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What to do? - Focus on Yourself First!

Many of us don't want to know the facts about our health but it can be a matter of life and death! Please remember that the primary concern of overweight and obesity is one of health and not appearance.

  1. The first thing we want to learn about our selves is: am I obese or morbidly obese?
  2. Then we will look into what causes our obesity?

Am I obese?

The Centers for Disease Control and Prevention estimates that 64.5 percent of adults and 15 percent of children in the United States are overweight. According to a recent RAND Corp. study, the number of extremely obese American adults - those who are at least 100 pounds overweight - has quadrupled since the 1980s to about 4 million, or about one in every 50 adults.

This prevalence has nearly tripled for adolescents in the past 2 decades. These increases in overweight and obesity cut across all ages, racial and ethnic groups, and both genders. As a result, 300,000 deaths each year in the United States are associated with obesity which is preventable through weight loss surgery (stomach stapling [gastric bypass surgery], lap band [adjustable gastric banding]) and non surgical weight loss methods (nutrition, diet, exercise). So this is a very important question! Lets understand what obesity is.

Obesity is defined as being 20% or more over ideal weight (BMI >25). Ideal weight is the weight associated with the longest life. Ideal weight tables show the ideal weight as it relates to gender and height. There are different tables and some controversy over what actually is ideal weight but a commonly used table is the 1983 Metropolitan Life Insurance Table. A rule of thumb often used by physicians to calculate ideal weight is to allow 100 lbs. for the first 5 feet of a woman's height and 5 lbs. For each inch over 5 feet. For men it is 106 lbs. For the first 5 feet and 6 lbs. For each inch thereafter.

Example: A 5 foot 6 inch woman should therefore weight 130 lbs.

Morbid obesity is a much more severe form of obesity. A person who is 100 or more pounds overweight or twice the ideal body weight and has a BMI of 40 or a BMI of 35 with multiple co-morbidities is morbidly obese. Morbid obesity affects an estimated 9 million Americans.
Morbid obesity is a common condition that can have profoundly negative health and social consequences. It is considered a serious disease and has been linked to shortened life expectancy. Most morbidly obese patients are candidates for the various forms of weight loss surgery (restrictive - lap band, Roux-en-Y Gastric Bypass surgery, Gastroplasty, or Malobsorbtive - biliopancreatic diversion, Duodenal Switch). According to C. Everett Koop, M.D. former Surgeon General of the United States, obesity is the second leading cause of preventable death in America! And more and more insurance companies are realizing that weight loss surgery is not a cosmetically motivated treatment but instead a life saving weight loss surgery treatment making weight loss treatments such as stomach stapling (gastric bypass surgery) or the lap band financially affordable to those in need.

OK, so how do I determine if I am obese and at risk?

According to the National Heart Lung and Blood Institute guidelines, assessment of overweight involves using three key measures:

  • body mass index (BMI)
  • waist circumference, and
  • risk factors for diseases and conditions associated with obesity.

The BMI is a measure of your weight relative to your height and waist circumference measures abdominal fat. Combining your BMI and your waist circumference with information about your additional risk factors yields your risk for developing obesity-associated diseases and determines whether your a candidate for weight loss surgeries such as gastric bypass surgery, the lap band or other weight loss procedures. So your BMI is a good number to start with in identifying your risk due to your weight.

Lets find out your BMI.

1. Body Mass Index (BMI):
BMI is a reliable indicator of total body fat, which is related to the risk of disease and death. The BMI score is valid for both men and women but it does have some limits. The limits are:

  • BMI may overestimate body fat in athletes and others who have a muscular build or those who are exceptionally tall.
  • BMI may underestimate body fat in older persons and others who have lost muscle mass.

Use the BMI calculator below to estimate your total body fat.

Enter Height: ft   in
Enter Weight: lb
Apply your BMI score to the following:
  • BMI = 18.5 Underweight Below
  • BMI = 18.5 - 24.9 Normal
  • BMI = 25.0 - 29.9 Overweight
  • BMI = 30.0 Obese
  • BMI = 35.0 - 40 Morbidly Obese (with risk factors)
  • BMI = 40.0 and up Morbidly Obese

2. Waist Circumference:
Determine your waist circumference by placing a measuring tape snugly around your waist. It is a good indicator of your abdominal fat which is another predictor of your risk for developing risk factors for heart disease and other diseases. This risk increases with a waist measurement of over 40 inches in men and over 35 inches in women.

The table, Risks of Obesity-Associated Diseases by BMI and Waist Circumference, provides you with an idea of whether your BMI combined with your waist circumference increases your risk for developing obesity associated diseases or conditions.

This table from the NHLBI is a classification of overweight and obesity by BMI, waist circumference,and associated disease risks:

Disease Risk* Relative to Normal Weight and Waist Circumference:

Men 102 cm (40 in) or less
Women 88 cm (35 in) or less
Men > 102 cm (40 in)
Women > 88 cm (35 in)
Underweight < 18.5
- -
Normal 18.5 - 24.9
- -
Overweight 25.0 - 29.9
Increased High
Obesity 30.0 - 34.9 I High Very High

35.0 - 39.9 II Very High Very High
Extreme Obesity 40.0 + III Extremely High Extremely High
* Disease risk for type 2 diabetes, hypertension, and CVD.
+ Increased waist circumference can also be a marker for increased risk even in persons of normal weight.

3. Other Risk Factors
Besides being overweight or obese, there are additional risk factors to consider.

  • high blood pressure (hypertension)
  • high LDL-cholesterol ("bad" cholesterol)
  • low HDL-cholesterol ("good" cholesterol)
  • high triglycerides
  • high blood glucose (sugar)
  • family history of premature heart disease
  • physical inactivity
  • cigarette smoking

4. Assessment
For people who are considered obese (BMI greater than or equal to 30) or those who are overweight (BMI of 25 to 29.9) and have two or more risk factors, the guidelines recommend the need for weight loss. Even a small weight loss (just 10 percent of your current weight) will help to lower your risk of developing diseases associated with obesity. Weight loss surgery treatment such as the adjustable lap band may be available to you. Patients who are overweight, but do not have a high waist measurement, and have less than 2 risk factors may need to prevent further weight gain rather than lose weight.

Talk to your practitioner to see if you are at an increased risk and if you should lose weight or consider weight loss surgery. Your doctor will evaluate your BMI, waist measurement, and others risk factors for heart disease. People who are overweight or obese have a greater chance of developing high blood pressure, high blood cholesterol or other lipid disorders, type 2 diabetes, heart disease, stroke, and certain cancers, and even a small weight loss (just 10 percent of your current weight) will help to lower your risk of developing those diseases. And there are a variety of weight loss surgery options available such as the less invasive lap band. Other surgeries include stomach stapling or gastric bypass surgery which can be done laparoscopically.

What Caused My Obesity?
Overweight and obesity are a result of an energy imbalance over a long period of time. The cause of the energy imbalance for each individual may be due to a combination of several factors. But generally, our behavior is out of sink with our bodies biological, and our life's environmental factors which together are all responsible for causing us to be overweight and obese. Many other factors also contribute to obesity and because of this; obesity is a complex health issue to address. We will focus on these three main factors: behavioral, biological and environmental.

Behavioral: Am I partially responsible!

The choices a person makes in eating and physical activity contributes to overweight and obesity. Weight gain is a result of consuming extra calories, decreasing the amount of calories your body uses (through physical activity) or both. Personal choices concerning calorie consumption and physical activity can lead to an energy imbalance. A difference of one 12-oz. soda (150 calories) or 30 minutes of brisk walking most days can add or subtract approximately 10 pounds to your weight each year. To maintain your weight, your intake of calories must equal your energy output. To lose weight, you must use more energy than you take in. The Surgeon General says "Make fitness a priority…COMMIT TO IT." Physical exercise is a great way to burn those calories off our bodies and maintain our energy balance. Note: Consult with your health care provider before starting a vigorous exercise program if you have ever had heart trouble or high blood pressure or suffer from chest pains, dizziness or fainting, arthritis, or if you are over age 40 (men) or 50 (women).

Biological: How do genes affect obesity?

Science shows that genetics plays a role in obesity. However genes do not always predict future health. It all depends on what other factors are in play. Genes and behavior usually both play hand in hand for those of us who are overweight.

Bottom Line: For people who are genetically predisposed to gain weight, preventing obesity is the best course. Predisposed persons may require individualized interventions (including weight loss surgery) and greater support to be successful in maintaining a healthy weight.

It is time to stop blaming yourself. Many obesity researchers believe that people who struggle with their weight are pushing against thousands of years of evolution that has selected for storing energy as fat in times of plenty for use in times of scarcity. Genes are not destiny; in fact obesity can be prevented or can be managed in many cases with a combination of diet, physical activity, and medication. Genetic predisposition will usually mean that fighting obesity will be a struggle and require a lifelong commitment to achieve better health as will any decision to under go weight loss surgery. Treatments such as the Lap Band, Gastric Stimulator, stomach stapling, and gastric bypass surgery all require life long commitments to living healthy. To learn more about genetics and obesity visit A Public Health Perspective web site at www.cdc.gov.

Environment: How does my environment influence my behavior?

People may make decisions based on their environment or community. For example, a person may choose not to walk to the store or work because of a lack of sidewalks. Communities, homes, and workplaces each shape health decisions. With fewer options for physical activity and healthy eating, it becomes more difficult for people to make good choices. These are all choices, sometimes very small choices that add up over time to make a big difference in our health.

Other Factors Diseases and Drugs

Some illnesses may lead to obesity or weight gain. These may include Cushing's disease or polycystic ovary syndrome. Drugs such as steroids and some antidepressants may also cause weight gain.

A doctor is the best source to tell you whether illnesses, medications, or psychological factors are contributing to weight gain or making weight loss hard.

In Review:

Body weight is the result of our behavior combined with our genes (predisposition to gain weight) and our environment (opportunities for physical activity and healthy eating). These are the greatest areas for prevention and treatment actions prior to under going weight loss surgery.

With a better understanding of our self (BMI, risk factors, waist circumference) and the potential reasons for our obesity, we can focus on our path to success (which may include weight loss surgery treatment such as the adjustable lap band or stomach stapling). And like the many factors that contribute to obesity, we will have to change many factors while on our path and knowing our self is the first step towards taking your life back from obesity.

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