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Medical Author:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In this Article

• Obesity facts
• What is obesity?
• How common is obesity?
• What are the health risks associated with obesity?
• What causes obesity?
• What are other factors associated with obesity?
• How is body fat measured?
• What about weight-for-height tables?
• What is the body mass index (BMI)?
• Does it matter where body fat is located?
• What can be done about obesity?
• What is the role of physical activity and exercise in obesity?
• What is the role of diet in the treatment of obesity?
• What is the role of medication in the treatment of obesity?
• What about herbal fen/phen?
• What about meal substitutes, artificial sweeteners, and OTC products?
• What is the role of surgery in the treatment of obesity?
• How can patients choose a safe and successful weight-loss program?
• Patient Comments: Obesity - Effective Treatments
• Find a local Internist in your town
• Obesity (Weight Loss) Index

Obesity has reached epidemic proportions in the United States. Over two-thirds of adults are overweight or obese, and one in three Americans is obese. The prevalence of obesity in children has increased markedly, with approximately 20%-25% of children either overweight or obese. Obesity has also been increasing rapidly throughout the world, and the incidence of obesity nearly doubled from 1991 to 1998.

Obesity is not just a cosmetic consideration; it is a dire dilemma directly harmful to one's health. In the United States, roughly 300,000 deaths per year are directly related to obesity, and more than 80% of these deaths are in patients with a BMI over 30. For patients with a BMI over 40, life expectancy is reduces significantly (as much as 20 years for men and five years for women). Obesity also increases the risk of developing a number of chronic diseases, including the following:

• Insulin resistance. Insulin is necessary for the transport of blood glucose (sugar) into the cells of muscle and fat (which is then used for energy). By transporting glucose into cells, insulin keeps the blood glucose levels in the normal range. Insulin resistance (IR) is the condition whereby the effectiveness of insulin in transporting glucose (sugar) into cells is diminished. Fat cells are more insulin resistant than muscle cells; therefore, one important cause of insulin resistance is obesity. The pancreas initially responds to insulin resistance by producing more insulin. As long as the pancreas can produce enough insulin to overcome this resistance, blood glucose levels remain normal. This insulin resistance state (characterized by normal blood glucose levels and high insulin levels) can last for years. Once the pancreas can no longer keep up with producing high levels of insulin, blood glucose levels begin to rise, resulting in type 2 diabetes, thus insulin resistance is a pre-diabetes condition.
• Type 2 (adult-onset) diabetes. The risk of type 2 diabetes increases with the degree and duration of obesity. Type 2 diabetes is associated with central obesity; a person with central obesity has excess fat around his/her waist, so that the body is shaped like an apple.
• High blood pressure (hypertension). Hypertension is common among obese adults. A Norwegian study showed that weight gain tended to increase blood pressure in women more significantly than in men. The risk of developing high blood pressure is also higher in obese people who are apple shaped (central obesity) than in people who are pear shaped (fat distribution mainly in hips and thighs).
• High cholesterol (hypercholesterolemia)
• Stroke (cerebrovascular accident or CVA)
• Heart attack. A prospective study found that the risk of developing coronary artery disease increased three to four times in women who had a BMI greater than 29. A Finnish study showed that for every 1 kilogram (2.2 pounds) increase in body weight, the risk of death from coronary artery disease increased by 1%. In patients who have already had a heart attack, obesity is associated with an increased likelihood of a second heart attack.
• Congestive heart failure
• Cancer. Obesity has been linked to cancer of the colon in men and women, cancer of the rectum and prostate in men, and cancer of the gallbladder and uterus in women. Obesity may also be associated with breast cancer, particularly in postmenopausal women. Fat tissue is important in the production of estrogen, and prolonged exposure to high levels of estrogen increases the risk of breast cancer.
• Gallstones
• Gout and gouty arthritis
• Osteoarthritis (degenerative arthritis) of the knees, hips, and the lower back
• Sleep apnea