Weighing the Options Criteria for Evaluating Weight-Management Programs (1995) / Chapter Skim
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2 The Nature and Problem of Obesity
2 The Nature and Problem of Obesity
Pages 37-63
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From page 37... ...
For most people, even a brief abatement in effort will be met with a significant setback in control. Studies in controlled settings show that individuals who complete weight-loss programs lose approximately 10 percent of their body weight, but gain two-thirds of it back within 1 year and almost all of it back within 5 years (NIH Technology Assessment Conference Panel, 1993~.
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From page 38... ...
In addition, obese individuals must learn to stay away from programs that give false hopes by suggesting that, compared to the programs of legitimate competitors, they are more effective at weight loss and that their unique methods ensure permanent loss. For its part, the scientific community must continue research that will provide us with a fundamental understanding of the basic causes of obesity; this understanding is essential if we are to design maximally effective obesity treatments and develop the means for preventing the disease.
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From page 39... ...
The problems involved in defining obesity are similar to those encountered in defining physical activity, hypertension, and hypercholesterolemia, in which continuous variables such as weight, blood pressure, energy expenditure, and blood cholesterol concentration are categorized
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From page 40... ...
Each entry gives the body weight in pounds for a person of a given height and body mass index. Pounds have been rounded off.
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From page 41... ...
The problems involved in defining obesity are similar to those encountered in defining physical activity, hypertension, and hypercholesterolemia, in which continuous variables such as weight, blood pressure, energy expenditure, and blood cholesterol concentration are categorized
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From page 42... ...
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From page 43... ...
They are comparable to a body weight 20 and 40 percent, respectively, above the so-called ideal body weight derived from the popular weight-for-height tables issued by Metropolitan Life Insurance Company in 1983. The meaning of the term healthy weight as well as how best to measure it remains the subject of scientific debate.
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From page 44... ...
Comorbidities linked to obesity include coronary heart disease, stroke, hypertension, obstructive sleep apnea, diabetes mellitus, gout, dyslipidemia, osteoarthritis of weight-bearing joints (such as the knees and hips) , gallstones and cholecystitis, reduced fertility, reduced physical agility and increased risk of accidents, and impaired obstetrical performance (IFT, 1994; Pi-Sunyer, 1 993a)
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From page 45... ...
They are comparable to a body weight 20 and 40 percent, respectively, above the so-called ideal body weight derived from the popular weight-for-height tables issued by Metropolitan Life Insurance Company in 1983. The meaning of the term healthy weight as well as how best to measure it remains the subject of scientific debate.
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From page 46... ...
Comorbidities linked to obesity include coronary heart disease, stroke, hypertension, obstructive sleep apnea, diabetes mellitus, gout, dyslipidemia, osteoarthritis of weight-bearing joints (such as the knees and hips) , gallstones and cholecystitis, reduced fertility, reduced physical agility and increased risk of accidents, and impaired obstetrical performance (IFT, 1994; Pi-Sunyer, 1 993a)
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From page 47... ...
A WHR of more than 1 .0 in males and 0.8 in females suggests a weight distribution that poses increased risks to health compared to the excess weight: alone. Abdominal diameter in the saggital plane is a marginally better measure than WHR, and scanning techniques (such as dual-energy x-ray absorptiometry are even more accurate in evaluating abdominal obesity.
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From page 48... ...
INCIDENCE AND PREVALENCE The most recent data on the prevalence of obesity in the United States come from the Third National Health and Nutrition Examination Survey (NHANES III) conducted by NCHS.
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From page 49... ...
These SES differentials hold for both genders (unpublished data from NHANES III, Phase 1, 1988-1991, provided by NCHS)
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From page 50... ...
However, adjusting for the effects of changes in smoking prevalence does not account for the increase in the proportion overweight from 1976-1980 to 1988-1991 (unpublished data from NHANES III, Phase 1, 1988-1991, provided by NCHS)
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From page 51... ...
Among the nonoverweight group, men and women 35 44 years old were most likely to become overweight, with the incidence of overweight decreasing with increasing age. Compared to white females, black women 35~4 years old gained more weight on average, were more likely to have experienced a major weight gain, and were more likely to become overweight (Williamson et al., 1990~.
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From page 52... ...
, lipid concentrations (cholesterol >200 mg/dl; triglycerides >225 mg/dl) , non-~nsulin-dependent diabetes mellitus, osteoarthritis, sleep apnea, and premature death in the family from coronary heart disease.
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From page 53... ...
associated with their obesity. However, obese persons are at increased risk for developing comorbidities, especially over time as they get older.
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From page 54... ...
The 1992 Weight Loss Practices Survey sponsored by the U.S. Food and Drug Administration and the National Heart, Lung, and Blood Institute found that 13 percent of adult males and 15 percent of adult females trying to lose weight were using commercial meal replacements (Levy and Heaton, 1993~.
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From page 55... ...
. Although it is clear that genetics has a modest influence on obesity on a population basis, by far the largest amount of the variance in body weight is due to environmental influences.
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From page 56... ...
The 1992 Weight Loss Practices Survey sponsored by the U.S. Food and Drug Administration and the National Heart, Lung, and Blood Institute found that 13 percent of adult males and 15 percent of adult females trying to lose weight were using commercial meal replacements (Levy and Heaton, 1993~.
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From page 57... ...
The long-term benefits of weight loss are not yet well studied, although important new data are becoming available from randomized, controlled clinical trials. Small Weight Losses Linked to Health Benefits Small weight losses, of as little as 10 to 15 percent of initial body weight, can generally help reduce obesity-related comorbidities (e.g., hypertension, abnormal glucose tolerance, and abnormal lipid concentrations)
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From page 58... ...
Furthermore, blood pressure rose more slowly than did body weight in those patients who subsequently regained weight. Results from the Framingham study showed a 15 percent decrease in weight to be associated with a 10 percent reduction in systolic blood pressure (Kennel et al., 1967~.
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From page 59... ...
So clear are the benefits of weight loss to lowering blood pressure that the Fifth Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure continues to advise weight reduction as an important goal for obese, hypertensive individuals (NHBPEP, 1993~. A companion report also recommends weight reduction for the primary prevention of hypertension (NHBPEPWG, 1993~.
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From page 60... ...
These results suggest that in a severely obese population, significant weight reduction decreases morbidity and ultimately should decrease mortality. They are consistent with the results of studies in experimental animals where restricting the food intake of genetically obese mice results in decreased mortality compared to obese controls fed ad libitum (Lane and Dickie, 1958~.
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From page 61... ...
Even without weight loss, obese individuals are likely to derive health benefits from improving their health-care practices and dietary patterns and incorporating more physical activity into their lives. THE COSTS OF OBESITY The high prevalence of obesity in this country together with its link to numerous chronic diseases leads to the conclusion that this disease is responsible for a substantial proportion of total health-care costs.
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From page 62... ...
These results suggest that in a severely obese population, significant weight reduction decreases morbidity and ultimately should decrease mortality. They are consistent with the results of studies in experimental animals where restricting the food intake of genetically obese mice results in decreased mortality compared to obese controls fed ad libitum (Lane and Dickie, 1958~.
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From page 63... ...
Even without weight loss, obese individuals are likely to derive health benefits from improving their health-care practices and dietary patterns and incorporating more physical activity into their lives. THE COSTS OF OBESITY The high prevalence of obesity in this country together with its link to numerous chronic diseases leads to the conclusion that this disease is responsible for a substantial proportion of total health-care costs.
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