A Patient's Guide to Obesity

Ruben Castaneda


The obesity epidemic in the United States that's affecting the health of tens of millions of people shows no signs of easing up. In 1990, about 15% of adults in most U.S. states had obesity, according to the Harvard T.H. Chan School of Public Health. As of 2015-16, about 40% of adults nationally and more than 18% of children nationwide were considered obese, according to data from the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey.

These figures were highlighted in a report, "The State of Obesity 2018: Better Policies for a Healthier America," released in 2018 by Trust for America's Health (a health policy organization based in the District of Columbia) and the Robert Wood Johnson Foundation. "We are unlikely to see progress in combating obesity unless we pay attention to the social and economic conditions that have led to dramatic increases in its rates," says John Auerbach, Trust for America's president and chief executive officer. "We have to support policies that will modify neighborhoods, schools and workplaces in ways that make it easier to have a healthy diet and to be physically active."

People who have obesity or are overweight face serious health consequences, says Dr. Garth Graham, a practicing cardiologist and president of the Aetna Foundation in Hartford, Connecticut. Being obese and being overweight are associated with a wide array of health problems, including heart disease, diabetes, some types of cancer, stroke, hypertension, reproductive dysfunction, psychiatric conditions and nonalcoholic fatty liver disease, he says.

Obesity Is a Chronic Disease

Some people think that people with obesity lack willpower and discipline when it comes to their eating and exercise habits, but it's important to keep in mind it's a chronic disease, says Angela Golden, vice president of the Arizona Nurse Practitioner Council. Golden has authored numerous articles about obesity in peer-reviewed journals. Like other chronic diseases, obesity has clear signs and symptoms, and it's also associated with other diseases and conditions, she says. "Obesity is a disease and is not just about behavior," Golden says.

Obesity Diagnosis

There's no lab test, like a blood screening, to diagnose obesity. A person is classified as being obese if he or she has a body mass index of 30 or higher, Graham says. Your height and weight determine your BMI. For example, an adult male who is 5 feet, 7 inches tall and weighs 174 pounds would have a BMI a little over 27, and would be considered overweight, according to the CDC's adult BMI calculator.

The BMI measurement is widely accepted in the medical community, says Dr. Shailendra Patel, a professor and director of the Division of Endocrinology, Diabetes and Metabolism at the University of Cincinnati College of Medicine. He's also a clinician at UC Health in Cincinnati. The BMI measurement is universally available and inexpensive. There are other ways to diagnose obesity, but they are typically not covered by insurance, are not widely available and are used primarily for research, Patel says. For example, an MRI or a CT scan can measure the amount of fat inside a patient's abdomen, which is an indicator of obesity. Specifically, health care providers can use an MRI or a CT scan to detect fat inside the abdomen, which is known as "bad fat." This kind of fat is associated with health issues, like diabetes, hypertension and heart disease that are in turn linked to obesity. But those exams cost hundreds to thousands of dollars, aren't available in every medical setting and would typically not be approved by health insurance companies to diagnose obesity, he says. Using a BMI to diagnose obesity is perfectly acceptable, though not perfect. That's because some patients may have a BMI of 30 or higher without any health issues like high blood pressure or diabetes that are associated with obesity. Conversely, some patients may have a BMI lower than 30 but have large amounts of internal abdominal fat, which would suggest a more harmful form of obesity.

Symptoms of Obesity

Obesity is associated with a number of health issues, including:

-- Sleeping difficulties.

-- Varicose veins.

-- Joint pain.

-- Shortness of breath.

A Significant Increase in Obesity

Since she began practicing medicine in 2010, Dr. Rocio Salas-Whalen, a triple board-certified endocrinologist and the founder of New York Endocrinology in New York City, has seen the number of patients she treats who have obesity rise significantly. At the outset of her medical career, about 1 in 10 patients had obesity, she says. Today, about 1 in 3 of the patients she sees have obesity. "I have days where I just see patients for obesity," she says. "And they're younger than in the past. Before, most of the patients with obesity were middle-aged or older. Now, the majority are in their 20s and 30s."

[See: 10 Unusual Weight-Loss Tips That Actually Work.]

There are three broad types of risk factors for obesity:

1. Behavioral.

Certain behaviors, consuming too many calories, eating the wrong types of foods and not exercising enough can lead to obesity, says Dr. Tirissa J. Reid, an assistant professor of medicine in the department of medicine endocrinology at Columbia University Vagelos College of Physicians and Surgeons. She's also a staff physician at the Weight Control Center at Columbia University Irving Medical Center in New York City. For example, eating a high-calorie diet that includes lots of processed, fatty and sugary foods can lead to being overweight or obese, she says.

2. Genetic.

Some people are genetically predisposed to obesity. "Your genes may affect the amount of body fat you store and where that fat is distributed," Graham says. "Genetics may also play a role in how efficiently your body converts food into energy and how your body burns calories during exercise."

3. Environmental.

Where you live can have a significant effect on your risks for obesity and being overweight, Graham says. "Your ZIP code is more important than your genetic code when it comes to your overall health," he says. "If you don't have easy access to healthy foods, can't walk around outside and are constantly surrounded by sources of stress, that can create a cycle that leads to obesity. Two Americans can live less than 10 miles apart from each other but face stark differences in life expectancy. Many social factors determine health outcomes, from stable housing and food security to employment opportunities and policy."

Here are specific risk factors for obesity:

-- A high-calorie diet.

-- Low or no physical activity.

-- Stress.

-- A family history of being overweight or obese.

-- Race and ethnicity (African Americans, Native Americans and Hispanics have higher rates of obesity).

-- Age (your metabolism slows as you get older).

-- Taking medications that promote weight gain (some antidepressants, antipsychotics and diabetes medications lead to an increase in pounds).

-- Poor sleep.

-- Certain medical conditions, like hypothyroidism, which decreases the body's metabolic rate.

Strategies to Fight Obesity

There are a wide array of strategies available to fight obesity, says Lauren Merryman, a registered dietitian based in College Station, Texas. Merryman is the senior team lead for Cecilia Health, a New York City-based health tech services company. Cecilia Health partners with pharmaceutical companies, payers, accountable care organizations and self-insured employers to provide approaches to improve health outcomes for people living with diabetes and related chronic conditions. Here are 13 strategies for fighting obesity:

-- Get help from your health care provider.

-- Eat a healthy, Mediterranean-style diet.

-- Reduce your stress.

-- Develop a healthy sleep regimen.

-- Exercise regularly.

-- Consider weight loss medication.

-- Explore switching medications that cause weight gain.

-- Beware of binge-watching.

-- Set small, achievable goals.

-- Don't skip meals.

-- Consider bariatric surgery.

-- Manage food cravings.

-- Control your environment.

1. Seek help from a health care provider who specializes in obesity.

While it's important for everyone to develop a good relationship with his or her primary care provider, many people who are obese would benefit from working with a doctor who specializes in obesity medicine and a registered dietitian who specializes in obesity and weight management, says Lisa Garcia, a registered dietitian based in Laconia, New Hampshire. "Obesity is a chronic disease," Garcia says. Multiple risk factors -- physiological, behavioral, environmental and emotional -- can lead to obesity, she says. Health care professionals trained in dealing with those risk factors can help you develop eating and exercise strategies to achieve a healthier weight, Garcia advises.

2. Eat a healthy, Mediterranean-style diet.

Consuming a Mediterranean diet is a great tool for healthy weight loss, says Dr. Eric Pham, a bariatric surgeon and weight loss specialist with St. Joseph Hospital in Orange, California. The Mediterranean diet is high in vegetables, whole grains, fruits and lean sources of protein like fish and poultry. Those who follow it will avoid drinking beverages high in sugar, fatty meats and processed foods, like snack chips, he says. Such offerings provide lots of empty calories and relatively few nutrients. It's important to keep in mind that the best eating regimen for weight loss is one you can follow. Find an approach that includes different kinds of healthy foods that you'll stick with.

[See: 7 Ways to Hack Your Grocery Trip for Weight Loss.]

3. Manage your stress.

Prioritizing your mental health is key when it comes to losing weight, Graham says. "Stress can trigger loss of sleep, lead to unhealthy eating and can prevent you from losing weight, so managing stress -- whether through exercise, mindfulness or another activity -- can help you lose weight," he says.

4. Develop a healthy sleep regimen.

"The amount of sleep you get can play a big role in managing your weight and your heart health," Graham says. Ongoing sleep deficiency is linked to an increased risk of problems like obesity, heart disease, high blood pressure and stroke, he says. He notes that the Centers for Disease Control and Prevention recommends adults ages 18 to 60 get at least seven hours of sleep nightly.

5. Exercise regularly.

You can't out-exercise a poor eating regimen, but if you improve your eating habits, exercise can help you lose weight and keep it off, Reid says. Walking, biking, swimming or working out at the gym -- with or without a trainer -- are good options, Reid says. Add small increments of exercise throughout the day, she advises. For example, take a 10-minute walk at the start of your lunch hour, and increase your exercise by getting off the train or the bus one or two stops earlier than usual, or by parking your car in the space farthest from the office. Get up to walk around the office for five minutes every hour.

6. Consider weight loss medication.

There are a number of medications approved by the Food and Drug Administration to treat obesity, Salas-Whalen says. Some weight loss medications keep your appetite and food cravings in check, while others boost metabolism. For example, Qsymia is an appetite suppressant and Saxenda mimics a hormone produced in the gut that decreases appetite and increases satiety, Salas-Whalen says. Talk to your doctor about whether such medications are right for you and discuss possible side effects.

7. Explore switching medications that cause weight gain.

Some antidepressants and medications to treat seizures, psychosis and diabetes can cause weight gain. If you're taking one or more of these, ask your health care provider about alternative medications that won't cause weight gain, Salas-Whalen says. "There may be a better option for you," she says.

8. Beware of binge-watching.

The abundance of streaming and on-demand services has popularized the practice of binge-watching TV shows like "Game of Thrones" and "Stranger Things." It's fine to watch your favorite shows, but space out the episodes, Garcia advises. Settling in front of your TV or laptop for marathon viewing can disrupt your sleeping regimen. Some people also consume more snacks when they spend long periods of time being sedentary. "The next episode you want to see will be there tomorrow," Garcia says. "You don't have to watch all the episodes at once. Make technology work for you."

9. Set small, achievable goals.

Losing a large amount of weight can seem overwhelming at first, so it's best to set small, achievable goals, Merryman says. Aim to lose a handful of pounds weekly, rather than trying to drop a large amount of weight in a short time. The same holds true for developing healthier eating habits. "For example, if you don't currently consume vegetables on a daily basis, then it may not be realistic to meet the recommendation of (consuming) at least three cups a day," she says. "Try starting with a half cup once or twice a day and go from there."

10. Don't skip meals.

Some people who skip meals think they're cutting back on the number of calories they're consuming, Garcia says. But if you skip a meal, chances are you'll be hungrier than usual later in the day and make poor food choices. "If you eat regularly scheduled meals, you're more likely to make good food choices," she says.

11. Manage food cravings.

Craving particular foods is not the same as being hungry, says Stephen Benoit, an associate professor of psychiatry and behavioral neuroscience at the University of Cincinnati College of Medicine. He practices at the UC Health Weight Loss Center in Cincinnati. Most food cravings are for a particular food, typically one that's sweet or high in fat or salt and loaded with calories, he says. Remember that cravings come and go; when they hit, go for a walk, play a game, read, call a friend or do something else to distract yourself until the craving subsides, he says.

12. Consider bariatric surgery.

Bariatric surgery could be an effective strategy for a motivated person with severe obesity, Pham says. Surgeries like the sleeve gastrectomy, duodenal switch or gastric bypass not only restrict the amount of food a person can eat, but also change the patient's hormones in such a way to promote weight loss, he says. He cautions that bariatric surgery patients can regain the weight they lose unless they change their lifestyle and eating habits.

According to the Mayo Clinic, in general, bariatric surgery can be an option for patients who:

-- Have unsuccessfully tried other ways to lose weight.

-- Have a BMI of 40 or higher.

-- Have a BMI of 35 or higher and another serious weight-related health problem, like diabetes.

-- Are teenagers who've gone through puberty and have a BMI of at least 45 and serious health problems related to obesity.

[See: 8 Weird Ways Obesity Makes You Sick. ]

13. Control your environment.

One way to cut down on eating unhealthy foods is to remove the temptation from your environment, says Lisa West-Smith, an assistant professor in the Department of Psychiatry and Behavioral Neuroscience and Department of Surgery at the University of Cincinnati College of Medicine. She's also director of behavioral health services at the UC Health Weight Loss Center in Cincinnati. Jettison offerings like sugary beverages, processed snack chips and meats, cookies, cakes and pastries in favor of healthy foods such as fresh fruits and vegetables and lean meats, she says.