America has become a country with a rapidly expanding population of overweight people. Today approximately 68.3 percent of American adults are either overweight or obese, and 33.9 percent are obese, according to the Centers for Disease Control and Prevention (CDC). The obesity epidemic is a rapidly growing problem in this country.

In 2000, no state had an obesity prevalence of 30 percent or more. In 2009, nine states had obesity rates of 30 percent or more. And by 2010, the number of states that had obesity rates of 30 percent or more increased to 12. Why are these facts alarming?

Obesity, defined as a Body mass index(BMI) of 30 or more, is the second leading cause of preventable death in the United States and results in an estimated $147 billion in health care costs each year.

Overweight individuals, defined as having a BMI between 25 and 29.9, are more likely to have high blood pressure and high blood cholesterol, major risk factors for heart disease and stroke. Additionally, the results of a large study supported by the U.S. National Heart, Lung, and Blood Institute (NHLBI) suggest that excess body weight is strongly and independently associated with an increased risk of heart failure.

Overweight and obesity also are major risk factors for developing type 2 diabetes. Diabetes is a major cause of early death, heart disease, kidney disease, stroke, blindness and amputation.

Several types of cancer are associated with being overweight, including cancer of theuterus, gallbladder, kidney, breast and colon. Other conditions linked with obesity include sleep apnea, osteoarthritis, gout, gallbladder disease and infertility. Obesity-related conditions worsen as weight increases and often improve as the excess weight is lost.

Obesity is a major component of a group of metabolic risk factors known collectively as metabolic syndrome,

which is defined as having at least three of the following five markers:

• A waist measurement of more than 35 inches in women and more than 40 inches in men
• A fasting blood glucose level of 100 mg/dL or higher; or you’re already taking medication because you have high blood glucose levels.
• A triglyceride level at or above 150 mg/dL. Triglycerides are a form of fat in your blood.
• An HDL cholesterol level (the “good” cholesterol) below 50 mg/dL (below 40 mg/dL in men); or you’re already taking medication to increase your HDL level.
• Blood pressure at or above 130 mm Hg systolic (the top number) or 85 mm Hg diastolic (the bottom number); or you’re already taking medication to treat high blood pressure.

Health conditions that promote metabolic syndrome are overweight/obesity, physical inactivity and genetic factors. People who have this syndrome are at increased risk for developing coronary heart disease, stroke, peripheral arterial disease and type 2 diabetes.

Obesity is a complex disorder. It is caused by multiple factors, both environmental and inherited, including excessive calorie and food intake, decreased physical activity and genetic influences. Though there may be other factors that affect weight gain, such as genetic and environmental influences, you most likely gain weight because you consume more calories (energy) than your body uses or needs.

What’s the difference between being obese and being overweight? The defining characteristic in both overweight and obese people is excess body fat. The difference is a matter of degree.

Health care professionals use a simple calculation called the body mass index (BMI) to determine body weight relative to height. In adults, the BMI calculation strongly correlates with total body fat content in adults. Overweight is defined as having a body mass index (BMI) between 25 and 29.9.

Obesity is defined as having a BMI of 30 or more. Use Health Women online calculator to check your BMI. Another way to determine your risk relative to your weight is to measure your waist circumference. Women with a waist circumference over 35 inches (and men over 40 inches) are at greater risk for disease.

Where excess body fat is distributed on your body also plays a role in your risk for disease. Weight gain around your waist (specifically in your abdominal area) is more of a health risk than weight gained on your hips and thighs. Unlike fat around the thighs, which is more common in women and is more likely to serve as an energy reservoir, abdominal fat deposits fatty acids directly into the bloodstream for immediate short-term energy, increasing triglyceride and, eventually, cholesterol levels.

Therefore, excess abdominal fat is associated with an increase in blood cholesterol and insulin resistance, which may result in diabetes. An “apple shaped” figure may also raise your risks for other life-threatening illnesses, such as heart disease and stroke.

Diagnosis

An excess of body fat—the defining characteristic of obesity—results from an imbalance between the amount of calories you take in and those you expend. The reasons for this imbalance are unclear, and the relationship between energy intake/expenditure and body fat storage and distribution varies from person to person.

Factors that promote obesity include:

• genetic predisposition
• family history of obesity
• age
• behavioral factors (including a high-fat or high-calorie diet and sedentary lifestyle)

Measuring Obesity

Assessing your weight to determine if you are obese involves two key measurements—body mass index (BMI) and waist circumference. Understanding your risk factors for conditions associated with obesity, according to clinical practice guidelines issued by the National Heart, Lung, and Blood Institute (NHLBI), is important. First, your health care professional should determine your body mass index (BMI), which describes your body weight relative to your height.

It is strongly correlated with total body fat content in adults. Your BMI is your weight in pounds divided by your height in inches squared, then multiplied by 703. The following chart shows body mass indices for people of various heights and weights. To determine your BMI, find the row that most closely approximates your weight. Read across the row until it crosses the column closest to your height. You may also use Health Women online calculator.

Weight	100	105	110	115	120	125	130	135	140	145	150
Height
5’0″	20	21	21	22	23	24	25	26	27	28	29
5’1″	19	20	21	22	23	24	25	26	26	27	28
5’2″	18	19	20	21	22	23	24	25	26	27	27
5’3″	18	19	19	20	21	22	23	24	25	26	27
5’4″	17	18	19	20	21	21	22	23	24	25	26
5’5″	17	17	18	19	20	21	22	22	23	24	25
5’6″	16	17	18	19	19	20	21	22	23	23	24
5’7″	16	16	17	18	19	20	20	21	22	23	23
5’8″	15	16	17	17	18	19	20	21	21	22	23
5’9″	15	16	16	17	18	18	19	20	21	21	22
5’10”	14	15	16	17	17	18	19	19	20	21	22
5’11”	14	15	15	16	17	17	18	19	20	20	21
6’0″	14	14	15	16	16	17	18	18	19	20	20
6’1″	13	14	15	15	16	16	17	18	18	19	20
6’2″	13	13	14	15	15	16	17	17	18	19	19
6’3″	12	13	14	14	15	16	16	17	17	18	19
6’4″	12	13	13	14	15	15	16	16	17	18	18

Weight	155	160	165	170	175	180	185	190	195	200
Height
5’0″	30	31	32	33	34	35	36	37	38	39
5’1″	29	30	31	32	33	34	35	36	37	38
5’2″	28	29	30	31	32	33	34	35	36	37
5’3″	27	28	29	30	31	32	33	34	35	35
5’4″	27	27	28	29	30	31	32	33	33	34
5’5″	26	27	27	28	29	30	31	32	32	33
5’6″	25	26	27	27	28	29	30	31	31	32
5’7″	24	25	26	27	27	28	29	30	31	31
5’8″	24	24	25	26	27	27	28	29	30	30
5’9″	23	24	24	25	26	27	27	28	29	30
5’10”	22	23	24	24	25	26	27	27	28	29
5’11”	22	22	23	24	24	25	26	26	27	28
6’0″	21	22	22	23	24	24	25	26	26	27
6’1″	20	21	22	22	23	24	24	25	26	26
6’2″	20	21	21	22	22	23	24	24	25	26
6’3″	19	20	21	21	22	22	23	24	24	25
6’4″	19	19	20	21	21	22	23	23	24	24

Weight	205	210	215	220	225	230	235	240	245	250
Height
5’0″	40	41	42	43	44	45	46	47	48	49
5’1″	39	40	41	42	43	43	44	45	46	47
5’2″	37	38	39	40	41	42	43	44	45	46
5’3″	36	37	37	38	39	40	41	42	43	44
5’4″	35	35	36	37	38	39	40	41	42	43
5’5″	34	35	36	37	37	38	39	40	41	42
5’6″	33	34	35	36	36	37	38	39	40	40
5’7″	32	33	34	34	35	36	37	38	38	39
5’8″	31	32	33	33	34	35	36	36	37	38
5’9″	30	31	32	32	33	34	35	35	36	37
5’10”	29	30	31	32	32	33	34	34	35	36
5’11”	29	29	30	31	31	32	33	33	34	35
6’0″	28	28	29	30	31	31	32	33	33	34
6’1″	27	28	28	29	30	30	31	32	32	33
6’2″	26	27	28	28	29	30	30	31	31	32
6’3″	26	26	27	27	28	29	29	30	31	31
6’4″	25	26	26	27	27	28	29	29	30	30

A woman or man with a BMI between 25 and 29.9 is considered overweight; 30 or more is considered obese; and 40 or greater is considered extreme obesity. Women in the highest obesity category have a significantly higher risk of hypertension and/or high blood cholesterol than women of normal weight.

In addition to comparing your weight to a chart of established acceptable weight ranges, your health care professional can actually measure your body composition—the most accurate assessment technique because it differentiates between weight that is attributable to fat accumulation and weight that represents muscle development. Women with more than 30 percent body fat (25 percent for men) are considered obese. However, it is difficult to measure body fat precisely. The most accurate method has been to weigh a person underwater, but this procedure is limited to laboratories with special equipment.

Your health care professional is more likely to conduct one or more of these tests:

Measuring skin-fold thickness and subcutaneous fat, which lie just under the skin, at targeted areas. These areas include the back of your upper arm, waist or thigh. The health care professional uses calipers, an instrument that looks like tongs. Measurements of skin-fold thickness depend on the skill of the examiner and may vary widely

Bioelectrical impedance analysis (BIA).

There are two forms of BIA. With one form, the patient stands on a special scale with footpads and a harmless amount of electrical current is sent through her body to calculate the percentage body fat. The second type of BIA involves the use of a portable instrument called an impedance analyzer to transmit a noninvasive, low frequency electrical current through electrodes placed on the patient’s hand and foot with a gel. The change in voltage between electrodes is measured, and the patient’s body fat percentage is calculated.

Waist circumference.

Unlike fat around the thighs, which is more common in women and is more likely to serve as an energy reservoir, abdominal fat delivers fatty acids directly into the bloodstream for immediate short-term energy, increasing triglyceride and, eventually, cholesterol levels. Health care professionals aren’t certain why this proves detrimental to your health, but higher proportions of abdominal fat are associated with higher risks of insulin resistance, diabetes, high blood pressure and cardiovascular disease (heart disease and stroke).

How can you estimate your body fat distribution? Look at yourself in the mirror. If you are more apple-shaped than pear-shaped, you probably have visceral fat accumulation. Women with a waist circumference over 35 inches (and men over 40 inches) are at greater risk.

Your health care professional also should ask you about or conduct tests to determine other risk factors for disease and conditions associated with obesity.

This includes:

• Taking a personal weight history
• Determining your waist-to-hip ratio. Divide your waist measurement by your hip measurement (the widest part of your behind). Ideally, women should have a waist-to-hip ratio of 0.8 or less.
• Asking if you have relatives with illnesses related to being overweight, such as type 2 diabetes mellitus or heart disease
• Discussion of weight-loss methods used in the past
• Taking your blood pressure and conducting blood tests such as measuring your cholesterol and screening for diabetes

It is important to tell your health care professional about any medical or health conditions you have and any medications, vitamins, minerals, herbs or nutritional supplements you’re taking. Also let your health care professional know if you are pregnant or breast-feeding or if you’re planning on surgery that requires general anesthesia.

The types of health care professionals you might consult to diagnose and treat obesity include:

A nutritionist

There is no accepted national definition for the title “nutritionist.” Some states have a statutory definition of nutritionist stating that the RD credential is not required for certification as a nutritionist but is required for licensing as a dietitian. In general, the license or certification as a dietitian can be obtained with a bachelor’s degree and a related supervised practice experience component (or proof of RD status with the Commission on Dietetic Registration), while the nutritionist licensure or certification typically requires a master’s degree or higher.

Make sure any nutritionist you see is licensed by a state agency. Nutritionists, with educational background in foods and nutrition, and dietitians evaluate the diets and nutritional habits of clients and help structure more healthful eating patterns and weight-management strategies based on their patients’ health needs, food selection and calorie goals. Nutritionists usually do not advise patients with chronic illnesses, disorders and other disease conditions.

A registered dietitian (RD).

An RD is a dietitian who has completed academic and practice requirements established by the American Dietetic Association. These include a bachelor’s degree, an accredited preprofessional experience program, successful completion of a national credentialing exam and ongoing continuing professional development. Many RDs also have a master’s degree and advanced training in a nutrition subspecialty, such as diabetes.

An endocrinologist

Endocrinology is the field of medicine involving the body’s chemical messengers, or hormones, and its biochemical control mechanisms, or metabolism. Endocrinologists are physicians who care for patients with complex hormonal disorders and metabolic conditions, including obesity, diabetes, thyroid disorders, metabolic bone disease, pituitary and adrenal conditions, and growth and gonadal disorders.

An obesity medicine specialist.

These physicians have specific training and clinical expertise in managing obesity and the related medical problems.

Treatment

Losing as little as 5 percent to 10 percent of your body weight and maintaining that loss can significantly improve your health by increasing glucose tolerance and lowering blood pressure and cholesterol levels. Thus, if you’re overweight or obese, you may need to seek medical help to lose weight as well as to maintain it.

Experts recommend losing no more than one to two pounds per week. Maintaining weight loss can be more difficult than losing the weight to begin with, so long-term lifestyle change is key.

The National Weight Control Registry is tracking over 10,000 individuals who have lost significant amounts of weight and kept it off for extended periods of time. Members of the registry have lost an average of 66 pounds and kept the weight off for an average of 5.5 years.

The individuals who are listed in the registry have reported the following:

• 90 percent exercise, on average, about 60 minutes per day.
• 45 percent of registry participants lost the weight on their own, and the other 55 percent lost weight with the help of some type of program.
• 78 percent eat breakfast every day.
• 62 percent watch less than 10 hours of TV per week.
• NWCR members kept the weight off in various ways. Most report continuing to maintain a low-calorie, low-fat diet and engaging in high levels of activity.

Other key habits of people who successfully maintain their weight loss include weighing themselves routinely and writing down their daily food intake in a journal or tracking it with an online application.

The good news is that burning off more calories than you’re taking in will cause you to lose weight. The bad news is that there’s no magic formula. Studies find that if you lose the weight slowly, you’ll be much more effective at keeping it off, especially if you incorporate exercise into your routine and reduce other sedentary behavior, such as watching TV.

The safest way to lose weight is to eat a nutritionally complete diet that is moderate in calories and fat, add exercise to your daily routine and decrease sedentary activities. In some cases, for example, if your health is being immediately and severely compromised because of your weight, faster weight loss may be appropriate. In these cases, your health care professional may recommend drug therapy or surgery.

Changing Your Diet

The first element of treatment is changing your diet. Your health care professional should provide detailed guidance on the number and types of calories you should eat. As a rule of thumb, however, if you take in about 250 calories per day less than is needed to maintain your current weight, combined with an exercise regime that burns an additional 250 calories a day, you’ll lose about a pound a week.

The number of calories your body needs to maintain its basic functions such as breathing and digestion is known as your basal metabolic rate (BMR). Several factors go into the calculation of your BMR, including your age, height, weight and gender. To get an idea of your BMR,.

It’s difficult to determine exactly how many calories you need to maintain your weight at your current level of physical activity. One way to estimate your BMR is to keep a detailed food diary over the course of a few days to a week during which you maintain your weight. Determine exactly how many calories you eat on an average day (several books and Web sites provide calorie counts for thousands of foods) and use that figure as a starting place from which you then subtract 250 calories.

After you’ve determined how many calories a day you should eat, you need to plan daily menus. A dietitian or nutritionist can help you plan menus that include the types and amounts of food you should eat, which, in most cases, should be based on guidelines developed by the federal government in its 2010 Dietary Guidelines for Americans. The guidelines emphasize calorie reduction as well as balance, moderation and variety in food choices, with an emphasis on whole-grain products, vegetables and fruits.

To satisfy basic nutritional needs, eat a variety of foods including low-fat dairy, healthy protein sources like chicken, fish, eggs and soy products, vegetables and whole grains, and allow for an occasional treat. While you should try to cut back on excess fats and sugars, all foods and beverages can be consumed in moderation. As soon as you label a food as “off limits,” chances are you will crave and perhaps even binge on it.

The 2010 Dietary Guidelines recommend the following (based on a 2,000 calorie-per-day diet). These are general guidelines from the U.S. Department of Agriculture and the U.S. Department of Health and Human Services. The amount you personally need will vary based on many factors, including your age, weight, activity level and personal medical history, so be sure to discuss your diet with your health care professional.

Meat and beans (protein)

• Eat five-and-a-half ounces of protein every day (vary your choices of meats, poultry, fish, beans, peas, nuts and seeds). Try to include at least 8 ounces of seafood per week. Generally, the guidelines recommend 10 percent to 35 percent of your daily calories come from protein. Another way of looking at it is you should eat at least 1 gram of protein per kilogram of body weight. If you weigh 70 kilograms (approximately 154 pounds), you should aim t