An issue that virtually all physicians face on a daily basis is the problems caused by the excess weight/obesity of many patients.
If we could somehow conquer this epidemic and also convince people to stop using tobacco, we would dramatically increase life
expectancy, save an enormous amount of money and give us doctors some well-deserved free time!
The term overweight refers to an excess of body weight compared to a set standard. The excess weight may come from muscle,
bone, fat and/or water. Obesity refers specifically to having an abnormally high proportion of body fat. A person can be overweight
without being obese, as in the example of a bodybuilder or other athlete who has a lot of muscle. However, many people who
are overweight are also obese.
Various methods are used to determine if someone's weight has increased his or her health risks. Some are based on the relationship
between height and weight; others are based on measurements of body fat. The most commonly used method today is the body mass
index, which is an index of weight adjusted for the height of an individual.
BMI can be used to screen for both overweight and obesity in adults. BMI is a calculation based on height and weight, and
it is not gender-specific in adults. BMI does not directly measure percentage of body fat, but it is a more accurate indicator
than relying on weight alone. It is calculated by dividing a person's weight in kilograms by height in meters squared. The
mathematical formula is "weight (kg)/height (m2)." To determine BMI using pounds and inches, multiply weight in pounds by 704.5, divide the result by height in inches, and
then divide that result by height in inches a second time. (For a BMI calculator, visit http://www.nhlbisupport.com/bmi/).
Over the past decade, expenses related to obesity have cost the United States over a trillion dollars. Direct health-care
costs refer to preventive, diagnostic and treatment services such as physician visits, medications, and hospital and nursing
home care. Indirect costs are the value of wages lost by people unable to work because of illness or disability, as well as
the value of future earnings lost by premature death.
According to a study of national costs attributed to both overweight (BMI 25–29.9) and obesity (BMI greater than 30), medical
expenses accounted for 9.1 percent of total medical expenditures in 1998 and may have reached as high as $78.5 billion ($92.6
billion in 2002 dollars). Approximately half of these costs were paid by Medicaid and Medicare.
Children and adults, across the board, are affected by this problem, as illustrated below:
- 58 million overweight; 40 million obese and three million morbidly obese
- Eight out of 10 adults over 25 are overweight
- 78% of American are not meeting basic activity-level recommendations
- 25% completely sedentary
Overweight and obese individuals are at increased risk for many diseases and health conditions, including hypertension
(high blood pressure), osteoarthritis (a degeneration of cartilage and its underlying bone within a joint), dyslipidemia (for
example, high total cholesterol or high levels of triglycerides), type 2 diabetes, coronary heart disease, stroke and gallbladder
disease.
These conditions barely scratch the surface, in my opinion. In fact, a good case can be made for excess weight contributing
to or exacerbating practically every pathology that primary care physicians treat, except for infectious diseases and a few
other exceptions. Other conditions made worse by increased weight include injuries from accidents, insomnia, chronic obstructive
pulmonary disease and chronic pain syndromes.
It can even prevent certain operations. I currently have a patient who must lose 50 pounds before her surgeon will consider
weight loss surgery for her.
