Facts about Obesity

Obesity is defined as a body mass index (BMI) of 30 kg per m2 or more. Overweight is defined as a BMI of 25 to 29.9 kg per m2. About 35 percent of American adults (aged 20 years of age or older) are overweight. In addition, 14 percent of children between the ages of 6 and 11, and 12 percent of adolescents between the ages of 12 and 17 are overweight.
Pathophysiology. The adipocyte has endocrine capabilities and secretes leptin — a protein product of the ob gene — in response to increased stores of energy. Leptin limits food intake by acting upon the OB receptor in the hypothalamus. In many obese adults, leptin levels are increased, whereas leptin uptake into the central nervous system is low.
Diagnosis of obesity begins with the determination of BMI. The BMI can be ascertained by measuring the patient’s height and weight and then using a BMI table to find the BMI value.

Management
For most patients, the initial weight loss objective should be a 10 percent reduction from baseline body weight over a period of about four to six months. After six months, the rate of weight loss often stabilizes or slows.
An overweight individual with a BMI of less than 30 kg per m2 and no health risk factors should have a target, six-month BMI in the range of 20 to 27. A decrease of 300 to 500 kcal per day will produce weight losses of 0.5 to 1 lb (0.22 to .45 kg) per week (10 percent reduction at six months).

Nutrition therapy
A meal plan that creates an energy deficit of 500 to 1,000 kcal per day less than the individual’s average daily intake will usually be suitable for weight reduction. Along with caloric reduction, a reduction in total fat consumption should be recommended. Caloric restrictions for the treatment of overweight and obesity can be classified as follows:
Moderate deficit diet (all health risk groups). Women: 1200+ kcal per day; men: 1400+ kcal per day
Low-calorie diet (moderate to extremely high health risk groups). Women: 800 to 1200 kcal per day; men: 800 to 1400+ kcal per day
Very low-calorie diet (high to extremely high-health risk groups). Less than 800 kcal per day.
Among patients treated with a moderate deficit diet, weight losses average about 1 lb (0.45 kg) per week. Because even moderate deficit diets may pose nutritional concerns, such as deficiencies in calcium, iron, and folic acid, vitamin and mineral supplementation may be recommended.

Physical activity
Although most weight loss is achieved through decreased caloric intake, physical activity is the primary factor responsible for increased caloric expenditure. Exercise may reduce the desire for foods that are high in fat and also may help to promote dietary compliance.
The long-term physical activity goal of most adults should be to perform 30 or more minutes of moderately intensive physical activity such as walking each day.

Behavior modification methods
Stimulus control to detect and respond to environmental cues associated with unhealthy eating habits and physical inactivity (eg, refraining from eating when not hungry).
Self-supervision of eating habits and physical activity (eg, keeping a food and activity diary).
Positive reinforcement of beneficial lifestyle changes (eg, rewards; social support from family and friends).
Stress management (eg, relaxation techniques, meditation, problem-solving strategies).
Cognitive restructuring to moderate self-defeating thoughts and emotions (eg, redefining body image and modifying unrealistic goals).

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