Obesity and Cardiovascular Disease

The Fact :

More than 65 percent (about 129 million people) of the US population is overweight or obese, according to the Centers for Disease Control and Prevention (CDC). Being obese increases the risk for many diseases, especially heart disease, stroke, cancer, and diabetes.

What is considered obese?

Obesity can be determined based on three key measurements, according to NHLBI:

• body mass index (BMI)
  BMI is your weight relative to your height, including considerations such as amount of bone, muscle, and fat in your body's composition. If your BMI calculation is 25.0 or higher, you are considered overweight (a BMI over 30 is considered obese).
• waist circumference
  Your waist circumference indicates abdominal fat. A waist circumference over 40 inches in men and over 35 inches in women increases the risk for heart disease and other diseases.
• risk factors
  People with two or more risk factors for heart disease are at even higher risk for heart disease, when combined with a high BMI and/or large waist circumference.

What are the risk factors for heart disease?

According to the American Heart Association, the major risk factors for heart disease are:

• age (65 years and older)
• male gender
• heredity
• smoking
• high blood cholesterol levels
• high blood pressure
• physical inactivity
• obesity
• diabetes

Obviously, some of these risk factors, such as age, gender, heredity, or diabetes, cannot be changed. However, it is possible to make lifestyle modifications which may decrease the risk of factors such as smoking, elevated blood cholesterol, elevated blood pressure, physical inactivity, or obesity.

Healthy tips for losing weight:

Successful weight loss requires a long-term weight management program that is realistic, according to the NHLBI Obesity Education Initiative. To help lose weight and/or maintain a healthy weight, consider the following:

• Set realistic goals. Do not focus only on the actual weight loss, but look at dietary and exercise changes that will help to keep weight off. In addition, goals should be:
  • Specific (Example: "I want to lose ten pounds in the next six weeks," not "I'd like to lose a few pounds.")
  • Attainable (Example: "I want to lose five pounds this month" is more realistic than "I want to lose 20 pounds this month.")
  • Forgiving (Example: "I only lost 3½ pounds this month instead of five pounds. But, you know what? My pants are starting to feel a little loose! I'll try again to lose more weight next month.")
• Set short-term goals that lead to long-term goals. Short-term goals are small steps that are easier to achieve and will help position you toward attaining your long-term goals. (Example: A goal of losing five pounds per month is realistic, in most cases, and will help lead you to a long-term goal of losing a larger amount.)
• Reward yourself. Effective rewards are those that are timely, contingent on your goal achievement, and something valuable to you. Rewards, however, should not include food. (Example: When you meet a goal, reward yourself with a new CD, a short weekend vacation, a new outfit, tickets to a concert or ball game, or other non-food item which makes you happy.)
• Monitor yourself. Keep track of your progress by keeping a record of what you eat, how often you exercise, and/or your weight on a regular basis. This way you can better evaluate your rate of success in losing weight and make adjustments where necessary.
• Avoid situations that cause you to overeat. By avoiding certain situations or settings that you associate with eating, you can often break the habit of overeating, such as not eating while watching television.
• Eat slower. Eating slower gives your body time to recognize that you have been fed. Also, schedule your meals at regular times, so that you will not skip or delay a meal, and overeat later to compensate.

Facts about cholesterol and obesity:

The link between high levels of low-density lipoprotein (LDL) cholesterol (often referred to as the "bad" cholesterol) in the blood and increased risk of coronary heart disease has been demonstrated many times. Although normal-weight people can have high LDL cholesterol levels, people who are overweight tend to have higher LDL cholesterol levels than people who are not overweight. According to the NHLBI, blood cholesterol levels are affected by:

• diet
  Excessive consumption of saturated fats, dietary cholesterol, and excess calories can adversely affect blood cholesterol levels.
• weight
  Obesity can increase LDL cholesterol levels and decrease high-density lipoprotein (HDL) cholesterol (often referred to as the "good" cholesterol).
• physical activity
  Lack of physical activity can increase LDL cholesterol levels and decrease (HDL) cholesterol.
• heredity
  Genetic background can determine the production and processing of cholesterol in your body.
• age
  Blood cholesterol levels increase after age 20.
• gender
  Until menopause, women tend to have lower LDL cholesterol levels than men. After menopause, a woman's LDL cholesterol levels rise, increasing the risk for heart disease.

From Women's Center

Childhood Obesity

What is it?

Obesity is the state of being extremely overweight according to standard growth charts.

Who gets it?

Obesity is one of the most common nutritional problems in the United States. Both infants and children can be obese. Infants with obese parents, however, have an 80 percent chance of developing obesity.

What causes it?

Obesity occurs when an infant or child takes in more calories than the body can use. Obesity can have many causes, ranging from diet and lifestyle to, in rare cases, hormonal disorders. Causes include overfeeding; providing only high calorie beverages to satisfy thirst; using food to solve problems, relieve stress, or as a reward; and not providing enough opportunities for exercise. Studies have also shown that children who struggle over food when young tend to have more weight problems when they are older. Other factors that contribute to obesity include a family history of obesity, abnormal eating patterns such as binge eating, and the use of corticosterioid drugs.

What are the symptoms?

The symptom of obesity is being grossly overweight according to standard growth charts. Complications of obesity include heart disease, hypertension, and some cancers.

How is it diagnosed?

At regular physical exams, your doctor will check your child's height and weight and plot them on a growth chart. A growth chart shows how your child's growth compares to other children of the same age and is plotted in percentiles. For example, if an infant is in the 20th percentile for weight on a growth chart, that means that 20 percent of infants weigh less than that child and 80 percent weigh more. Infants and toddlers naturally have chubby bodies. However, an infant or toddler is considered obese when his or her weight gain is far out of proportion to his or her growth in height. An overweight baby will look fat, not just chubby. An older child is considered obese when there is a drastic change in the growth curve on the chart. For example, if your child has been at the 30th percentile level and suddenly jumps to the 75th over a six-month time period, there is probably a weight problem. An adolescent's height and weight are converted to body mass index, which is weight in kilograms divided by height in meters squared. An adolescent is considered mildly obese when his or her body mass index is higher than 27. The doctor will recommend a treatment plan when the body mass index is 30 or higher.

What is the treatment?

While a child is still growing, treatment for obesity is to slow the rate of weight gain. However, never reduce your child’s food intake to promote weight loss without first consulting a doctor. The most important treatment for obesity is prevention through healthy eating habits. With an infant, avoid overfeeding. According to the American Academy of Pediatrics, breastfed newborns should be nursed whenever they show signs of hunger. Newborns should be nursed approximately 8 to 12 times every 24 hours, usually 10 to 15 minutes on each breast. If you are bottle feeding, don't allow your child to have the bottle readily available day and night. Most infants need to be fed every two hours from birth to around two months of age, then every three hours from two to six months of age. By six months, most babies are satisfied with three meals a day and two snacks. Don't rush your infant at feeding times. It generally takes 15 to 20 minutes for a baby to feel comfortably full. If your baby stops feeding before the bottle is empty, don't insist that he or she finish it. Your baby knows how much he or she needs. Solid foods can be introduced around six months of age. Again, children on solid foods will let you know when they are full, usually by turning their heads away or holding their mouths closed.

Children also should not receive sweets until after 12 months. With a child of any age, it is extremely important not to use food as a reward or to control behavior. These children learn to use food as a stress reliever. Balance and moderation are important. Underfeeding a child is actually more harmful than overfeeding. Teach your children the basic food groups and provide the recommended number of servings per day. It's been said many times, but we'll say it again “breakfast is the most important meal of the day.” Children who skip breakfast have more difficulty performing in school and tend to snack and eat heavier meals later in the day. When your child does snack, provide healthy snacks, such as fruits, vegetables, and grains. Don't deprive your child of all sweets, but provide them in moderation. Children who feel deprived are more likely to associate negative feelings with food and suffer from eating disorders later in life. Follow your doctor's recommendations for diet carefully. Because your child is still growing, it is important to make sure you provide the right amounts of nutrients and calories for growth.

Obese adolescents usually benefit from the same types of behavior modification programs used with adults. This involves reducing the amount of calories they take in by following a well-balanced diet and making permanent changes to their eating habits, combined with a regular program of physical activity, such as bike riding, swimming, or walking. Obese adolescents often have a poor self-image and become isolated socially. These children may also need counseling to help deal with their problems.

Self-care tips

You can help your child avoid obesity by providing the right kinds of foods in the right amounts. If you're not sure of the guidelines for a healthy diet, ask your doctor. He or she can give you nutritional information that is appropriate for your child's age. Also keep in mind that chubbiness is normal at certain ages, and that many children gain weight when going through a normal growth spurt. Never change your child's diet to promote weight loss without consulting with your doctor.

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This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.

Is Obesity A Disease?

This isn't as simple a question as it might appear, because the answer has a cascading effect in terms of implications. For example, if obesity were classified as a disease, it could take much of the stigma away from being severely overweight, make it easier to get treatment, could help provide insurance coverage for people grappling with weight problems, and could even speed up the approval of new diet drugs.

However, for many of these positives there also are negatives. For example, if insurance companies were forced to cover people's efforts to reduce their weight, this could increase insurance premiums and the already skyrocketing cost of health care in the US. Opponents of classifying obesity as a disease say that it is just a risk factor, not a disease, and that such a formal shift in how it is viewed could actually divert resources from legitimate diseases.

Besides these issues, it is interesting to see how people respond to this question on a personal level. We've been gathering opinions about this issue from a number of different sources over the past week or so, and the debate is almost polarizing.

One person told us, "Obesity is not a 'disease.' It is a product of confusion and misinformation."

And another said, "We all control 100% of the calories that we ingest and of the time that we spend exercising. If I carry too many pounds, it's my choice, but not a disease."

And yet another person we spoke with said, "If people think that obesity is really a disease and it should be treated that way, just wait until we get the newest rate increases in health insurance. Among other factors as we already know, people hop from one "answer" or fad to another, and even after losing weight, they gain it back and do something again to bring it down. Usually when one has a disease, there is, hopefully, a cure. Personal responsibility is the only cure for obesity, coupled with common sense. Tie obesity into health issues, which the insurance companies will have to support in trying to combat it, and our health system will break down under the burden."

Those seem like persuasive arguments…but there is another side.

"Isn't Bulimia a 'real' disease?" asked one person. "How about Anorexia? These diseases revolve around bad food choices or lack thereof and distortions of self image. Both of these factors seem to be very involved with obesity. People die from Anorexia, from Bulimia AND Obesity - often helplessly. They are just as "real" as cancer. Ask anyone who's had a relative or friend die from an eating disorder."

Someone else we spoke with suggested that obesity is a disease in the same way that alcoholism is a disease. (And it wasn't that many years ago that alcoholism was considered a matter of choice and/or personal weakness.) This person, who happens to be an alcoholic, said that he could not have gotten the treatment and support he needed if his condition had not been classified and treated as a serious disease.

Also very persuasive arguments.

This is a serious issue, and not one that should be politicized or trivialized. After all, there are millions of lives at stake in how and what decision is made.

It strikes us that at some level, the argument is between fiscal prudence and unrestrained compassion…and we're not sure that either one makes sense in a vacuum. We do believe that by classifying obesity as a disease, it may bring important and necessary attention to this serious American health issue…but that it must be done in such a way that does not bankrupt an already fragile health care system.

by Kevin Coupe