Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 8, 2016

Obesity is becoming a global epidemic even though many populations still suffer from starvation and malnutrition. The World Health Organization (WHO) declares that the rate of obesity has nearly doubled between 1980 and 2008.

It also indicates that the condition affects young children to the point where 42 million preschoolers globally were discovered to be overweight in 2013. Being overweight at a young age often leads to obesity in adulthood.


Definition & Facts

Obesity is roughly defined as being 20 percent over an ideal weight. The National Institutes of Health (NIH) defines obesity as having a body mass index (BMI) of 30 or more. A BMI of 30 is approximately 30 pounds over an ideal weight. However, some people with a normal weight according to the BMI can have very little muscle and a higher ratio of fat that makes them susceptible to the same increased risks for metabolic syndromes and cardiovascular diseases, such as diabetes as the clinically obese.

The Centers for Disease Control (CDC) indicates that almost 35 percent of adults in the United States are obese. They also report that about 17 percent of children between the ages of 2 and 19 are obese. This accounts for a population of 78.6 million adults and 12.7 million children.

Obesity used to be a condition that was only obtainable by the wealthy due to their increased access to rich food resources. High calorie processed and fast foods along with an increase in sedentary living has increased the prevalence of obesity in adults and children in both the middle and low-income groups.

Symptoms & Complaints

Symptoms of obesity usually progress as weight from body fat increases. Age is also a factor as young bodies can often compensate for the physical and metabolic stresses that obesity causes.

Symptoms are subjective and expressed by patients. Symptoms of obesity usually begin with early fatigue in exercise, walking up stairs and other physical activities. Typical complaints as obesity and age increase are joint pain, depression, and social problems.

Obesity is linked to serious medical conditions such as diabetes, cardiovascular disease, obstructive sleep apnea, cancer, stroke, hypertension (high blood pressure), gout, asthma and arthritis.


Obesity is primarily caused by the daily consumption of more calories than are burned. It is not the quantity of food but the caloric density and the amount of daily activity that is at the root cause. People who have high activity levels can consume more calories in a day than those who are sedentary without gaining weight.

The modern technological age has more adults and children leading mostly sedentary lives with little to no weight-bearing exercise or aerobic exercise. Therefore, what may be a normal meal for a younger person with a physically demanding job is excessive for a middle-aged person working in an office cubicle.

Though overeating is the primary cause, medications, psychological disorders, genetic factors, and diseases such as hypothyroidism and insulin resistance can make people more prone to weight gain that leads to obesity.

Cushing's syndrome caused by too much glucocorticoids from medication or problems with adrenal glands can also lead to obesity. Polycystic ovary syndrome (PCOS) may also lead to obesity. Also, certain medications, especially long-term use of some steroids such as prednisone and megestrol acetate, a progesterone, can lead to obesity.

Diagnosis & Tests

Obesity can largely be diagnosed upon a physical examination by a medical professional. The standard diagnostic criteria is to measure body mass index. The height and weight are converted into metric units of meters and kilograms. Height is squared and divided into the weight. The sum is the BMI. A 72 inch (1.828 meters) tall man that weighs 200 pounds (90.71 kilograms) has a BMI of 24.8.

Obesity begins at a BMI of 30. Below 18.5 is considered underweight. From 18.5 to 24.9 is considered normal weight. The range from 25.0 to 29.9 is considered overweight. Obesity is diagnosed at a BMI of 30, but there are additional classes. Class I obesity is a BMI that is 30.0 to 34.9. Class II is 35.0 to 39.9. Class III obesity begins at a BMI of 40. Athletes with a lot of muscle may have a high BMI but not be obese. If there are concerns, a medical professional should be consulted.

Some people carry most of their fat around their waist. An increased amount of weight carried centrally is a marker for increased risk for heart disease and diabetes. Risk is elevated in men who have a waist size greater than 40 inches or women who have a waist size greater than 35 inches.

Treatment & Therapy

To lose weight, caloric intake must be reduced or activity increased to permit a daily caloric deficit. Lifestyle changes to reduce weight often use a combination approach of lowered caloric intake and increased activity levels.

Strengthening exercises to increase muscle mass protect against muscle catabolism (loss of lean muscle) during weight loss efforts. Also, muscle burns more calories at rest than fat, increasing weight loss potential even higher. Psychological issues that are a factor should be treated when beginning a weight loss treatment program.

Bariatric surgery is an option. This could include the insertion of a gastric band or gastric bypass surgery. Surgical procedures for weight loss have all of the risks of other surgeries, including serious or life-threatening problems with anesthesia and post-operative infections.

Prevention & Prophylaxis

Preventing obesity is best begun in childhood. Parents who exercise and eat a healthy diet often have children who are active and eat the proper amount of a wide variety of healthy foods.

Adults can overcome obesity, but it takes commitment to overall lifestyle changes and not just a temporary diet. A strong family or friend support structure is also helpful. The proven route to weight loss for all ages are proper diet and exercise.

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