What is Obesity?
Obesity is an excess of body fat frequently resulting in a significant impairment of health. The precise determination of the amount of body fat requires technically sophisticated methods that are available only in research laboratories. Body composition varies among persons of the same height and weight.

What Causes Obesity?
Studies indicate that human fatness results from genetically predetermined body weight set-point that exerts its control over an individual's body weight through alterations of that person's basal metabolic rate. This set-point may be further influenced by learned eating behavior, perception of body image, and the availability of food.

What is the evidence that obesity has adverse effects on health?
A strong association between the prevalence of obesity and cardiovascular disease risk exists. The prevalence of hypertension is 2.9 times higher in overweight than for normal weight persons. Lower levels of blood pressure and serum cholesterol can be achieved by weight reduction. There is a positive relationship of obesity to the risk of coronary artery heart disease.

The prevalence of diabetes reported is 3 times higher in overweight than in normal weight persons. Weigh reduction can reverse the abnormal biochemical characteristics of diabetes.


What is the evidence that obesity effects longevity?
Obese males, regardless of smoking habits, have a higher mortality from cancer of the colon, rectum, and prostate.

Obese females have a higher mortality from cancer of the gallbladder, biliary passages, breast, uterus, and ovaries, colon, and rectum.

Regarding endometrial cancer, women with marked obesity show the highest relative risk (5.4) compared with the nonobese.

Obesity has an adverse affect on longevity. The greater the degree of obesity, the higher the mortality rate or excess death rate.

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For what medical conditions can weight reduction be recommended?
Weight reduction may be lifesaving for patients with extreme obesity.
* Weight reduction is highly desirable in patients with extreme obesity.
Weight reduction is highly desirable in patients with lesser degree of obesity in the following circumstances:
* Non-insulin dependent diabetes mellitus
* Family history of diabetes mellitus
* Women with a history of gestational diabetes or birth of an infant large for gestational age
* Hypertension (when due to a specific, identifiable cause)
* Hypertriglyceridemia or hypercholesterolemia

In cases where excessive weight imposes functional burdens, weight reduction may improve functioning of the affected system, organ, or region, such as heart disease, chronic obstructive pulmonary disease, and osteoarthritis of the spine, hips, or knees. Weight reduction in the treatment of these conditions should be under the direction of a physician. Particular attention should be paid to efforts to reduce weight in younger patients.

What is the criteria for being eligible for surgical management of obesity?
* 100 pounds or more over ideal body weight (IBW) or BMI > 40.
Use the Calculator on the Left to Determine your BMI (Body Mass Index)
* Low probability of success with non-surgical measures
* Well informed and motivated patients with acceptable
operative risks
* Should have the capacity to ensure participation in treatment
and long term follow-up

LESS SEVERELY OBESE PATIENTS (75 - 100 POUNDS OVER IBW)
WITH OBESITY RELATED DISEASES (NIH 1991)

* Sleep apnea and Pickwickian Syndrome
* Heart disease (cardiomyopathy)
* Poorly controlled diabetes
* Poorly controlled hypertension
* Physical problems significantly interfering with lifestyle
(e.g. joint disease treatable but for the obesity,
or body size problems precluding or severely
interfering with employment, family function, ambulation, etc.)

CONTRAINDICATIONS TO OBESITY SURGERY
* Drug dependency
* Alcohol dependency
* Psychoses
*(criteria from NIH 1991)

If you are interested in becoming a patient, or attending a free class and seminar, we ask that you sign up online through Patient Hub. This secure link will allow you to fill out your patient profile online. This will be used to submit a prior authorization or letter of medical necessity to your insurer.

What is the difference between overweight and obese ?
An adult is considered "overweight" when he/she is are above a healthy weight, which varies according to a person's height. An individual is overweight when their BMI is between 25–29.9. The standard used by researchers to define a person's weight according to their height is the "body mass index" (BMI). An adult with a BMI of 30 or more is considered obese. For example, for a 5'4" woman, this means that she is 30 or more pounds over her healthy weight.

Why are so many people overweight or obese today ?
There are a number of factors that influence overweight or obesity, including Behavior—eating too many calories while not getting enough physical activity. Environment—home, work, school, or community can provide barriers to or opportunities for an active lifestyle. Genetics—heredity plays a large role in determining how susceptible people are to overweight and obesity. Genes also influence how the body burns calories for energy or stores fat. Behavioral and environmental factors are the main contributors to overweight and obesity and provide the greatest opportunities for prevention and treatment.

How does overweight and obesity affect your health ?
If you are overweight, you are more likely to develop health problems; such as,
* Heart disease
* Stroke
* Diabetes
* Cancer (such as colon cancer, endometrial cancer, and postmenopausal breast cancer)
* Gallbladder disease
* Sleep apnea (interrupted breathing during sleep)
* Osteoarthritis (wearing away of the joints)

The more overweight you are, the more likely you are to have health problems. Weight loss and regular exercise can help improve the harmful effects of being overweight. Studies show if you are overweight or obese, losing 5–10% of your body weight can improve your health.

What can you do to lose weight ?
The safest and most effective way to lose weight is to reduce calories and increase physical activity. Government research and recommendations can provide the facts based on science so that people can make informed choices about appropriate weight loss. The fact is the majority of people who are attempting weight loss are not using the correct method to achieve or maintain positive results.

Does obesity cause complications?
Yes. Obese patients are at a risk of developing Diabetes mellitus, Cardiovascular diseases and Hypertension in the long term.

Does a low calorie diet help in losing weight?
Yes. Weight reduction can be achieved by reducing food intake and by regular exercise. A low calorie diet
should constitute a low carbohydrate, high fiber, moderate protein and a low fat diet.

Does exercise help in losing weight?
1. Most obese people are capable of moderate aerobic exercise such as walking, swimming, gardening,dancing, provided it does not exceed their cardiovascular capacity. 2. Because of their heavy weight obese people expand more food energy than lean people doing exercise of this type. 3. Regular daily exercise will help in reducing than exercising once in a while.

What are the methods in surgical treatment?
1. Wiring the jaws together to prevent eating has been used to treat those who have found it impossible to ahere to a low calorie diet. 2. Although this usually results in marked loss of weight, many patients regain weight when the procedure is reversed. 3. An alternative and fairly safe operation (major) is to reduce the size of the stomach, for eg. by stapling, which can be undone. 4. Small intestine bypass, aimed at inducing mal-absorption, has been undertaken in some centres for the treatment of severe "morbid" obesity, but complications can be severe and sometimes fatal. 5. It should be emphasized that surgery should be considered only for those with gross, interactable obesity.

What are some of the risks of obesity?
Morbid obesity may lead to a shorter life span and an incidence of life-threatening health conditions, these are frequently referred to as co-morbidities. Recent studies have shown that the risk of an early death for those struggling with obesity is twice that of a non-obese person. With treatment, chances are better for enjoying healthy activities and a longer life. Dedicating yourself to effective treatment is necessary for better health. Finding that treatment begins with learning how weight affects you.


What are some obesity-related health conditions?
Bariatric surgery may be right for you if you find yourself struggling with one or more obesity-related health conditions. When choosing to have bariatric surgery, the choice should be made based on discussions between you and your doctor, including goals and strategy for long-term care. A good resource to understand how patients are chosen for surgery is as follows: Patient selection for bariatric surgery is based on the National Institutes of Health (NIH) criteria- 100 pounds or more above ideal body weight or a BMI of 40 or greater BMI of 35 or greater with one or more obesity-related health condition Other factors your doctor may consider include: History of documented dietary weight loss attempts Lifelong commitment to dietary, exercise, and medical guidelines and follow-up care Psychological evaluation

2005 Obesity Statistics
USA Obesity Rates Reach Epidemic Proportions

* 3 million morbidly obese people, 40 million obese people, 58 million overweight people
* Eight out of 10 over the age of 25 are overweight
* 78% of Americans are not meeting the basic activity level recommendations
* 25% of Americans are completely sedentary
* 76% increase in Type II diabetes in adults aged 30-40 since 1990


Obesity Related Diseases
* 80% of all type II diabetes is related to obesity
* 70% of Cardiovascular disease is related to obesity
* 42% of breast and colon cancer is diagnosed amongst obese individuals
* 30% of gall bladder surgery is related to obesity
* 26% of obese people have high blood pressure


Childhood Obesity Running Out of Control
* 4% of children were overweight in 1982 vs. 20% of children who are overweight 2005
* 25% of all white children overweight in 2005
* 33% African American and Hispanic children overweight 2005
* Hospital costs associated with childhood obesity are rising from $35 Million (1979) to $140 Million (2005)


Childhood Metabolic and Heart Risks
New study suggests that one in four overweight children is already showing early signs of type II diabetes (impaired glucose intolerance) and 60% already have one risk factor for heart disease.

Surge in Childhood Diabetes
* Between 8% - 45% of all newly diagnosed cases of childhood diabetes are type II, associated with obesity.
* 4% of Childhood diabetes was type II in 1990, that number has risen to approximately 20% depending upon the age group (Type II most frequently afflicted ages 10-19) and the racial/ethnic mix of group stated
* Of Children diagnosed with Type II diabetes, 85% are obese

Effects of obesity – What are the dangers in being obese?
If you are overweight, it is important to understand the health effects of obesity. Obesity is associated with more than thirty medical conditions and scientific evidence has established a strong relationship with at least fifteen of those conditions.

* Obesity is associated with the development of osteoarthritis of the hand, hip, back, and knees.
* Obesity increases the risk of breast cancer in men and women.
* It is strongly associated with cancer of the esophagus.
* Obese women have three to four times the risk of endometrial cancer than women with lower BMI. Obesity increases cardiovascular disease risk because of its effect on blood lipid levels. Obesity is a major risk factor for heart attack.
* Gallstones are common in overweight and obese persons.
* Obesity decreases the body’s resistance to harmful organisms.
* Obesity is the most common factor of nonalcoholic steatophepatitis, a major cause of liver disease.

These are just some examples of how obesity negatively affects the health of a person.

What is the White House Obesity Initiative?
The First Lady’s national campaign against childhood obesity called “Let’s Move” is a comprehensive and coordinated initiative with many partners. The focus is to prevent childhood obesity. The campaign has four pillars: healthy schools, access to affordable and healthy food, raising children’s physical activity levels, and empowering families to make healthy choices. The American Academy of Pediatrics (AAP) is proud to join the White House in this initiative.

What is BMI?
BMI, or body mass index, is a calculation that uses height and weight to estimate body fat. For years, pediatricians have used height and weight measurements to assess a child’s physical growth. Now they have another tool: BMI. Using this tool, a pediatrician can determine how appropriate a child’s weight is for her height and age. Starting when your child is 2 years old, your pediatrician will determine BMI at routine checkups and plot this measurement on a chart, just like the growth charts you may already be familiar with. Because what is considered a normal BMI changes with age, your child’s BMI must be plotted, rather than using a universal normal range for BMI as is done with adults. There are also separate charts for boys and girls to account for differences in growth rates and amounts of body fat as boys and girls mature. For children under 2 years, instead of BMI your pediatrician will be charting weight for length on a graph. Plotting the BMI is the first step in evaluating a child’s healthy eating and activity patterns and behaviors, so your pediatrician will also be asking you about your family’s nutrition and physical activity and working with you to
make healthy lifestyle choices.

Why do parents need to know their child’s BMI?
Parents need to know their child’s BMI because prevention is the best medicine. By plotting BMI and monitoring physical activity and nutrition throughout childhood, parents and pediatricians can keep an eye out for children at-risk of becoming overweight and take action early to prevent future obesity. By catching at-risk children early, families in partnership with their pediatrician can explore ways to make changes to live healthier active lives.

How do I talk with my children about making healthy active changes?
Talk with your children about the importance of the whole family being healthy. Get together with your family and decide ways your family can make healthier choices. Talk with the whole family and decide what changes to make together. Remember to make it fun to try new things together. White House Obesity Initiative FAQ for Families

What can families do to lead healthier lives?
Healthy active living can be fun and family-oriented. Make healthy choices together – grow a garden, play outdoor games, cook as a family. Have fun! As parents, it’s important to set a good example. There are a lot of things families can do to be healthier and it can be overwhelming trying to decide where to start. But it is important to remember that small changes can make a big difference. The AAP recommends starting with one of these behaviors:· 5 – Eat 5 fruits and vegetables a day. 2 – Limit screen time (TV, computer, video games) to 2 hours each day. Children younger than 2 should have no screen time at all. · 1 – Strive for 1 hour of physical activity a day. · 0 – Limit sugar-sweetened drinks. To start, families can pick one of these behaviors and set specific goals to improve their health. In addition to 5, 2, 1, 0, goals, families can make small changes in their family routines to help everyone lead healthier active lives. Science suggests these activities can help prevent obesity:

• · Eating breakfast every day;

• · Eating low-fat dairy products like yogurt, milk, and cheese;

• · Regularly eating meals together as a family;

• · Limiting fast food, take-out food, and eating out at restaurants;

• · Preparing foods at home as a family

• Eating a diet rich in calcium; and Eating a high fiber diet.

How do we start to make changes to our family’s routine?
You can start in small steps. Small changes can make a big difference in your child’s health. First Lady Michelle Obama gives a few concrete examples of doing just that – putting water in your child’s lunch box, providing a fruit serving at breakfast, and curbing fast food consumption. The AAP’s healthy active living prescription available at www.aap.org/obesity/whitehouse is designed to help you and your pediatrician identify some areas where you might want to begin. Remember, small changes you make every day can make a big difference in your family’s health in the long run!

How can our communities support healthy active children?
The environments our children live in have a profound impact on the foods they eat and the amount of activity they get. Some communities lack full-service grocery stores, but have an abundance of fast food restaurants. In turn, families may fall back on these fast food options because healthy, fresh foods are not available nearby. Working with community leaders to encourage the creation of healthy, fresh food options can make a difference in the choices available for families. White House Obesity Initiative FAQ for Families
Communities can also ensure that children have a safe place to play. Community centers, green space, parks – these all provide an opportunity for kids to be active. Encourage your community to have fun and safe places for children to play – inside and outside – so they have options for fun and safe activities.

Why has the First Lady chosen to make childhood obesity prevention one of her top
priorities?
Our world has changed dramatically over the past 20 years and as a result children and families are left in an environment where it is often hard to make healthy and informed choices. It is our job as parents, citizens and policy makers to create an environment where people can make informed decisions and where healthy choices are widely available, and affordable, for all children and families. The First Lady not only has the visibility to draw attention to the issue, she also has experienced the challenges associated with trying to lead a healthy active lifestyle in today’s world. The AAP commends the First Lady on her dedication to this extremely important child health issue and is committed to working in partnership with families and communities to ensure the life success of every child.

How can pediatricians and parents partner on healthy active living?
Your pediatrician can partner with you on a prescription for healthy active living that is right for your family. He or she knows your family and understands the nutritional and physical activity needs for your child. Your pediatrician is also familiar with your community and may be able to help you find needed resources to support your healthy active lifestyle goals. Together, you and your pediatrician can help your family get started on the path to leading healthier lives.