Because of these risks, it is
important to lose weight even if you don't feel bad now. It is hard to change
eating habits and exercise habits. But you can do it if you make a plan.
How do you know if you are obese?
You can use a
measurement called a body mass index, or BMI, along with your waist size, to decide whether your weight is
dangerous to your health. The BMI is a combination of your height and weight.
If you have a BMI of 30 or higher, your extra weight is putting your health in
danger.
People who
carry too much fat around the middle, rather than around the hips, are more
likely to have health problems. In women, a
waist size of 35 in. (88 cm)
or more raises the chance for disease. In men, a waist size of
40 in. (101 cm) or more raises
the chance for disease.1
If you are Asian, your health may be at risk with a BMI of 27.5 or
higher. Also, health
problems are seen with a smaller waist size. In Asian women, a waist size of
32 in. (80 cm) or more raises
the chance for disease. In Asian men, a waist size of
36 in. (90 cm) or more raises
the chance for disease.2
When you take in more
calories than you burn off, you gain weight. How you eat, how active you are,
and other things affect how your body uses calories and whether you gain
weight.
If your family members are obese, you may have inherited
a tendency to gain weight. And your family also helps form your eating and
lifestyle habits, which can lead to obesity.
Also, our busy lives
make it harder to plan and cook healthy meals. For many of us, it's easier to
reach for prepared foods, go out to eat, or go to the drive-through. But these
foods are often high in fat and calories. Portions are often too large. Work
schedules, long commutes, and other commitments also cut into the time we have
for physical activity.
You've tried diets, but you always gain the weight back. What can you do?
Focus on health, not diets.
Diets are hard to stay on and usually don't work in the long run. It is very
hard to stay with a diet that includes lots of big changes in your eating
habits.
Instead of a diet, focus on lifestyle changes that will
improve your health and achieve the right balance of energy and calories. To
lose weight, you need to burn more calories than you take in. You can do it by
eating healthy foods in reasonable amounts and becoming more active. And you
need to do it every day.
Little steps mean a lot. Losing just
10% of your body weight can make a
difference in your health.1
Make a plan for change. Work with your doctor to create a plan that will work for you.
Ask family members and friends for help in keeping with your plan. Ask your
doctor to recommend a dietitian to help you with meal planning.
When you stray from your plan, don't get upset. Figure out what got you
off track and how you can fix it.
How can you stay on your plan for change?
It's
hard to change habits. You have to be ready. Make sure this is the right time
for you. Are you ready to make a plan and stay on it? Do you have the support
of your family and friends? Do you know what your first steps will be? Becoming
healthier and staying that way is a lifelong effort.
Most people
have more success when they make small changes, one step at a time. For
example, you might eat an extra piece of fruit, walk 10 minutes more, or add
more vegetables to your meals.
Studies show that people who keep
track of what they eat are better at losing weight. Keep a notebook where you
can write down everything you eat and drink each day. You may be surprised to
see how much you are eating. Use a calorie counter to add up your calories.
(You can find calorie counters online and at bookstores.)
As you
keep track of calories, look at whether you skip meals, when you eat, how often
you eat out, and how many fruits and vegetables you eat. This will help you see
patterns that you may want to change.
You may want to write down
the amount of physical activity you've had each day and compare the calories
you burned to those you took in. Use the
Interactive Tool: How Many Calories Did You Burn? to see how many
calories you burn through daily activities.
Can you take medicines or have surgery to lose weight?
Surgery
and medicines don't work by themselves. Most people also need to make changes
in what they eat and how active they are.
Before your doctor will
prescribe medicines or surgery, he or she will probably want you to work on
healthier eating and activity for at least 6 months. Even if your doctor gives you
medicines or recommends surgery, you will need to keep your new healthy habits
for the rest of your life.
Obesity is a
complex disease for which no single cause or cure exists. You gain weight when
you take in more calories than you burn off. But obesity is influenced by many
other factors, including:
Your lifestyle. Modern conveniences—such as elevators,
cars, and the remote control for the television—cut activity out of our lives.
Your genes. If one of your parents is
obese, you are 3 times as likely to be obese as someone with parents of healthy
weight.3
Your friends and family.
If they eat a lot of
high-fat or snack foods, eat at irregular times, and skip meals, you probably
will too. And if they are not physically active, you may not be either.
Other things influence your weight and whether you are physically active,
including:
Low self-esteem. Being
overweight or obese may lower your
self-esteem and lead to eating as a way to comfort
yourself. Repeated failure at dieting also can affect your self-esteem and make
it even harder to lose weight.
Emotional concerns. Emotional
stress,
anxiety, or illnesses such as
depression or chronic pain can lead to overeating.
Some people eat to calm themselves, to avoid dealing with unpleasant tasks or
situations, or to dampen negative emotions.
Trauma. Distressing events—such as childhood sexual,
physical, or emotional abuse; loss of a parent during childhood; or marital or
family problems—can contribute to overeating.
Alcohol. Alcohol (beer and mixed drinks)
is very high in calories.
Medicines or medical conditions. Some
medical conditions and medicines may also cause weight gain. Examples include
having
Cushing's syndrome or
hypothyroidism or taking certain antidepressants or
corticosteroids.
Health Risks of Obesity
How
obesity affects your health depends on many things,
including your age, gender, where you carry your body fat, and how physically
active you are.
If you have healthier habits or lose
weight, your risk for these conditions is reduced.
Where you carry fat
If fat builds up mostly around your stomach (sometimes
called apple-shaped), you are at greater risk for type 2 diabetes, high blood
pressure,
high cholesterol, and coronary artery disease than
people who are lean or people with fat around the hips (sometimes called
pear-shaped). Your waist size affects your risk of health problems.
People
with obstructive
sleep apnea who lost as little as 10% of their weight
improved their sleep patterns and had less daytime sleepiness.3
Exams and Tests
Along with a regular medical
checkup, you may have some tests to check on your health.
Your
doctor may want to do blood tests to check for
type 2 diabetes,
thyroid or liver problems, and
high cholesterol or
high triglyceride levels.
Your doctor
will check your blood pressure, ask about any medicines you are taking, and
discuss your medical history and your family's medical history. He or she will
ask how active you are, whether you drink alcohol (and how much), your history
of weight gain, and how often you have tried to lose weight.
Tests are available to estimate your body fat percentage (to find out about how much of your weight is fat). This is different from your BMI. With some of these tests, you may also learn your basal metabolic rate (BMR). Knowing your BMR can help your doctor or registered dietitian plan how many calories you need each day.
Early detection
Doctors use BMI to help screen for unhealthy weight. If you have a BMI of 30 or higher, your extra weight is putting your health in danger. If you are Asian, your health may be at risk with a BMI of 27.5 or higher.2
If you have concerns that your child is overweight or at risk of becoming so, ask your doctor to review your child's growth charts and medical history with you. If your child's BMI and growth pattern suggest a weight problem, your doctor will give your child an exam to look for problems that can cause weight gain. He or she may ask questions about eating and exercise habits. Regular checkups will also be important over time.
Treatment for
obesity will be most successful if you create a
long-term plan with your doctor. A reasonable goal might be to begin making
lifestyle changes by increasing physical activity and eating healthy foods. Your initial goal should be to improve your health, not to achieve an
ideal weight.
Guidelines suggest
a goal of losing 10% of your body weight in 6 months.1 Doctors often recommend that people make lifestyle changes for at least 6 months before trying
medicines or surgery.
Your doctor may also
suggest
counseling. If you use food to cope with depression,
loneliness, anxiety, or boredom, you need to learn new skills to deal with
those feelings.
Cut calories
Eating fewer calories
while increasing activity is the best way to lose weight. For most adults, eating 1,200 to 1,500 calories a day for
women and 1,500 to 1,800 calories a day for men is recommended for weight
loss.
People often convince themselves that they don't
overeat. Keeping a food journal(What is a PDF document?) can help you find out how many calories you consume in a day. Then you can set a goal to cut out 500 to 1,000 calories a day. This will help you lose 1 to 2 pounds a week.1
Limiting your calories to very low levels might seem like the way to quick weight loss, but it can have serious negative effects on your body and your ability to keep the weight off.
Research shows that limiting calories—not the types of
foods you eat—causes more weight loss over the long term. For example, cutting only carbohydrate
or fat will not cause any more weight loss than a healthful and balanced
low-calorie diet.3
Eat healthier foods—don't diet
Rather than focusing
on a particular type of diet, try to eat healthier foods. Don't try to restrict
the foods you love. Eat less of them. Eat smaller portions.
Physical
activity helps you burn more calories. Overall, experts recommend doing moderate or vigorous activity
to get and stay healthy.5
One of the best ways to increase your
activity is by walking.
Keep track of your steps with
a step counter or pedometer. If you have a desk job, you may be surprised to
see how little you move in a typical day. Start with a goal of
increasing your steps by 2,000 steps a day and work up to 10,000 to 12,000.
See your doctor after 6
months to check your progress. Some people stop losing weight around this time,
because their bodies adjust to fewer calories and their motivation starts to
slip.
At this point your doctor may want you to increase your
activity and revisit the dietitian to make further changes to your eating habits. Your
goals may switch from losing more weight to keeping the weight off. Staying
active is very important.
If you have
lost weight but gained it back, don't be discouraged. It is not uncommon to try
several times before weight comes off and stays off. Talk to your doctor about
starting again. It may be helpful to work with others who are trying to lose
weight by following a structured program.
When to consider medicines or surgery
If you do
not lose weight, continue to gain weight, or have lost weight several times
only to regain it, or if your doctor is concerned about a
related health problem, you might need to try
medicines or surgery.
Most weight-loss programs can help you lose weight at first. But you will lose
more and have more health benefits if you can keep with it for a longer time.
You need to find the right balance of
eating and physical activity that you can keep doing or a program that works
with your lifestyle.
Are you ready to make changes?
Before you begin treatment,
decide if you are ready to make the lifestyle changes needed to lose weight.
Losing weight and keeping it off can be hard. Think
about successes that you had before and how you were able to achieve them.
If you are
ready to make a plan for healthier eating, your doctor may suggest losing 10% of your weight at a rate of
1 lb (0.45 kg) to
2 lb (0.9 kg) a week as your
first target. Research shows that a 10% weight loss can improve your
health.1 It is better that you maintain a small amount
of loss rather than lose a lot of weight fast and gain it back.
Tips to help with your weight-loss program
Set realistic goals. Many people expect to
lose much more weight than is realistic. Think about why you want to lose weight, and prepare for slip-ups..
Find what
works best for you. If you don't have time to cook and hate to prepare meals,
a program that offers meal replacement bars or shakes may be better for you. Or
if you like to prepare meals, finding a plan that includes daily menus and
recipes may be best.
Get family and friends involved to provide
support. Talk to them about why you are changing your eating habits and physical
activity and how important losing weight is to you.
Identify obstacles to losing weight. Keep a food journal(What is a PDF document?). Look at it to try to find things that cause you to overeat, such as stress or
depression.
Remove food temptations such as high-calorie snacks,
and replace them with healthier foods such as fruit and low-fat
yogurt.
Make healthy fast-food,
restaurant, and convenience-food choices to maintain your healthy eating when you eat out.
Keep unhealthy food out of the house.
Eat before
you go grocery shopping.
Tips for staying with it
Research shows that people who keep track of what they eat
and drink each day have more success at losing weight:
Keep a
food journal to record everything you eat and drink.
Pay attention to
portion sizes.
Use a calorie counter to check calories. You can find a
calorie counter at a bookstore or online (see www.caloriecontrol.org or
www.nutritiondata.com).
Think ahead about situations that may be
hard. Ask yourself if you are eating for reasons other than hunger:
Have you noticed a change in your eating
or weight since a change occurred in your lifestyle or stress
level?
Do you use
food as a reward?
Do
you eat whatever is most available because you don't plan ahead?
Weight-loss programs
Many commercial weight-loss programs (such as
Weight Watchers or Lifesteps) and self-help or support groups (such as
Overeaters Anonymous) are available. The quality and effectiveness of
programs vary widely, from reputable obesity clinics associated with hospitals
to quick weight-loss schemes that may even harm your health with untested
"miracle" products.
When
considering a weight-loss program, ask
questions about the staff's qualifications and whether counseling is offered.
Be aware that the advertising strategies for weight-loss programs and products,
such as using celebrities and "before and after" pictures, are usually
unrealistic.
Most weight-loss medicines for
obesity work by making you feel less hungry or making
you feel full sooner. They are used together with healthy eating habits and exercise.
Medicine is generally used only for those who have a
body mass index (BMI) of 30 or higher. But they
sometimes are used for those with a BMI of 27 or higher who are at risk for
high blood pressure,
high cholesterol,
coronary artery disease,
type 2 diabetes, and
sleep apnea.1
Medicine choices
Orlistat (Xenical)
is a prescription medicine that prevents some of the fat calories you eat from
being absorbed in your intestines. Also, orlistat (Alli) is available
over the counter. Alli contains half of the medicine
that is in Xenical.
Appetite suppressants like phentermine suppress your appetite. They are approved
only for short-term use. Phentermine is no longer
sold in Europe because of a possible link with heart and lung
problems.
Lorcaserin (Belviq) is a prescription medicine that you take twice a day. It can help you eat less and feel satisfied with eating smaller amounts of food.
Phentermine/topiramate (Qsymia) is a prescription medicine that combines the drugs phentermine and topiramate. Taking it once a day can help you eat less.
Prescription orlistat is the only weight-loss drug that is approved for children. It is meant to be used only in children over the age of 12. The over-the-counter form of orlistat is not meant for use by anyone under 18 years old.
What to think about
Medicine doesn't
work for everyone. And medicine alone is not as effective as when combined with
healthy eating habits or activity.
Surgery may be an option if you have a
body mass index (BMI) of 40 or more. It may also be an option if you have a BMI of 35 and another health
problem related to your weight, such as
diabetes or
arthritis.
Experts are still debating whether surgery for obesity is okay for children.
The goal of surgery is to cause
significant weight loss. This should reduce
obesity-related health problems, including type 2
diabetes and
high blood pressure.
Surgery can help you lose weight in a couple of ways. Restrictive operations (such as adjustable gastric band ) reduce how much food you can eat by making the stomach smaller. Malabsorptive operations (such as Roux-en-Y gastric bypass) make it harder for your body to digest and absorb food.
It is important to
remember that you may still be obese or overweight after the surgery. Also,
surgery will require you to make extreme changes in how you eat, such as eating
only a few ounces of food at a time because the surgery creates a much smaller
stomach.
After surgery, you
will need to learn new ways to eat. You'll need to eat very slowly and
chew your food well. You will not be able to drink for 30 minutes before eating, during your
meal, and for 30 minutes after eating. If you don't make these changes, you may vomit frequently
and have pain. You may also develop nutrition problems.
Your doctor may recommend calcium, iron, and
vitamin supplements.
What to think about
All surgeries have risks. Discuss your treatment options
with your doctor to decide what is best for you.
Most people who
have surgery to treat obesity begin to lose weight quickly. Weight loss usually
continues for about 2 years.
Risks common to all surgeries for
weight loss include an infection in the incision, a leak from the stomach into
the abdominal cavity or where the intestine is connected (resulting in an
infection called
peritonitis), and a blood clot that blocks blood flow
in the lung (pulmonary embolism). Some people develop
anemia or
osteoporosis.
It is important to
compare the risks of being obese with the risks of surgery.
Other Places To Get Help
Organizations
Centers for Disease Control and Prevention
(CDC)
1600 Clifton Road
Atlanta, GA 30333
Phone:
1-800-CDC-INFO (1-800-232-4636)
TDD:
1-888-232-6348
Email:
cdcinfo@cdc.gov
Web Address:
www.cdc.gov
The Centers for Disease Control and Prevention (CDC) is
an agency of the U.S. Department of Health and Human Services. The CDC works
with state and local health officials and the public to achieve better health
for all people. The CDC creates the expertise, information, and tools that
people and communities need to protect their health—by promoting health,
preventing disease, injury, and disability, and being prepared for new health
threats.
National Heart, Lung, and Blood Institute
(NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
TDD:
(240) 629-3255
Email:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:
Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
pneumonia.
Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK)
Building 31, Room 9A06
31 Center Drive, MSC 2560
Bethesda, MD 20892-2560
Phone:
(301) 496-3583
Web Address:
www.niddk.nih.gov
The National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) provides information and conducts research on a wide
variety of diseases as well as issues such as weight control and
nutrition.
Overeaters Anonymous (OA)
P.O. Box 44020
Rio Rancho, NM 87174-4020
Phone:
(505) 891-2664 (or check the White Pages for a local number)
Fax:
(505) 891-4320
Email:
info@oa.org
Web Address:
www.oa.org
Overeaters Anonymous (OA) is a nonprofit international organization
that sponsors a 12-step program to help people understand and overcome
compulsive eating disorders. OA is not a weight-loss program and makes no
claims for weight loss. The program focuses on the psychological and social
aspects of overeating.
Shape Up America!
P.O. Box 15009 Native Dancer Road
North Potomac, MD 20878
Phone:
(240) 715-3900
Email:
info@shapeup.org
Web Address:
www.shapeup.org
Shape Up America! is a national coalition of industry
and medical experts in nutrition and fitness. Its goals are to make Americans
more aware of the importance of maintaining a healthy weight and to provide
information about how to lose weight and stay fit. The organization has
published several booklets on weight loss and diet, which can be ordered from
the Web site.
Weight-Control Information Network
(WIN)
1 WIN Way
Bethesda, MD 20892-3665
Phone:
1-877-946-4627 toll-free
Fax:
(202) 828-1028
Email:
win@info.niddk.nih.gov
Web Address:
http://win.niddk.nih.gov/index.htm
The Weight-control Information Network (WIN) is a
service of the National Institute of Diabetes and Digestive and Kidney
Diseases, part of the National Institutes of Health. WIN supplies information
on weight control, obesity, and nutritional disorders for the public and for
health professionals.
National Heart, Lung, and Blood Institute, National
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Purnell JQ (2008). Obesity. In DC Dale,
DD Federman, eds., ACP Medicine, section 3, chap. 10.
Hamilton, ON: BC Decker.
American Gastroenterological Association (2002, reapproved 2008). AGA
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882–932. [Erratum in Gastroenterology, 123(5):
1752.]
Klien S, Romijin JA (2008). Obesity. In HM Kroneberg
et al., eds., Williams Textbook of Endocrinology, 11th
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U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/guidelines/default.aspxf.
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