OBESITY

The definition of obesity varies depending on what one reads. In general, overweight and obesity indicate a weight greater than
what is considered healthy. Obesity is a chronic condition defined by an excess amount of body fat. A certain amount of body fat is
necessary for storing energy, heat insulation, shock absorption, and other functions.
Obesity is best defined by using the body mass index. The body mass index is calculated using a person's height and weight. The
body mass index (BMI) equals a person's weight in kilograms (kg) divided by their height in meters (m) squared. Since BMI
describes body weight relative to height, it is strongly correlated with total body fat content in adults. An adult who has a BMI of 2529.9 is considered overweight, and an adult who has a BMI over 30 is considered obese.

How common is obesity?

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. Obesity has also been increasing rapidly
throughout the world, and the incidence of obesity nearly doubled from 1991 to 1998

What is the health risks associated with obesity?

Obesity is not just a cosmetic consideration; it is a dire dilemma directly harmful to one's health. In the United States, roughly
112,000 deaths per year are directly related to obesity, and most of these deaths are in patients with a BMI over 30. For patients
with a BMI over 40, life expectancy is reduced significantly. Obesity also increases the risk of developing a number of chronic
diseases, including the following:

What are other factors associated with obesity?

Ethnicity. Ethnicity factors may influence the age of onset and the rapidity of weight gain. African-American women and
Hispanic women tend to experience weight gain earlier in life than Caucasians and Asians, and age-adjusted obesity rates are
higher in these groups. Non-Hispanic black men and Hispanic men have a higher obesity rate then non-Hispanic white men,
but the difference in prevalence is significantly less than in women.
Childhood weight. A person's weight during childhood, the teenage years, and early adulthood may also influence the
development of adult obesity. For example,
o
being mildly overweight in the early 20s was linked to a substantial incidence of obesity by age 35;

being overweight during older childhood is highly predictive of adult obesity, especially if a parent is also obese;

Being overweight during the teenage years is even a greater predictor of adult obesity.
Hormones. Women tend to gain weight especially during certain events such as pregnancy, menopause, and

in some cases, with the use of oral contraceptives. However, with the availability of the lower-dose estrogen pills, weight gain
has not been as great a risk.

How is body fat measured?

BMI is a calculated value and approximates the body's fat percentage. Actually measuring a person's body fat percentage is not
easy and is often inaccurate if the methods are not monitored carefully. The following methods require special equipment, trained
personnel, can be costly, and some are only available in certain research facilities.

Underwater weighing (hydrostatic weighing): This method weighs a person underwater and then calculates lean body
mass (muscle) and body fat. This method is one of the most accurate ones; however, it is generally done in special research
facilities, and the equipment is costly.

BOD POD: The BOD POD is a computerized, egg-shaped chamber. Using the same whole-body measurement principle

as hydrostatic weighing, the BOD POD measures a subject's mass and volume, from which their whole-body density is
determined. Using this data, body fat and lean muscle mass can then be calculated.
DEXA: Dual-energy X-ray absorptiometry (DEXA) is used to measure bone density. It uses X-rays to determine not only

the percentage of body fat but also where and how much fat is located in the body.
The following two methods are simple and straightforward:

Skin calipers: This method measures the skin fold thickness of the layer of fat just under the skin in several parts of the
body with calipers (a metal tool similar to forceps); the results are then used to calculate the percentage of body fat.
Bioelectric impedance analysis (BIA): There are two methods of the BIA. One involves standing on a special scale with

footpads. A harmless amount of electrical current is sent through the body, and then percentage of body fat is calculated. The
other type of BIA involves electrodes that are typically placed on a wrist and an ankle and on the back of the right hand and on
the top of the foot. The change in voltage between the electrodes is measured. The person's body fat percentage is then
calculated from the results of the BIA. Early on, this method showed variable results. Newer equipment and methods of
analysis seem to have improved this method.
Health clubs and weight-loss centers often use the skin caliper or bioelectric impedance analysis method; however, these can yield
inaccurate results if an inexperienced person performs them or they are used on someone with significant obesity.

What about weight-for-height tables?

Measuring a person's body fat percentage can be difficult, so other methods are often relied upon to diagnose obesity. Two widely
used methods are weight-for-height tables and body mass index (BMI). While both measurements have their limitations, they are
reasonable indicators that someone may have a weight problem. The calculations are easy, and no special equipment is required.
Most people are familiar with weight-for-height tables. Although such tables have existed for a long time, in 1943, the Metropolitan
Life Insurance Company introduced their table based on policyholders' data to relate weight to disease and mortality. Doctors and
nurses (and many others) have used these tables for decades to determine if someone is overweight. The tables usually have a
range of acceptable weights for a person of a given height.
One small problem with using weight-for-height tables is that doctors disagree over which is the best table to use. Several versions
are available. Many have different weight ranges, and some tables account for a person's frame size, age and sex, while other
tables do not.
A significant limitation of all weight-for-height tables is that they do not distinguish between excess fat and muscle. A very muscular
person may be classified as obese, according to the tables, when he or she in fact is not.