical activity.
- Lack of access to healthy foods. Some people
don't live in neighborhoods that have supermarkets that sell healthy foods such
as fresh fruits and vegetables. Or if they do, these items are often too
costly.
- Advertisements from food companies. Often
children are the targets of advertising for high-calorie, high-fat snacks and
sugary drinks. The goal of these ads is to sway people to buy these foods, and
often they do.
Genetics and family history also can contribute to
overweight and obesity. Studies of identical twins who have been raised apart
show that genes have a strong influence on one's weight. Overweight and obesity
tend to run in families. Your chances of being overweight are greater if one or
both of your parents are overweight or obese. Your genes also may affect the
amount of fat you store in your body and where on your body you carry the extra
fat.
Because families also share food and physical
activity habits, there is a link between genes and the environment. Children
adopt the habits of their parents. So, a child with overweight parents who eat
high-calorie foods and are inactive will likely become overweight like the
parents. On the other hand, if a family adopts healthful food and physical
activity habits, the child's chance of being overweight or obese is reduced.
Health conditions can affect overweight and obesity.
For example, hormone problems sometimes cause overweight and obesity. These
problems include underactive thyroid, Cushing's syndrome, and polycystic
ovarian syndrome.
Underactive thyroid is also called hypothyroidism.
This is a condition in which the thyroid gland doesn't make enough thyroid
hormone. Lack of thyroid hormone will slow down your metabolism and cause
weight gain. You'll also feel tired and weak.
Cushing's syndrome is a condition in which the
body's adrenal glands make too much of the hormone cortisol. Cushing's syndrome
also can happen when people take high levels of medicines, such as prednisone,
for long periods. People with Cushing's syndrome gain weight, have upper-body
obesity, a rounded face, fat around the neck, and thin arms and legs.
Polycystic ovarian syndrome is a condition that
affects about 5 to 10 percent of women of childbearing age. Women with
polycystic ovarian syndrome often are obese, have excess hair growth, and have
reproductive and other health problems due to high levels of hormones called
androgens.
Another factor that can affect overweight and
obesity is medicines. Certain medicines, such as corticosteroids like
prednisone, antidepressants like Elavil,® and medicines for
seizures like Neurontin,® may cause you to gain weight. These
medicines can slow the rate at which your body burns calories, increase your
appetite, or cause your body to hold on to extra waterall of which can
lead to weight gain.
Emotional factors also may contribute to overweight
and obesity. Some people eat more than usual when they are bored, angry, or
stressed. Over time, overeating will lead to weight gain and may cause
overweight or obesity.
Smoking also can play a part in weight gain. Some
people gain weight when they stop smoking. One reason is that food often tastes
and smells better. Another reason is because nicotine raises the rate at which
your body burns calories, so you burn fewer calories when you stop smoking.
However, smoking is a serious health risk, and quitting is more important than
possible weight gain.
Age can affect overweight an obesity. As you get
older, you tend to lose muscle, especially if you're less active. Muscle loss
can slow down the rate at which your body burns calories. If you don't reduce
your calorie intake as you get older, you may gain weight.
Midlife weight gain in women is mainly due to aging
and lifestyle, but menopause also plays a role. Many women gain around 5 pounds
during menopause and have more fat around the waist than they did before.
Pregnancy also can contribute to overweight and
obesity. During pregnancy, women gain weight so that the baby gets proper
nourishment and develops normally. After giving birth, some women find it hard
to lose the weight. This may lead to overweight or obesity, especially after a
few pregnancies.
Lack of sleep may also affect weight gain. Studies
find that the less people sleep, the more likely they are to be overweight or
obese. People who report sleeping 5 hours a night, for example, are much more
likely to become obese compared to people who sleep 78 hours a night.
People who sleep fewer hours also seem to prefer
eating foods that are higher in calories and carbohydrates, which can lead to
overeating, weight gain, and obesity over time.
Hormones that are released during sleep control
appetite and the body's use of energy. For example, insulin controls the rise
and fall of blood sugar levels during sleep. People who don't get enough sleep
have insulin and blood sugar levels that are similar to those in people who are
likely to have diabetes.
Also, people who don't get enough sleep on a regular
basis seem to have high levels of a hormone called ghrelin, which causes
hunger. They also have low levels of a hormone called leptin, which normally
helps to curb hunger.
What Are the Health Risks of Overweight and
Obesity?
Being overweight or obese isn't a cosmetic problem.
It greatly raises the risk in adults for many diseases and conditions,
including heart disease, high blood pressure, stroke, type 2 diabetes, abnormal
blood fats, metabolic syndrome, cancer, osteoarthritis, sleep apnea,
reproductive problems, and gallstones.
Heart disease occurs when a fatty material called
plaque builds up on the inside walls of the coronary arteries. These arteries
supply blood and oxygen to your heart. Plaque narrows the coronary arteries,
which reduces blood flow to your heart. Your chances for having heart disease
and a heart attack get higher as your body mass index, or BMI, increases.
Obesity also can lead to congestive heart failure, a serious condition in which
the heart can't pump enough blood to meet your body's needs.
High blood pressure, or hypertension, occurs when
the force of the blood pushing against the walls of the arteries is too high.
Your chances for having high blood pressure are greater if you're overweight or
obese.
A stroke occurs when blood flow to your brain is
blocked. Being overweight or obese can lead to a buildup of fatty deposits in
your arteries that form a blood clot. If the clot is close to your brain, it
can block the flow of blood and oxygen, causing a stroke. The risk of having a
stroke rises as BMI increases.
Type 2 diabetes is a disease in which blood sugar,
or glucose, levels are too high. Normally, the body makes insulin to move the
blood sugar into cells where it's used. In type 2 diabetes, the cells don't
respond enough to the insulin that's made. Diabetes is a leading cause of early
death, heart disease, stroke, kidney disease, and blindness. More than 80
percent of people with type 2 diabetes are overweight.
If you're overweight or obese, you have a greater
chance of having abnormal levels of blood fats. These include high amounts of
triglycerides and LDL cholesterol, which is a fat-like substance often called
"bad" cholesterol, and low HDL cholesterol, which is often called "good"
cholesterol. Abnormal levels of these blood fats are a risk for heart disease.
Metabolic syndrome is the name for a group of risk
factors linked to overweight and obesity that raise your chance for heart
disease and other health problems such as diabetes and stroke. A person can
develop any one of these risk factors by itself, but they tend to occur
together. Metabolic syndrome occurs when a person has at least three of the
following heart disease risk factors:
- A large waistline. This is also called abdominal
obesity or "having an apple shape. " Having extra fat in the waist area is a
greater risk factor for heart disease than having extra fat in other parts of
the body, such as on the hips.
- Abnormal blood fat levels, including high
triglycerides and low HDL cholesterol.
- Higher than normal blood pressure, and
- Higher than normal fasting blood sugar levels.
Being overweight or obese raises the risk for colon,
breast, endometrial, and gallbladder cancers.
Osteoarthritis is a common joint problem of the
knees, hips, and lower back. It occurs when the tissue that protects the joints
wears away. Extra weight can put more pressure and wear on joints, causing
pain.
Sleep apnea is a condition that causes a person to
stop breathing for short periods during sleep. A person with sleep apnea may
have more fat stored around the neck. This can make the breathing airway
smaller so that it's hard to breathe.
Obesity can cause menstrual irregularity and
infertility in women.
Gallstones are hard pieces of stone-like material
that form in the gallbladder. They're mostly made of cholesterol and can cause
abdominal or back pain. People who are overweight or obese have a greater
chance of having gallstones. Also, being overweight may result in an enlarged
gallbladder that may not work properly.
Overweight and obesity also increase the health
risks for children and teens. Type 2 diabetes was once rare in American
children. Now it accounts for 8 to 45 percent of newly diagnosed diabetes
cases. Also, overweight children are more likely to become overweight or obese
as adults, with the same risks for disease.
Who Is At Risk for Overweight and Obesity?
Overweight and obesity affect Americans of all ages,
sexes, racial/ethnic groups, and educational levels. This serious health
problem has been growing over the years. In fact, overweight and obesity in
adults have doubled since 1980, and overweight in children and teens has
tripled.
According to the 20032004 National Health and
Nutrition Examination Survey, called NHANES for short, about one-third of
adults in the United States are overweight and slightly more than one-third are
obese. The survey also shows differences in overweight and obesity according to
racial/ethnic groups.
- In women, overweight and obesity are highest for
non-Hispanic Black womenabout 82 percentcompared to about 75
percent for Mexican American women and 58 percent for non-Hispanic White women.
- In men, overweight and obesity also are higher
for minority groups. They're highest for Mexican American menabout 76
percentcompared to about 71 percent for non-Hispanic White men and about
69 percent for non-Hispanic Black men.
According to NHANES 20032004, overweight and
the risk for overweight is rising in children and teens. The survey shows
that:
- About 19 percent of school-aged children and
about 17 percent of teens are overweight, and
- About 18 percent of school-aged children and
about 17 percent of teens are at risk for overweight.
There are also some differences in overweight
according to racial/ethnic groups.
- In male children and teens, overweight is highest
for Mexican Americansabout 22 percentcompared to 17 percent for
non-Hispanic Whites and about 16 percent for non-Hispanic Blacks.
- In female children and teens, overweight is
highest for non-Hispanic Blacksabout 23 percentcompared to 16
percent for Mexican Americans and about 14 percent for non-Hispanic Whites.
Overweight and obesity are also common in groups
with low incomes. Women with low incomes are about 50 percent more likely to be
obese than women with higher incomes. Among children and teens, overweight in
non-Hispanic White teens is related to a lower family income.
Low-income families also buy more high-calorie,
high-fat foods, which may add to the problem. This is because they tend to cost
less than more healthful foods such as fruits and vegetables.
How Are Overweight and Obesity Diagnosed?
Weight gain usually happens over time. Most people
know when they've gained weight. Some of the signs of overweight or obesity
include:
- Clothes feeling tight and needing a larger size,
- The scale showing that you've gained weight,
- Having extra fat around the waist, and
- A higher than normal body mass index and waist
circumference.
The most common way to find out whether you're
overweight or obese is to figure out your body mass index, or BMI for short.
BMI is an estimate of body fat and a good gauge of your risk for diseases that
occur with more body fat. The higher your BMI, the higher your risk of disease.
BMI is calculated from your height and weight. You
or your health care provider can determine your BMI using the National Heart,
Lung, and Blood Institute's online calculator at
www.nhlbisupport.com/bmi.
In adults, a BMI of 18.5 to 24.0 is considered
normal weight. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 to
39.9 is considered obese. And a BMI of 40 or above is considered extremely
obese.
Although BMI can be used for most men and women, it
does have some limits. It may overestimate body fat in athletes and others who
have a muscular build, and it may underestimate body fat in older persons and
others who have lost muscle.
Overweight is defined differently for children and
teens than it is for adults. Because children are still growing and boys and
girls mature at different rates, BMIs for children and teens compare their
heights and weights against growth charts that take age and sex into account.
This is called BMI-for-age percentile. A child or teen's BMI-for-age percentile
shows how his or her BMI compares with other boys and girls of the same age.
For more information about BMI-for-age and growth
charts for children, go to the Centers for Disease Control and Prevention's Web
site at www.cdc.gov and search the term "BMI.
"
When diagnosing overweight and obesity, health care
professionals also may take your waist measurement. This helps to screen for
the possible health risks that come with overweight and obesity in adults. If
you have abdominal obesity and most of your fat is around your waist rather
than at your hips, you're at higher risk for heart disease and type 2 diabetes.
This risk goes up with a waist size that is greater than 35 inches for women or
greater than 40 inches for men.
You also may want to measure your waist size. To do
so correctly, stand and place a tape measure around your middle, just above
your hipbones. Measure your waist just after you breathe out.
A primary care doctor, or pediatrician for children
and teens, will assess your BMI, waist measurement, and overall health risk. If
you're overweight or obese, or have a large waist size, your doctor should
explain the health risks and find out whether you're interested and willing to
lose weight. If you are, you and your doctor should work together to create a
treatment plan. The plan should include weight loss goals and treatment options
that are realistic for you.
Your doctor may send you to other health care
specialists if you need expert care. These specialists may include:
- An endocrinologist if you need to be treated for
type 2 diabetes or a hormone problem such as an underactive thyroid,
- A registered dietitian or nutritionist to work
with you on ways to change your eating habits,
- An exercise physiologist or trainer to figure out
your level of fitness and show you how to start physical activities suitable
for you,
- A bariatric surgeon if weight loss surgery is an
option for you, and
- A psychiatrist, psychologist, or clinical social
worker to help treat depression or stress.
How Are Overweight and Obesity Treated?
Successful treatments for weight loss include
setting goals and making lifestyle changes such as eating fewer calories and
being more physically active. Drug therapy and weight loss surgery are also
options for some people if lifestyle changes don't work.
Setting the right weight loss goals is an important
first step to losing and maintaining weight.
For adults:
- Lose just 5 to 10 percent of your current weight
over 6 months. This will lower your risk for heart disease and other
conditions.
- The best way to lose weight is slowly. A weight
loss of 1 to 2 pounds a week is do-able, safe, and will help you keep off the
weight. It also will give you the time to make new, healthy lifestyle changes.
- If you've lost 10 percent of your body weight,
have kept it off for 6 months, and are still overweight or obese, you may want
to consider further weight loss.
If your child is overweight or at risk of
overweight, the goal is to maintain his or her current weight and to focus on
eating healthy and being physically active. This should be part of a family
effort to make lifestyle changes.
If your child is overweight and has a health
condition related to overweight or obesity, your doctor should refer you to a
pediatric obesity treatment center.
For long-term weight loss success, it's important
for you and your family to make lifestyle changes.
- Focus on energy IN, which is calories from food
and drinks, and energy OUT, which is physical activity,
- Follow a healthy eating plan, and
- Learn how to adopt more healthful lifestyle
habits.
Over time, these changes will become part of your
everyday life.
Cutting back on calories, or energy IN, also will
help you lose weight. To lose 1 to 2 pounds a week, adults should cut back
their calorie intake by 500 to 1,000 calories a day.
- In general, 1,000 to 1,200 calories a day will
help most women lose weight safely.
- In general, 1,200 to 1,600 calories a day will
help most men lose weight safely. This calorie range is also suitable for women
who weigh 165 pounds or more or who exercise routinely.
These calorie levels are a guide and may need to be
adjusted. If you eat 1,600 calories a day but don't lose weight, then you may
want to cut back to 1,200 calories. If you're hungry on either diet, then you
may want to boost your calories by 100 to 200 a day. Very low-calorie diets of
less than 800 calories a day shouldn't be used unless your doctor is monitoring
you.
For overweight children or teens, it's important to
slow the rate of weight gain; however, reduced-calorie diets aren't advised
before you talk to a health care provider.
A healthy eating plan is part of a healthy
lifestyle. Healthy eating gives your body the nutrients it needs every day.
Your body will have enough calories for good health, but not so many that you
gain weight.
A healthy eating plan also will lower your risk for
heart disease and other conditions. A plan low in total, saturated, and
trans fat; cholesterol; and sodium will help lower your risk for heart
disease. Cutting down on fats and added sugars also can help you eat fewer
calories and lose weight. Healthful foods include:
- Fat-free and low-fat milk and milk products such
as low-fat yogurt, cheese, and milk,
- Lean meat, fish, poultry, cooked beans, and peas,
- Whole grain foods such as whole wheat bread,
oatmeal, and brown rice. Other grain foods like pasta, cereal, bagels, bread,
tortillas, couscous, and crackers,
- Fruits canned in juice or water or fresh, frozen,
or dried, and
- Vegetables canned without salt or fresh, frozen,
or dried.
Canola or olive oils and soft margarines made from
these oils are heart healthy. They should be used in small amounts because
they're high in calories. Unsalted nuts, like walnuts and almonds, also can be
built into a healthful diet as long as you watch the amount you eat, because
nuts are high in calories.
Foods that are high in saturated and trans
fats and cholesterol raise blood cholesterol levels and also may be high in
calories. These fats raise the risk of heart disease, so they should be
limited.
Saturated fat is found mainly in:
- Fatty cuts of meat such as ground beef, sausage,
and processed meats such as bologna, hot dogs, and deli meats,
- Poultry with the skin,
- High-fat milk and milk products like whole-milk
cheeses, whole milk, cream, butter, and ice cream, and
- Lard, coconut, and palm oils found in many
processed foods.
Trans fat is found mainly in:
- Foods with partially hydrogenated oils such as
many hard margarines and shortening,
- Baked products and snack foods such as crackers,
cookies, doughnuts, and breads, and
- Food fried in hydrogenated shortening such as
french fries and chicken.
Cholesterol is found mainly in:
- Egg yolks,
- Organ meats such as liver,
- Shrimp, and
- Whole milk or whole-milk products, including
butter, cream, and cheese.
Limiting foods and drinks with added sugars, like
high-fructose corn syrup, is important. Added sugars will give you extra
calories without nutrients like vitamins and minerals. Added sugars are found
in many desserts, canned fruit packed in syrup, fruit drinks, and nondiet
drinks. Check the nutrition label on food packages for added sugars like
high-fructose corn syrup. Drinks with alcohol also will add calories, so it's a
good idea to watch alcohol intake.
Healthy eating is more than just knowing which foods
to eat. It also means knowing how much food to eat. A portion is the amount of
food that you choose to eat for a meal or snack. It's different from a serving,
which is a measured amount of food and is noted on the nutrition label on food
packages.
Anyone who has eaten out lately is likely to notice
how big the portions are. In fact, they're oversized. These ever-larger
portions have changed what we think of as normal.
Cutting back on portion size is a good way to help
you eat fewer calories and balance your energy IN.
Studies have shown that we all tend to eat a
constant "weight" of food. Ounce for ounce, our food intake is fairly constant.
Knowing this, you can lose weight if you eat foods that are lower in calories
and fat for a given measure of food. For example, replacing a full-fat food
product that weighs 2 ounces with one that's the same weight but lower in fat
helps you cut back on calories. Another helpful practice is to eat foods that
contain a lot of water like vegetables, fruits, and soups.
More information on healthy eating is available on
the Aim for a Healthy Weight Web pages found on the NHLBI Web site at
www.nhlbi.nih.gov.
Physical activity is another important lifestyle
change. Staying active and eating fewer calories will help you lose weight and
keep the weight off over time. Physical activity also will benefit you in other
ways. It will:
- Lower the risk of heart disease, diabetes, and
cancers, such as breast, uterus, and colon
- Strengthen your lungs and help them to work
better,
- Strengthen your muscles and keep your joints in
good condition,
- Slow bone loss,
- Give you more energy,
- Help you to relax and cope better with stress,
- Allow you to fall asleep faster and sleep more
soundly, and
- Give you an enjoyable way to share time with
friends and family.
For adults:
- Aim for at least 30 minutes of moderate-intensity
physical activity most days of the week for overall health and to lower the
risk of disease.
- Aim for 60 minutes of
moderate-to-vigorous-intensity physical activity most days of the week to help
manage body weight and prevent gradual weight gain.
- Aim for at least 60 to 90 minutes of daily
moderate-intensity physical activity to maintain weight loss.
In general, children and teens should aim for at
least 60 minutes of physical activity on most, if not all, days of the week.
Many people lead inactive lives and may not be
motivated to do more physical activity. Some people may need help and
supervision when they start a physical activity program to avoid injury.
If you're obese, or if you haven't been active in
the past, start physical activity slowly and build up the intensity a little at
a time. When starting out, one way to be active is to do more "everyday"
activities such as taking the stairs instead of the elevator and doing
household chores and yard work. The next step is to start walking, biking, or
swimming at a slow pace, and then build up the amount of time you exercise or
the intensity level of the activity.
To lose weight and gain better health, it's
important to get moderate-intensity physical activity. Choose activities that
you enjoy and that fit into your daily life. A daily, brisk walk is an easy way
to be more active and improve your health. Use a pedometer to count your daily
steps and keep track of how much you're walking. Try to increase the number of
steps you take each day.
Other examples of moderate-intensity physical
activity include dancing, bicycling, gardening, and swimming. For greater
health benefits, try to step up your level of activity or the length of time
you're active. For example, start walking for 10 to 15 minutes three times a
week, and then build up to brisk walking for 60 minutes, 5 days a week. You
also can break up the amount of time that you're physically active into shorter
amounts such as 15 minutes at a time.
Making behavioral changes also can help you lead a
healthier life. Changing your behaviors or habits around food and physical
activity is important for losing weight. The first step is to understand the
things that lead you to overeat or have an inactive lifestyle. The next step is
to change these habits.
The following tips are simple ideas to help build
healthier habits.
Change your surroundings. You may be more likely to
overeat when watching TV, when treats are available in the office break room,
or when you're with a certain friend. You also may not be motivated to take the
exercise class you signed up for. But you can change these habits.
- Instead of watching TV, dance to music in your
living room or go for a walk.
- Leave the office break room right after you get a
cup of coffee.
- Bring a change of clothes to work. Head straight
to the exercise class on the way home from work.
- Put a note on your calendar to remind yourself to
take a walk or go to your activity class.
Another helpful tip is to keep a record. A record of
your food intake and the amount of physical activity that you do each day will
help inspire you. You also can keep track of your weight. For example, when the
record shows that you've been meeting your goal to be more active, you'll want
to keep it up. A record is also an easy way to track how you're doing,
especially if you're working with a registered dietitian or nutritionist.
Seek support. Ask for help or encouragement
from your friends, family, and health care provider. You can get support in
person, through e-mail, or by talking on the phone. You also can join a support
group.
Reward success. Reward yourself for meeting your
weight loss goals or other achievements with something you would like to do,
not with food. Choose rewards that you'll enjoy, such as a movie, music CD, an
afternoon off from work, a massage, or personal time.
If lifestyle changessuch as healthy eating,
physical activity, and behavioral changesaren't enough, your doctor may
prescribe weight loss medicines approved by the Food and Drug Administration,
or FDA for short.
If you're not successful at losing 1 pound a week
after 6 months of using lifestyle changes, medicines may help. These medicines
should be used only as part of a program that includes diet, physical activity,
and behavioral changes.
Weight loss medicines may be suitable for adults who
are obesethat is, adults who have a body mass index, or BMI, of 30 or
greater. People who have BMIs of 27 or greater and are at risk for heart
disease and other health conditions also may benefit from medicines.
The FDA has approved two weight loss medicines for
long-term use: sibutramine and orlistat. The brand name for sibutramine is
Meridia.® The brand name for orlistat is
Xenical.® These medicines cause a weight loss between 4
and 22 pounds, although some people lose more weight. Most of the weight loss
occurs within the first 6 months of taking the medicine.
- Sibutramine sends signals to your brain to curb
your appetite. Sibutramine raises blood pressure and pulse, so it shouldn't be
taken if you have high blood pressure or a history of heart disease or stroke.
- Orlistat reduces the absorption of fats, fat
calories, and vitamins A, D, E, and K by the body. Orlistat can result in mild
side effects such as oily and loose stools.
The FDA also has approved Alli, an
over-the-counter weight loss aid for adults. Alli is the lower dose form of
orlistat. It's meant to be used along with a reduced-calorie, low-fat diet and
physical activity. In studies, most people taking Alli lost 5 to 10 pounds over
6 months.
Like orlistat, Alli reduces the absorption of fats,
fat calories, and vitamins A, D, E, and K to promote weight loss. It also has
similar side effects to orlistat. If you're taking orlistat or Alli, you should
take a multivitamin at bedtime due to the possible loss of some vitamins. You
also should talk to your doctor before starting Alli if you're taking
blood-thinning medicines or being treated for diabetes or thyroid disease.
Combined with healthy eating and physical activity,
these medicines can help people lose weight. If you think you would benefit
from weight loss medicines, talk to your doctor.
People taking these medicines need regular checkups
with their doctors, especially in the first year after starting the medicine.
During checkups, your doctor will check your weight, blood pressure, and pulse
and order laboratory tests. He or she also will discuss any medicine side
effects and answer your questions.
Some prescription medicines are used as weight loss
treatment, but aren't FDA-approved for treating obesity. They include drugs to
treat depression, seizures, and diabetes.
- Some medicines for depression cause an initial
weight loss and then a regain of weight while taking the medicine.
- Two drugs used for seizures, topiramate and
zonisamide, have been shown to cause weight loss. These drugs are being studied
to see whether they will be useful in treating obesity.
- Metformin, a drug used to treat diabetes, may
cause small amounts of weight loss in people with obesity and diabetes. It's
not known how this drug causes weight loss, but it has been shown to reduce
hunger and food intake.
Over-the-counter, or OTC, products often claim that
a person taking them will lose weight. The FDA doesn't regulate these products
because they're considered dietary supplements, not medicines. However, many of
these products have serious side effects and aren't generally recommended. A
few OTC products include ephedra, chromium, diuretics and herbal laxatives, and
hoodia.
- Ephedra, also called ma-huang, comes from plants
and has been sold as a dietary supplement. The active ingredient in the plant
is called ephedrine. Ephedra can cause short-term weight loss. It also has
serious side effects. It causes high blood pressure and stresses the heart. In
fact, because ephedra poses a serious health risk, the FDA has advised people
to stop using dietary supplements that contain it.
- Chromium is a mineral that's sold as a dietary
supplement to reduce body fat. While studies haven't found any weight loss
benefit from chromium, there are few serious side effects from taking it.
- Diuretics and herbal laxatives cause you to lose
water weight, not fat. They also can lower your body's potassium levels, which
may cause heart and muscle problems.
- Hoodia is a cactus that is native to Africa. It's
sold in pill form as an appetite suppressant. However, there is no firm
evidence that hoodia works. No large-scale research has been done on humans to
show whether hoodia is effective or safe.
Weight loss surgery may be an option for people with
extreme obesitythat is, a BMI of 40 or greaterwhen other treatments
have failed. It's also an option for people with a BMI of 35 or greater who
have life-threatening conditions such as:
- Severe sleep apnea, which is a condition in which
your breathing stops or gets very shallow while you're sleeping,
- Obesity-related cardiomyopathy, a disease of the
heart muscle, and
- Severe type 2 diabetes.
Two common weight loss surgeries are banded
gastroplasty and roux-en-Y gastric bypass.
- During banded gastroplasty, a band or staples are
used to create a small pouch at the top of your stomach. This surgery limits
the amount of food and liquids the stomach can hold.
- During roux-en-Y gastric bypass, a small stomach
pouch is created with a bypass around part of the small intestine where most of
the calories you eat are absorbed. This surgery limits food intake and reduces
the calories your body absorbs.
Weight loss surgery can improve your health and
weight. However, the surgery can be risky depending on your overall health.
There are few long-term side effects with gastroplasty; however, you must limit
your food intake dramatically. Roux-en-Y gastric bypass has more side effects.
These include nausea, bloating, diarrhea, and faintnesswhich are all part
of a condition called dumping syndrome. After Roux-en-Y gastric bypass,
multivitamins and minerals may be needed to prevent nutrient deficiencies.
Lifelong medical followup is needed after both
surgeries. A monitoring program, both before and after surgery, also is advised
to help you with diet, physical activity, and coping skills.
If you think you would benefit from weight loss
surgery, talk to your doctor. Ask whether you're a candidate for the surgery
and discuss the risks, benefits, and what to expect.
Maintaining your weight loss over time can be a
challenge. For adults, weight loss is a success if you lose at least 10 percent
of your initial weight and you don't regain more than 6 or 7 pounds in 2 years.
You also must keep a lower waist circumferenceat least 2 inches lower
than your waist circumference before you lost weight.
After 6 months of keeping off the weight, you can
think about losing more if:
- You've already lost 5 to 10 percent of your body
weight, or
- You're still overweight or obese.
The key to further weight loss or to maintain your
weight loss is to continue with lifestyle changes. Adopt these changes as a new
way of life. However, if you want to lose more weight, you may need to eat
fewer calories and increase your activity level. For example, if you eat 1,600
calories a day but don't lose weight, you may want to cut back to 1,200
calories.
Adults should aim for 60 to 90 minutes of daily
moderate-intensity physical activity. Children and teens should aim for 60
minutes of physical activity a day.
How Can Overweight and Obesity Be Prevented?
Staying at a healthy weight and preventing
overweight and obesity can be achieved through living a healthy lifestyle.
Because lifetime habits begin in childhood, it's important for parents and
families to create habits that encourage healthy food choices and physical
activity early in life.
- Follow a healthy eating plan. Make healthful food
choices, keep your calories and your family's calorie needs in mind, and focus
on the balance of energy IN and energy OUT.
- Focus on portion size. Watch the size of portions
in fast food and other restaurants. The portions served are often enough for
two or three people. Children's portion sizes should be smaller than those for
adults. Cutting back on portion size is a sure way to help keep energy IN and
energy OUT in balance.
- Be active. Make personal and family time active.
Find activities that everyone will enjoy. For example, go for a brisk walk,
bike or rollerblade, or train together for a walk or run.
- Reduce screen time. Limit the use of TVs,
computers, DVDs, and video games, because they crowd out time for physical
activity. Health experts recommend 2 hours or less a day of screen time that's
not work- or homework-related.
- Keep track of weight and other measurements.
Monitor your weight, body mass index, and waist circumference on a regular
basis. Also, keep track of your children's growth.
Four Institutes from the National Institutes of
Health, led by the NHLBI, have come together to promote We
Can!Ways to Enhance Children's Activity & Nutrition. We
Can! is a national education program designed for parents and caregivers to
help children 8 to 13 years old stay at a healthy weight.
The evidence-based program offers parents and
families tips and fun activities to encourage healthy eating, increase physical
activity, and reduce time spent being inactive. Currently, more than 140
communities around the country are participating in We Can! programs for
parents and youth. These community groups include hospitals, health
departments, clinics, faith-based organizations, YMCAs, schools, and more.
Links to Other Information About Overweight and
Obesity
More information about We Can! and other
information and publications about overweight and obesity can be found on the
NHLBI Web site at www.nhlbi.nih.gov.
The NHLBI Portion Distortion Web pages show you how
food portion sizes have increased in the last 20 years. Quiz yourself to see if
you know how today's portions compare to portions in the past.
The NHLBI Interactive Menu Planner can help you plan
and monitor your healthy eating plan.
Other overweight- and obesity-related NHLBI
publications include:
- The "Aim for a Healthy Weight" Patient
Booklet
- "Facts About Healthy Weight"
- "We Can! Families Finding the Balance: A
Parent Handbook"
- "Your Guide to a Healthy Heart"
- "Your Guide to Healthy Sleep"
- "Your Guide to Physical Activity and Your
Heart"
You can download or order copies of NHLBI
publications from the Web site. To speak with a health information specialist
or order print copies of publications, call the NHLBI Health Information Center
at 3015928573. |