FAQs

A: Obesity used to be understood in fairly simple terms, excess body weight resulting from eating too much and exercising too little, due in large   part to a lack of willpower or self-restraint. Fortunately for the millions of American adults who are overweight, obesity is now regarded as a chronic medical disease with serious health implications caused by a complex set of factors.

Recognized since 1985 as a chronic disease, obesity is the second leading cause of preventable death, exceeded only by cigarette smoking. Obesity has been established as a major risk factor for hypertension, cardiovascular disease, diabetes mellitus and some cancers in both men and women. Obesity affects 58 million people across the nation and its prevalence is increasing. Approximately one-third of adults are estimated to be obese.

Obesity results from a complex interaction of genetic, behavioral and environmental factors causing an imbalance between energy intake and energy expenditure. According to the National Institutes of Health, an increase in body weight of 20 percent or more above desirable weight is the point at which excess weight becomes an established health hazard. Lower levels of excess weight can also constitute a health risk, particularly in the presence of other disorders like diabetes, hypertension and heart disease.

A: A bariatrician is a licensed physician (Doctor of Medicine [MD] or Doctor of Osteopathy [DO]) who, as a member of the American Society of Bariatric Physicians (ASBP), has received special training in bariatric medicine the medical treatment of overweight and obesity and its associated conditions. Bariatricians address the obese patient with a comprehensive program of diet and nutrition, exercise, lifestyle changes and, when indicated, the prescription of appetite suppressants and other appropriate medications. (The word bariatric stems from the Greek word barros, which translates as heavy or large.

While any licensed physician can offer a medical weight loss program to patients, members of the ASBP have been exposed, through an extensive continuing medical education program, to specialized knowledge, tools and techniques to enable them to design specialized medical weight loss programs tailored to the needs of individual patients and modify the programs, if needed, as the treatment progresses. ASBP members are uniquely equipped to treat overweight and obesity and associated conditions.

A physician-supervised medical weight loss program may be the safest and wisest way to lose weight and maintain the loss. Overweight and obesity are frequently accompanied by other medical conditions, such as type 2 diabetes, hypertension, cancer and others. A bariatric physician is trained to detect and treat these conditions, which might go undetected and untreated in a non-medical weight loss program.

The total cost attributable to obesity amounted to $99.2 billion in 1995. Approximately $51.65 billion of those dollars were direct medical costs. Compared with 1988 … data, in 1994 the number of restricted-activity days, bed-days, and work-lost days increased substantially. The number of physician visits attributed to obesity increased 88 % from 1988 to 1984. (Obesity Research 1998; 6(2):97-106)

The cost of obesity to US business in 1994 was estimated to total $12.7 billion. The health-related economic cost of obesity to US business is substantial, representing approximately 5% of total medical care costs. (American Journal of Health Promotion 1998;13(2): 120-127)

Sustained modest weight loss among obese persons would yield substantial health and economic benefits. (American Journal of Public Health 1999;89(10): 1536-42)

We found that as BMI increases, so do the number of sick days, medical claims and health care costs and that the mean annual health care costs for the BMI “at risk” population was $2,274 versus $1,499 for the “not at risk” group. (Statistical Bulletin of the Metropolitan Insurance Co. 1999 Jul-Sep;80)

The total cost attributable to obesity amounted to $99.2 billion in 1995. Approximately $51.65 billion of those dollars were direct medical costs. Compared with 1988 … data, in 1994 the number of restricted-activity days, bed-days, and work-lost days increased substantially. The number of physician visits attributed to obesity increased 88 % from 1988 to 1984. (Obesity Research 1998; 6(2):97-106)

The cost of obesity to US business in 1994 was estimated to total $12.7 billion. The health-related economic cost of obesity to US business is substantial, representing approximately 5% of total medical care costs. (American Journal of Health Promotion 1998;13(2): 120-127)

Sustained modest weight loss among obese persons would yield substantial health and economic benefits. (American Journal of Public Health 1999;89(10): 1536-42)

We found that as BMI increases, so do the number of sick days, medical claims and health care costs and that the mean annual health care costs for the BMI “at risk” population was $2,274 versus $1,499 for the “not at risk” group. (Statistical Bulletin of the Metropolitan Insurance Co. 1999 Jul-Sep;80)

Approximately one in five children in the US between the ages of 6 and 17 is overweight. The number of overweight children in the US has more than doubled in the past 30 years. (NHANES III) · The number of overweight children (age 6-17) has doubled within three decades. (Pediatrics (Suppl) 1998;101(3): 497-504)

A new chronic disease has emerged over the past two decades, one that overshadows all others in frequency in the pediatric population - obesity. Changes in the Western lifestyle have led to significant reductions in energy expenditure of children and have encouraged “super-sizing” of calorie-dense, high-fat foods and snacks. (Journal of Pediatrics (Editorial) 2000;136(6))

Physical inactivity (a 1996 US Surgeon General’s report on fitness says that nearly half of young people ages 12 to 21 are not vigorously active), “junk” food diets (including high calorie soft drinks and fruit beverages), increased television watching accompanied by snacking, increased time playing video and computer games all contribute to increased obesity among the young.

When we think of the major problems facing pediatrics in the next millennium, the disturbing trend toward obesity has to be among the most serious, with all the adverse health implications that obesity carries. (Pediatric Alert, March 27, 1997)

Obesity has been established as a major risk factor for diabetes, hypertension, cardiovascular disease and some cancers in both men and women. Other comorbid conditions include sleep apnea, osteoarthritis, infertility, idiopathic intracranial hypertension, lower extremity venous stasis disease, gastro-esophageal reflux and urinary stress incontinence.

Obesity-related medical conditions contribute to 300,000 deaths each year, second only to smoking as a cause of preventable death. (JAMA, 1996;276:1907-1915)

The estimated number of annual deaths attributable to obesity among US adults is approximately 280,000 based on relative hazard ratio from all subjects and 325,000 based on hazard ratio from only non-smokers and never-smokers. (JAMA, 1999;282: 1530-1538)

One-third of all cases of high blood pressure are associated with obesity, and obese individuals are 50% more likely to have elevated blood cholesterol levels. (American Family Physician 1997;55(2): 551-558)

Adult onset diabetes (type II, non-insulin dependent) accounts for nearly 90% of all cases of diabetes. Researchers estimate that 88 to 97% of type II diabetes cases diagnosed in overweight people are a direct result of obesity. (Shape Up America, December 1995)

Excess weight is an established risk factor for high blood pressure, type 2 diabetes (adult-onset), high blood cholesterol level, coronary heart disease and gallbladder disease. (JAMA, 1999;282:1523-1529)

Bariatricians have a wide range of tools to offer their overweight patients, including special diet and nutrition products, individualized exercise programs, suggestions for lifestyle changes and prescription medications, if indicated.

Prescription anti-obesity medications can be a useful adjunct to a medical weight loss program, when used as part of a comprehensive program including diet and nutrition changes, exercise, and lifestyle modification. Medications alone will not lead to successful weight loss and maintenance. These medications are intended for patients who have a great deal of weight to lose, not for someone who wants to lose 5 or 10 pounds or drop a dress size. Many of the appetite suppressants and other medications available today have a long history of safe and successful use. New medications are being researched and will be available after clinical testing and FDA approval.

Just as there are some risks and side effects with almost any medication, including aspirin, acetaminophen and birth control pills, so may there be side effects and risks with anti-obesity medications. For most people, the side effects are minimal and of short duration. Bariatricians are trained to know how to prescribe the drugs properly and monitor patients taking these medications. Obese patients, particularly those with comorbid conditions, such as diabetes and cardiovascular disease, may be at greater risk from remaining obese than the risk they might incur by taking the medications. The decision to prescribe anti-obesity medications must be made by the bariatric physician and the patient after carefully weighing the risks of the medications vs. the risks of remaining obese.

Bariatricians frequently prescribe low calorie diets or very low calorie diets (VLCD) along with vitamins and nutritional supplements, together with exercise and lifestyle changes to bring about a relatively rapid loss of weight. The VLCD, especially, should only be used under the careful supervision and monitoring of a physician and other health care personnel trained in its use.

Just as there are side effects of any medications, such as aspirin and penicillin, so are there side effects of taking appetite suppressants. Some common side effects are dryness of the mouth, dizziness, abdominal pain, diarrhea or constipation, nausea, difficulty sleeping, nervousness, increased blood pressure and headache. Most of these drugs affect the body’s nervous system. While they generally suppress appetite, some may also alter the way the body burns calories.

Among the best-known medications:

AMPHETAMINES (amphetamine, dextroamphetamine, methamphetamine) are strong stimulants that are no longer recommended by most authorities for weight control because they are highly addictive. Potential side effects include heart palpitations, elevation of blood pressure, gastrointestinal disturbances and insomnia. Amphetamines are prescribed for other problems than obesity, such as attention deficit disorder the narcolepsy.

APPETITE SUPPRESSANTS — Phentermine was first approved by the Food and Drug Administration in 1959 as a “short term (a few weeks) adjunct in a regimen of weight reduction based on caloric restriction.” It is sold under the brand names Ionamin, Adipex, Fastin, Banobese, Obenix and Zantryl. Among other drugs of this type are phendimetrizine, mazindol, and the over-the-counter diet aid phenylpropanolamine (Accutrim, Dexatrim). Sibutramine, which is being marketed as Meridia, the newest prescription appetite suppressant, became available in February 1997.

ORLISTAT, which is being marketed as Xenical, became available in the US in May 1999. Not an appetite suppressant, Orlistat is a lipase inhibitor or “fat blocker” drug. It prevents the absorption of about 30 percent of dietary fat by the digestive tract. It is meant to be used in conjunction with a reduced-calorie diet. Some side effects, which are generally mild and transient, may include oily spotting, flatulence with discharge, fecal urgency, oily evacuation and fecal incontinence. Maintaining a diet of no more than 30 percent of calories from fat may minimize these side effects. The medication also reduces the absorption of fat-soluble vitamins; patients are advised to take a daily supplement that contains vitamins A, D, E and K as well as beta-carotene.

LEPTIN is a form of the human protein made in fat cells. It’s currently in human clinical trials and may help reduce body weight and fat through curbs on metabolism and appetite.

Always consult a licensed physician before taking any medication.

Using a BMI table, a person 5'6" tall weighing 140 pounds would have a BMI of 23, well out of the range of risk. That same 5'6" person weighing 190 pounds would have a BMI of 31, in the range of Grade 2 obesity.

A BMI of 27 or higher is associated with increased morbidity and mortality; this is generally considered the point at which some form of treatment for obesity is required. A BMI between 25 and 27 is considered a warning sign and may warrant intervention, especially in the presence of additional risk factors.

BMI is defined as body weight (in kg) divided by height (in m2 ). You can easily calculate your BMI by multiplying your weight in pounds by 703, then dividing the result by your height in inches and dividing that result by your height in inches.

In recent years, researchers and clinicians have shifted focus from “ideal”body weights as reflected in the height-weight tables, to helping patients achieve and maintain “healthy” or “healthier” body weights. Studies have shown that losing even modest amounts of weight — just 5 to 10 percent of initial body weight — and maintaining the loss improves health and well-being and decreases the risk for a variety of obesity-related health complications.