Since the 19th century, people have used the body mass index (BMI) to correlate weight with health. Obesity is defined as a BMI greater than 30, with “morbid” obesity occurring at a BMI over 35. Individuals may have an elevated BMI but be perfectly healthy, notably pregnant women and certain athletes. But a BMI over 35 is strongly associated with potentially debilitating medical conditions such as:
- Type-2 diabetes
- High cholesterol
- High blood pressure
- Fatty liver
- Sleep apnea
These diseases, in turn, can lead to chronic health issues including heart disease, fertility problems and even certain forms of cancer. Excess weight can also contribute to fatigue, arthritis, and depression as affected individuals find it more difficult to work and participate in family or social activities. Altogether, these conditions can dramatically decrease quality of life and life expectancy among people with obesity. With rates steadily increasing – over 37% of Americans as of 2016 – obesity has been identified as one of the most expensive and dangerous medical challenges of our lifetime.
Adding insult to injury, people struggling with excess weight face cruel, undeserved biases in the workplace and society at large, often because of the misconception that obesity is something that people can simply choose to not have. This fallacy is rooted in a misunderstanding of how genetics, metabolism, and socioeconomic factors contribute to how an individual stores excess calories. Individual choices in diet and exercise certainly contribute to weight, but so does age, pregnancy status, family history, and access to healthy and affordable food. Furthermore, human beings (like all animals) evolved to store excess calories as fat, an adaptive feature that has become detrimental as highly processed foods become cheaper and more available.
But as the problem of obesity has grown, so have our abilities to understand and treat it. Crash diets and short-lived aggressive exercise programs are largely understood to be ineffective, with most weight loss and nutritional programs now focusing on small, sustainable lifestyle changes. Medications and non-invasive therapies to assist in these interventions are increasingly endorsed by the medical community and patients alike. Bariatric surgery (or weight loss surgery) remains the most reliable way to lose a large amount of weight and minimize the risk of regaining weight. Though an option of last resort for many, bariatric surgery is now more effective, available, and nuanced than ever before, with fellowship training in minimally invasive techniques becoming widespread. Most importantly, these surgeries are safer than ever, having lower complication rates than common procedures like appendectomy or knee replacement.
Nonetheless, these treatment options are tools, not cures. Like all tools, one must understand how to take care of them and how they work. They cannot change the root causes of obesity, and they require a lifetime of effort and partnership with healthcare providers in order to maximize success. Winning the battle against the effects of obesity is a real possibility, but requires patience and empathy from providers and patients alike!
Causes of Obesity
Treatments for Obesity
Childhood & Adolescent Obesity