Many of us are concerned when our clothing starts to fit a bit too snugly, or we catch an unflattering glimpse of ourselves in the mirror. With a little more discipline at the table and getting out and exercising more, we’re usually able to get back into our comfort zone. For millions of Americans today who are obese and overweight, however, tipping the scales is more than just a little disconcerting. It’s a recipe for some serious trouble. Disturbing Statistics First, let’s look at the facts. According to a data brief from the National Center for Health Statistics (NCHS), more than one-third of adults in the U.S. (34 percent), over 72 million people, were obese in 2005-2006. This compares with 32.7 percent who classified as overweight. Of the obese, just under 6 percent were “extremely” obese. In previous studies by the NCHS from 1988-1994, 33 percent of Americans were overweight, 22.9 percent were obese, and 2.9 percent were morbidly obese. As the NCHS studies show, over time, the prevalence of obesity has more than doubled, while that of overweight has remained about the same. Breaking the 2005-2006 obese category down further, 33.3 percent were men and 35.3 percent were women. Adults aged 40 to 49 were more likely to be obese than individuals younger and older. Approximately 40 percent of men and 41.1 percent of women aged 40 to 49 were obese. This compares with obesity prevalence of 28.1 percent of men aged 20 to 39 and 32.2 percent of men aged 60 and older. Among women, the obesity prevalence for those aged 20 to 39 was 30.5 percent, while there was no significant difference between the oldest women (aged 60 and older) and younger ones. There were also large disparities in obesity prevalence among race-ethnic groups in women aged 40 to 59. Mexican-American (51 percent) and non-Hispanic black women (53 percent) were more likely to be obese than non-Hispanic white women (approximately 39 percent). In the oldest age category, again there were differences between race-ethnic groups. Figures show 61 percent of non-Hispanic black women aged 60 and older were obese in 2005-2006, compared with 37 percent of Mexican-American and 32 percent of non-Hispanic white women. Approximately two-thirds of obese adults, according to NCHS data, have been told by a health practitioner that they are overweight. Obesity Risks Obesity is associated with increased risks for a number of conditions, including certain cancers (colon, breast, endometrial, and gallbladder), cardiovascular disease, diabetes mellitus, gallbladder disease, hypertension, osteoarthritis, reproductive problems, and stroke. Obesity is also associated with increased risk of disability and a modestly-elevated risk of all-cause mortality. Among children and adolescents, being overweight increases the risk of high cholesterol, diabetes, hypertension, low self-esteem, orthopedic disorders, sleep apnea, and becoming an overweight adult (possibly leading to obesity). Factors Contributing to Obesity and Overweight There is no single contributing factor that accounts for obesity and overweight conditions. Indeed, there are several and one or more may be present in the affected individuals. These factors include: • Genetic factors – Overweight and obesity tend to run in families. If you come from a family where one or more blood relatives are overweight or obese, you are at an increased likelihood to become so yourself. • Diet – Eating poorly, overeating, and taking in too many calories that aren’t burned equals overweight or obesity over time. • Inactivity – Sedentary lifestyles contribute to obesity and overweight. Studies show that more than 2 hours spent in front of the television each day has been linked to overweight and obesity. • Environmental factors – Too many hours spent working, no parks or recreational areas nearby, oversized food portions, constant food advertising, lack of access to healthy foods – all can contribute to increased weight gain, overweight and obesity. • Health concerns – An underactive thyroid can lead to increased weight gain. Other health conditions that may contribute to weight gain include Cushing’s syndrome and polycystic ovarian syndrome. • Smoking – When people stop smoking, they tend to eat more. The reasoning behind this is that food smells and tastes better, so people consume more. In addition, since nicotine increases the rate of calorie burn, when you stop smoking, fewer calories are burned. • Age – When people get older, they have a tendency to lose muscle – especially if they are inactive. Muscle loss slows down the rate at which the body burns calories. Without reducing caloric intake as you get older, you will gain weight. Menopause also contributes to a small weight gain in many women, along with an increase in fat around the waist. Assessment of Overweight To obtain an assessment of overweight, doctors utilize three key measures: body mass index (BMI), waist circumference, and an analysis of risk factors for diseases and conditions associated with obesity. Individuals can calculate their own assessment using BMI tables, tape measure, and information they know about their own risk factors. • BMI – BMI is a measurement of weight relative to height. While it is a reliable indicator of total body fat, which is also associated with risk of disease and death, BMI does have some limitations. It tends to overestimate body fat in athletes and other individuals who have a muscular build. It tends to underestimate the body fat in older individuals and those who have lost muscle mass. BMI scores fall into the following categories: o Underweight – BMI below 18.5 o Normal – BMI 18.5 – 24.9 o Overweight – BMI 25.9 – 29.9 o Obese – BMI 30.0 and above • Waist Circumference – Determine your waist circumference by placing a tape measure snugly around your waist. This measurement is a good indicator of abdominal body fat, which is another predictor of risk for developing heart disease and other debilitating conditions. The risk increases with a waist measurement exceeding 40 inches in men and 35 inches in women. • Additional Risk Factors – If you have any of the following conditions, you are at increased risk of becoming overweight: o High blood pressure – hypertension o High LDL-cholesterol – also called the “bad” cholesterol o Low HDL-cholesterol – also called the “good” cholesterol o High blood glucose – sugar o High triglycerides o Physical inactivity o Cigarette smoking o Family history of premature heart disease Following a self-assessment or examination by a doctor, if you are overweight or obese, you should consider beginning an immediate program to safely lose weight. Your doctor can give you guidelines for how to do this. In general, if you are either overweight (BMI of 25.9 to 29.9) or obese (BMI of 30.0 or higher), and have two risk or more factors, weight loss is definitely recommended. Experts say that even a 10 percent weight loss can help to reduce your risk of developing diseases related to obesity. If you are merely overweight but do not have a high waist circumference and less than two risk factors, you may merely need to prevent gaining additional weight (rather than losing weight). Weight Loss Programs If you need to lose weight, you definitely want to do so safely. By all means, investigate the various weight loss programs out there, but don’t just jump into one because you see it advertised on television or the Internet. Do your due diligence. Here are some questions you need to ask: • Does the program provide ongoing counseling to help you change your personal and eating habits? The kind of program you need will teach you how to permanently change lifestyle factors (such as lack of physical activity) and eating habits that contributed to your overweight or obese condition. • What are the qualifications of the staff? You need to be assured of the credentials of professionals in the program. Are there a number of qualified counselors and health professionals – registered dieticians, nurses, doctors, psychologists, and exercise physiologists? Make sure you have a health checkup by your personal physician to get the go-ahead before getting started with any weight loss program. • Is training available to help you deal with times when you have increased stress? Such training may include learning how to deal with urges to eat to cope with stress and emotional difficulties, setting up and using a support network, and establishing a routine of regular physical activity. • How much attention is paid to getting the weight off, and how long does this phase last? You need a program that regularly monitors weight loss and helps you permanently affect changes that will help you keep the weight off. • What about food choices? Are they acceptable and in keeping with your likes and dislikes? How flexible are they? • Who sets weight loss goals? It should be a combination of the weight loss professional and the client. • What is the program’s success rate? While statistics are only a reference point, and your own results may differ, it is nevertheless important to inquire what percentage of clients have been able to reach their weight loss goals using the program. • What percentage of clients completes the program? • What percentage of clients experience side effects or have problems as a result of being in the program? What are some of those problems and how are they dealt with? • What is the average weight loss of clients in the program? • What does the program cost? • What fees or costs are involved for any other aspects of the program, such as nutritional supplements? Increasing Physical Activity Besides changing eating habits, in order to lose weight you need to increase your daily physical activity. Many overweight and obese people have sedentary lifestyles – they sit at a desk or computer or lay around on the couch instead of getting out and being physically active. Experts recommend that you first check with your doctor before beginning any specific exercise program, and that you implement changes gradually. Here are some suggestions for how you can slowly build up your daily amount of physical activity. • Take a walk. – Start out by walking for a period of 30 minutes three days a week. Increase to 45 minutes to an hour and five days a week. Initially, walk at a slow pace. You are getting your lungs, heart and muscles used to the physical exertion. Over time, increase your pace so that you are walking more briskly. Doing this regimen can burn 100 to 200 calories more a day. • Use the stairs. – Instead of taking the elevator, use the stairs. This kind of “everyday” activity is easy to do, and doesn’t require going out of your way, buying expensive gym memberships or special equipment. Don’t have a stairs in your home? If you go to the mall, use the stairs in the department store or the mall proper (including outside mall stairs from one level to another). If you’re concerned about the safety of enclosed stairwells, take the escalator, but walk up and down instead of riding it. • Get involved in a sport. – Competitive sports, such as basketball, tennis, volleyball, and badminton, for example, are fun and easy ways to increase your exercise quotient. You need to be healthy enough to be able to participate, however, and guard against being injured. • Step up common chores. – Think exercising is all about going somewhere else? You can gain the benefits of exercise by stepping up your common chores around the house. Raking leaves, shoveling snow, washing windows indoors and out (be careful of second-story or out-of-reach windows), washing the car, painting, and gardening are all excellent ways to be physically active – and get something done in the process. • Go swimming. – Aerobic benefits of swimming laps count, too, in your overall goal to increase physical activity. Aim for about 20 minutes at a time. Water aerobics is another fun activity you can do for about 30 minutes at a stretch. • Add fun stuff. – Love to dance or want to learn? Dancing helps burn calories, tones your body and trims off pounds. And it’s fun to do. Physical activity regimens should progress from very light activity (an increase in standing activity, pushing a stroller, playing a musical instrument), to light activity (walking slow, housework, carpentry, table tennis, sailing), to moderate activity (brisk walking, weeding, dancing, skiing), to high activity (very brisk walking, carrying a load uphill, heavy digging, climbing, soccer/kickball). Also consider flexibility or range of motion exercises, strength or resistance exercises, and aerobic conditioning. Adopt a Positive Outlook Overcoming a problem with weight – overweight or obesity – is a long-term process. It isn’t something you can expect to occur overnight. To best prepare you for the necessary eating and lifestyle changes, experts recommend you adopt and maintain a positive outlook. This includes setting and working toward realistic and achievable weight loss goals, beginning and stepping up physical activities, and learning how to enjoy a more active life. Having a support system and network of friends in place can make all the difference in the world when it comes to sustaining your new lifestyle. As you drop pounds, you will feel more energetic and have a greater interest in pursuing new interests. Things that you thought out of reach before, like travel to different countries, applying for a new job, meeting a love interest, being more outgoing, will not seem so unattainable. Along with the new outlook on life, you will likely also gain a few more years. In addition, those extra years are more likely to be healthier than when you tipped the scales. Adding it all up, getting serious about becoming healthy and losing weight is a recipe worth looking into.