Weight Management - Frequently Asked Questions

• What is Obesity?
• What are the Health Consequences of Obesity?
• How are Overweight and Obesity Defined?
• What is a Bariatrician?
• How Do Bariatricians Treat Obesity?
• How Prevalent is Obesity?
• What About Childhood Obesity?
• What Costs are Associated with Obesity?

What is Obesity?

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% 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.

What are the Health Consequences of Obesity?

• Coronary heart disease
• Type 2 diabetes
• Cancers (endometrial, breast and colon)
• Hypertension (high blood pressure)
• Dyslipidemia (high total cholesterol or high levels of triglycerides)
• Stroke
• Liver and gallbladder disease
• Sleep apnea and respiratory problems
• Osteoarthritis
• Gynecological problems (abnormal menses, infertility)

  How are Overweight and Obesity Defined?

There are several methods to measure obesity levels including Bioelectrical Impedance Analysis, Hydrostatic (underwater) Weighing and Dual Energy X-ray Absorptiometry.  Bioelectrical Impedance Analysis is typically the most practical and convenient method used by bariatricians.  The Body Mass Index (BMI) is a screening tool to identify people who may be at increased health risk due to being overweight or obese.  The BMI formula = weight in pounds / (height in inches x height in inches) x 703.  The following classifications for BMI were recommended by the National Heart Lung and Blood Institute:

• Underweight: lower than 18.5
• Normal weight: 18.5 to 24.9
• Overweight: 25 to 29.9
• Obesity: 30 to 34.9 (Class 1)
• Obesity: 35 to 39.9 (Class 2)
• Extreme Obesity: greater than 40 (Class 3)

Waist-to-hip measurements are also critical.  These are obtained by dividing the circumference of an individual’s waist by their hips.  A healthy waist-to-hip ratio for women is no more than 0.8 and a healthy ratio for men is no more than 0.95.

What is a Bariatrician?

These licensed physicians (Doctor of Medicine - MD or Doctor of Osteopathy - DO) have received special training in Bariatric Medicine: the art and science of medical weight management. Bariatricians treat overweight and obese patients with a comprehensive program of diet and nutrition, exercise, behavioral therapy and, when necessary, the prescription of appetite suppressants and other appropriate medications.  

How Do Bariatricians Treat Obesity?

Physician supervision is necessary to detect and treat weight-related medical conditions. The cost of participating in a medically supervised weight loss program is comparable to the cost of weight loss programs that do not have a physician on site. Health insurance companies may cover some or all of your bariatric treatment if you have heart disease, metabolic syndrome, diabetes or a pre-diabetic condition. Often, a 10% reduction in an obese person’s body weight can bring about a significant reduction in their health risk from obesity. ASBP has developed and promoted Bariatric Practice Guidelines which provide a framework that helps to ensure a high standard of medical practice.  These guidelines define the most appropriate procedures for assessing, counseling, and treating patients with weight management issues and associated medical conditions.

  How Prevalent is Obesity?

• More than one-third of U.S. adults were obese in 2005-2006. (Centers for Disease Control & Prevention) 
• Adults aged 40-59 had the highest obesity prevalence compared with other age groups. Approximately 40% of men in this age group were obese, compared with 28% of men aged 20-39, and 32% of men aged 60 and older. Among women, 41% of those aged 40-59 were obese compared with 30.5% of women aged 20-39. Women aged 65 and older had obesity prevalence rates comparable with women in the 20 to 39 age group. (Centers for Disease Control & Prevention’s National Center for Health Statistics)
• There were large race-ethnic disparities in obesity prevalence among women. Approximately 53% of non-Hispanic black women and 51% of Mexican-American women aged 40-59 were obese compared with about 39% of non-Hispanic white women of the same age.  Among women 60 and older, 61% of non-Hispanic black women were obese compared with 37% of Mexican-American women and 32% of non-Hispanic white women. (Centers for Disease Control & Prevention’s National Center for Health Statistics)
• Maintaining weight loss over the long term is exceedingly difficult. Most people regain as much as two-thirds of weight lost within one year, and regain all of it within five years.

What About Childhood Obesity?

Among children aged 6 to 11 years, the prevalence of obesity has more than doubled over the past three decades, rising from 6.5% in 1980 to 17.0% in 2006. The rate among adolescents aged 12 to 19 years has more than tripled during the same period, increasing from 5.0% to 17.6%. (Centers for Disease Control & Prevention) Surveyed United States high school students exhibited the following unhealthy behaviors on a daily basis:

• More than 70% ate fruits and vegetables less than five times.
• More than 30% drank a non-diet soda at least once.
• More than 50% did not meet recommended levels of physical activity.
• More than 30% watched three or more hours of television.

  What Costs are Associated with Obesity?

• The World Bank estimated that roughly 12% of the U.S. health care budget is spent on obesity treatment.
• U.S. medical expenditures attributable to obesity reached $75 billion in 2003 (RTI International and Centers for Disease Control & Prevention).