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Overweight and Obesity
Defining Overweight and Obesity

Overweight and Obesity Among Adults

Results of the National Health and Nutrition Examination Survey (NHANES) 1999–2000 indicate that an estimated 64 percent of U.S. adults are either overweight or obese, defined as having a body mass index (BMI) of 25 or more.

Overweight

Overweight refers to increased body weight in relation to height, when compared to some standard of acceptable or desirable weight (NRC p.114; Stunkard p.14). NOTE: Overweight may or may not be due to increases in body fat. It may also be due to an increase in lean muscle. For example, professional athletes may be very lean and muscular, with very little body fat, yet they may weigh more than others of the same height. While they may qualify as “overweight” due to their large muscle mass, they are not necessarily “over fat,” regardless of BMI.

Desirable weight standards are derived in a number of ways:

• By using a mathematical formula known as Body Mass Index (BMI), which represents weight levels associated with the lowest overall risk to health. Desirable BMI levels may vary with age.
• By using actual heights and weights measured and collected on people who are representative of the U.S. population by the National Center for Health Statistics. Other desirable weight tables have been created by the Metropolitan Life Insurance Company, based on their client populations.

These sources are consistent with the U.S. Dietary Guidelines and with the National Heart, Lung, and Blood Institute’s Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.

Obesity

Obesity is defined as an excessively high amount of body fat or adipose tissue in relation to lean body mass. (NRC p114; Stunkard p14) The amount of body fat (or adiposity) includes concern for both the distribution of fat throughout the body and the size of the adipose tissue deposits. Body fat distribution can be estimated by skinfold measures, waist-to-hip circumference ratios, or techniques such as ultrasound, computed tomography, or magnetic resonance imaging.

Overweight and Obesity Among Children and Adolescents

• The percentage of children and adolescents who are defined as overweight has more than doubled since the early 1970s.
• About 15 percent of children and adolescents are now overweight.

In spite of the public health impact of obesity and overweight, these conditions have not been a major public health priority in the past. Halting and reversing the upward trend of the obesity epidemic will require effective collaboration among government, voluntary, and private sectors, as well as a commitment to action by individuals and communities across the nation.

Body Mass Index (BMI)

BMI is a common measure expressing the relationship (or ratio) of weight-to-height. It is a mathematical formula in which a person’s body weight in kilograms is divided by the square of his or her height in meters (i.e., wt/(ht)2. The BMI is more highly correlated with body fat than any other indicator of height and weight (NRC p563).

Individuals with a BMI of 25 to 29.9 are considered overweight, while individuals with a BMI of 30 or more are considered obese.

What BMI levels are risky?

According to the NIH Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, all adults (aged 18 years or older) who have a BMI of 25 or more are considered at risk for premature death and disability as a consequence of overweight and obesity. These health risks increase even more as the severity of an individual’s obesity increases.

Waist circumference

Waist circumference is a common measure used to assess abdominal fat content. The presence of excess body fat in the abdomen, when out of proportion to total body fat, is considered an independent predictor of risk factors and ailments associated with obesity.

What waist size is risky? Undesirable waist circumferences differ for men and women.

• Men are at risk who have a waist measurement greater than 40 inches (102 cm).
• Women are at risk who have a waist measurement greater than 35 inches (88 cm).

NOTE: If a person has short stature (under 5 feet in height) or has a BMI of 35 or above, waist circumference standards used for the general population may not apply.

Waist-to-hip ratio (WHR)

Waist-to-hip ratio (WHR) is the ratio of a person’s waist circumference to hip circumference, mathematically calculated as the waist circumference divided by the hip circumference. For most people, carrying extra weight around their middle increases health risks more than carrying extra weight around their hips or thighs. (NOTE: Overall obesity is still more risky than body fat storage locations or waist-to-hip ratio.)

What waist-to-hip ratio is considered risky?
For both men and women, a waist-to-hip ratio of 1.0 or higher is considered “at risk” or in the danger zone for undesirable health consequences such as heart disease and other ailments connected with being overweight.

What is a good waist-to-hip ratio?
For men, a ratio of .90 or less is considered safe.
For women, a ratio of .80 or less is considered safe.

References

Stunkard AJ, Wadden TA. (Editors) Obesity: theory and therapy, Second Edition. New York : Raven Press, 1993.

National Research Council. Diet and health: implications for reducing chronic disease risk. Washington , DC : National Academy Press, 1989.

National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Bethesda , Maryland : Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, 1998.

http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm

The Surgeon General’s Call To Action To Prevent and Decrease Overweight and Obesity

Overweight in Children and Adolescents

THE PROBLEM OF OVERWEIGHT IN CHILDREN AND ADOLESCENTS

 In 1999, 13% of children aged 6 to 11 years and 14% of adolescents aged 12 to 19 years in the United States were overweight. This prevalence has nearly tripled for adolescents in the past 2 decades.

 Risk factors for heart disease, such as high cholesterol and high blood pressure, occur with increased frequency in overweight children and adolescents compared to children with a healthy weight.

 Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Overweight and obesity are closely linked to type 2 diabetes.

 Overweight adolescents have a 70% chance of becoming overweight or obese adults. This increases to 80% if one or more parent is overweight or obese. Overweight or obese adults are at risk for a number of health problems including heart disease, type 2 diabetes, high blood pressure, and some forms of cancer.

 The most immediate consequence of overweight as perceived by the children themselves is social discrimination. This is associated with poor self-esteem and depression.

THE CAUSES OF OVERWEIGHT

 Overweight in children and adolescents is generally caused by lack of physical activity, unhealthy eating patterns, or a combination of the two, with genetics and lifestyle both playing important roles in determining a child’s weight.

 Our society has become very sedentary. Television, computer and video games contribute to children’s inactive lifestyles.

 43% of adolescents watch more than 2 hours of television each day.

 Children, especially girls, become less active as they move through adolescence.

DETERMINATION OF OVERWEIGHT IN CHILDREN AND ADOLESCENTS

 Doctors and other health care professionals are the best people to determine whether your child or adolescent’s weight is healthy, and they can help rule out rare medical problems as the cause of unhealthy weight.

 A Body Mass Index (BMI) can be calculated from measurements of height and weight. Health professionals often use a BMI “growth chart” to help them assess whether a child or adolescent is overweight.

 A physician will also consider your child or adolescent’s age and growth patterns to determine whether his or her weight is healthy.

GENERAL SUGGESTIONS

 Let your child know he or she is loved and appreciated whatever his or her weight. An overweight child probably knows better than anyone else that he or she has a weight problem. Overweight children need support, acceptance, and encouragement from their parents.

 Focus on your child’s health and positive qualities, not your child’s weight.

 Try not to make your child feel different if he or she is overweight but focus on gradually changing your family’s physical activity and eating habits.

 Be a good role model for your child. If your child sees you enjoying healthy foods and physical activity, he or she is more likely to do the same now and for the rest of his or her life.

 Realize that an appropriate goal for many overweight children is to maintain their current weight while growing normally in height.

PHYSICAL ACTIVITY SUGGESTIONS

 Be physically active. It is recommended that Americans accumulate at least 30 minutes (adults) or 60 minutes (children) of moderate physical activity most days of the week. Even greater amounts of physical activity may be necessary for the prevention of weight gain, for weight loss, or for sustaining weight loss.

 Plan family activities that provide everyone with exercise and enjoyment.

 Provide a safe environment for your children and their friends to play actively; encourage swimming, biking, skating, ball sports, and other fun activities.

 Reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games. Limit TV time to less than 2 hours a day.

HEALTHY EATING SUGGESTIONS

 Follow the Dietary Guidelines for healthy eating (www.health.gov/dietaryguidelines).

 Guide your family’s choices rather than dictate foods.

 Encourage your child to eat when hungry and to eat slowly.

 Eat meals together as a family as often as possible.

 Carefully cut down on the amount of fat and calories in your family’s diet.

 Don’t place your child on a restrictive diet.

 Avoid the use of food as a reward.

 Avoid withholding food as punishment.

 Children should be encouraged to drink water and to limit intake of beverages with added sugars, such as soft drinks, fruit juice drinks, and sports drinks.

 Plan for healthy snacks.

 Stock the refrigerator with fat-free or low-fat milk, fresh fruit, and vegetables instead of soft drinks or snacks that are high in fat, calories, or added sugars and low in essential nutrients.

 Aim to eat at least 5 servings of fruits and vegetables each day.

 Discourage eating meals or snacks while watching TV.

 Eating a healthy breakfast is a good way to start the day and may be important in achieving and maintaining a healthy weight.

IF YOUR CHILD IS OVERWEIGHT

 Many overweight children who are still growing will not need to lose weight, but can reduce their rate of weight gain so that they can “grow into” their weight.

 Your child’s diet should be safe and nutritious. It should include all of the Recommended Dietary Allowances (RDAs) for vitamins, minerals, and protein and contain the foods from the major Food Guide Pyramid groups. Any weight-loss diet should be low in calories (energy) only, not in essential nutrients.

 Even with extremely overweight children, weight loss should be gradual.

 Crash diets and diet pills can compromise growth and are not recommended by many health care professionals.

 Weight lost during a diet is frequently regained unless children are motivated to change their eating habits and activity levels for a lifetime.

 Weight control must be considered a lifelong effort.

 Any weight management program for children should be supervised by a physician.

OBESITY RISK MAY STEM FROM PRE-BIRTH AND EARLY CHILDHOOD FACTORS

Below is a news release on the supplement to the October issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).

For Release: October 4, 2004, 12:01 am (ET)

CHICAGO - A child’s risk of becoming obese may begin before birth and continue throughout infancy and early childhood - critical periods for cellular growth and development, according to research results discussed during a national conference and outlined in the October supplement to Pediatrics.

The conference, “Preventing Childhood Obesity: A National Conference Focusing on Pregnancy, Infancy, and Early Childhood Factors,” was organized by the non-profit organization Shape Up America! The Washington , DC , conference was held in December 2003.

During the last 30 years, the number of obese children and adults has grown rapidly. The percentage of children ages 6 to 11 who are overweight increased from 4 percent in the 1970s to 15 percent in 1999-2000.

Studies presented at the conference showed that a child’s size at birth and early eating habits may affect body mass and weight gain. Such critical periods, according to researchers, should be the focus of childhood obesity prevention efforts.

While large for gestational age (LGA) infants (generally greater than the 90th percentile of weight at birth) are more susceptible to high weight or high body mass index (BMI) later in life, these infants have a greater proportion of lean tissue relative to body fat and a lower risk of cardiovascular disease, stroke, hypertension, and type 2 diabetes at a given BMI.

Conversely, small for gestational age (SGA) infants have a greater percentage of body fat and a higher risk of obesity-related conditions and diseases.

Rapid infant weight gain during the first year of life increases the risk of high adult BMI, particularly for SGA infants. An early “adiposity rebound,” the time in childhood when body fat reaches a minimum and then rises - usually between ages 5 and 6 - also increases adult obesity risk.

Breastfeeding may prevent obesity later in life, according to the supplement, as can a parent’s encouragement of healthy eating during the toddler and early childhood years. Increased activity and decreased television viewing were also encouraged.

The conference recommended more research on the effects of breastfeeding and formula, early exposure to flavors and food groups, and parental feeding styles on later child behavior, food choices and body weight. Increased monitoring of pediatric weight and improved tools for measuring and defining obesity and body mass were also encouraged.

The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

http://www.aap.org/advocacy/releases/octobesity.htm

Assalamu’alaikum.. good night all..

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