It is estimated that more than eight million Americans are affected by severe obesity. Severe obesity is a chronic disease characterized by an individual weighing more than 100 pounds over their ideal body weight, or having a body mass index (BMI) of 40 or higher.
What is the difference between obesity and severe obesity?
Obesity is a serious health epidemic that affects one in three Americans. It is estimated that more than 93 million Americans are affected by obesity, with that number predicted to climb to 120 million in the next five years. Obesity is a chronic disease characterized by excessive body fat or by having a BMI greater than 30. Obesity increases the likelihood of certain diseases and other related health problems.
Severe obesity is characterized by an individual having a BMI greater than 40. It also has a much higher correlation with conditions and diseases, such as diabetes, heart disease and many more.
Measuring Severe Obesity
Severe obesity is most commonly calculated using BMI. BMI is calculated by dividing a person’s weight in kilograms by his or her height in meters squared. Individuals with a BMI of 40 or higher are classified as being affected by severe obesity. To calculate your BMI, please click here.
BMI is not used to determine a person’s actual percentage of body fat, but it is a good indicator to categorize weight in terms of what is healthy and unhealthy.
What are the risks associated with severe obesity?
Many obesity-related conditions and diseases accompany severe obesity. These diseases and conditions negatively impact the quality of health for an individual affected by severe obesity.
The terminology “obesity-related conditions and diseases” relate to illnesses that are related to or negatively impacted by obesity.
The most prevalent severe obesity-related diseases and conditions include:
- High blood pressure
- High cholesterol
- Type 2 Diabetes
- Heart disease
- Gallbladder disease
- Sleep apnea and respiratory problems
- Some cancers (endometrial, breast and colon)
- Liver disease
- Venous disease
- Acid reflux
- Menstrual irregularities and infertility
Those who are affected by severe obesity are encouraged to talk with a healthcare professional concerning the obesity-related conditions and diseases listed. The earlier these are detected, the better advantage an individual may have to keep them under control with the assistance of a healthcare professional.
Causes of Severe Obesity
Severe obesity is simply not a result of overeating. It is a serious chronic disease that needs to be prevented and treated. The causes of severe obesity are widespread but target three main contributors: behavior, environment and genetics.
In today’s fast-paced environment, it is easy to adopt unhealthy behaviors. Behavior, in the case of severe obesity, relates to food choices, amount of physical activity you get and the effort to maintain your health.
Americans are consuming more calories on average than in past decades. The increase in caloric intake has also decreased the nutrients consumed that are needed for a healthy diet. This behavioral problem also relates to the increase in portion sizes at home and when dining out.
While Americans are consuming more calories, they are not expending them with enough physical activity. Physical activity is an important element in modifying and molding behaviors. The influence of television, computers and other technologies discourage physical activity and add to the problem of obesity in our society.
Environment plays a key role in shaping an individual’s habits and lifestyle. There are many environmental influences that can impact your health decisions. Today’s society has developed a more sedentary lifestyle. Walking has been replaced by driving cars, physical activity has been replaced by technology and nutrition has been overcome by convenience foods.
Science shows that genetics play a role in obesity and severe obesity. Genes can cause certain disorders which result in obesity. However, not all individuals who are predisposed to obesity will be affected by severe obesity. Research is currently underway to determine which genes contribute most to severe obesity.
What are the social effects of severe obesity?
Individuals affected by severe obesity often face obstacles far beyond health risks. Emotional suffering may be one of the most painful parts of severe obesity. Society often emphasizes the importance of physical appearance. As a result, people who are affected by severe obesity often face prejudice or discrimination.
Effects at Work
Due to the negative stigma associated with severe obesity, employees affected by severe obesity are often viewed as less competent, lazy and lacking in self-discipline by their co-workers and employers. Often times, discriminatory attitudes can negatively impact wages, promotions and employment status for employees affected by obesity.
In Healthcare Settings
Negative attitudes about patients affected by severe obesity also exist in the healthcare setting. These patients are often reluctant to seek medical care, may be more likely to delay important preventative healthcare services and may more frequently cancel medical appointments. Delaying medical attention can lead to delayed discovery or treatment of obesity-related conditions and diseases, such as diabetes and cardiovascular disease, while becoming more physically damaging.
The consequences of discrimination against individuals affected by severe obesity can seriously impact an individual’s quality of life and only further intensify the negative stigma associated with obesity.
Treating Severe Obesity
(*Note: Please consult with a healthcare professional before beginning any treatment program.)
Because the health risks associated with severe obesity can be life-threatening, clinical programs, such as medically managed weight-loss, bariatric surgery and other options are available for treatment.
Medical Weight Management
Medical weight management is provided by an obesity medicine physician in a clinical setting. Other healthcare professionals such as nurse practitioners, physician assistants, nurses, registered dietitians and psychologists may also be a part of the program. These programs typically offer services such as nutrition counseling, physical activity and behavioral therapy. Often, these programs incorporate total meal replacement plans and/or the use of FDA-approved medications for the treatment of obesity.
Currently, there are several medications that are FDA-approved for chronic weight management:
- phentermine products (Adipex-P®, Lomaira®)*
- orlistat (Xenical®, alli®)+
- lorcaserin HCI (BELVIQ®)+
- phentermine-topiramate ER (Qsymia®)+
- naltrexone HCI and bupropion HCI (CONTRAVE®)+
- liraglutide injection (Saxenda®)+
*Approved for short term use
+Approved for chronic (long term) use
All are to be used in conjunction with a reduced-calorie diet, exercise and behavior modification. As with all therapies, medical weight management needs to be approached with a focused treatment plan.
If your BMI is more than 40, or your BMI is more than 35 and you have an obesity-related condition or disease, such as diabetes or hypertension, you may consider bariatric surgery (also called weight-loss surgery). After bariatric surgery, individuals must still modify their lifestyle habits, adjust their diet and increase their physical activity. It is important to speak with your physician to determine if surgery is right for you.
Today, there are a few different types of bariatric surgery treatment options available today such as:
- Roux-en-Y Gastric Bypass
- Laparoscopic Adjustable
- Gastric Banding
- Sleeve Gastrectomy
- Biliopancreatic Diversion with Duodenal Switch
- Neuromodulation (VBLOC®)
When considering bariatric surgery, you must balance the personal risk of being affected by severe obesity with the potential risk and complications of the surgery. This treatment option is a tool that you will continually use to lose weight. Behavioral, physical and psychological changes are required for you to maintain a healthy quality of life. Continued positive weight-loss relies upon your desire and dedication to change your lifestyle with a proactive approach.
If you are a candidate for bariatric surgery, you will likely be referred for evaluation and consultation with a psychologist. Although this may seem surprising to you, it has become a routine part of your preparation for surgery. Your follow-up care will be provided by a team of professionals and each of them, including a dietitian, exercise therapist and psychologist, will need to become more familiar with you and your individual situation and needs.
To learn more about bariatric surgery, please click here.
Additional Treatment Options
In addition to bariatric surgery and medical weight management, the following therapies are also utilized to treat severe obesity.
Behavior plays a significant role in severe obesity. Modifying behaviors that have contributed to developing obesity is one way to treat the disease either alone or in conjunction with other treatments. A few suggested behavior modifiers include: changing eating habits, increasing physical activity, becoming educated about the body and how to nourish it appropriately, engaging in a support group or extracurricular activity and setting realistic weight management goals.
Increasing or initiating a physical activity program is an important aspect in managing severe obesity. Routine physical activity can greatly impact your health. Set realistic goals and make sure to consult with your physician before initiating any exercise program.
Non-Clinical Weight Management Programs
Participating in non-clinical programs is another form of treatment for obesity. Some programs may be commercially operated, such as a privately owned weight-loss chain. Counselors, books, Web sites or support groups are all ways you can be involved in a non-clinical weight-loss program.
The success of any weight-loss treatment option is dependent on you continuing with your chosen treatment to improve your quality of health.
The information contained in the Understanding Severe Obesity Brochure is not a substitute for medical advice or treatment from a healthcare professional. The OAC recommends consultation with your doctor and/or healthcare provider.
To download a PDF of the Understanding Severe Obesity Brochure, click here.