Obesity and Overweight Sourcebook, 1st Ed.

By Omnigraphics

Provides basic health information about the causes, prevalence, associated health risks, prevention, and treatment of obesity and overweight along with the impact of society and tips for people to cope up with excess weight.

• Language: English
• Publisher: Omnigraphics
• Release date: Jul 1, 2020
• ISBN: 9780780818095

Book preview

Preface

ABOUT THIS BOOK

Obesity and overweight are serious health conditions caused due to the increase in size and amount of fat cells. They are becoming increasingly common among the U.S. families affecting the overall health, economy, and productivity of the nation. According to the National Health and Nutrition Examination Survey (NHANES), the age-adjusted prevalence of obesity among the U.S. adults was about 42.4 percent in 2017–2018. Obesity can lead to several other health issues such as diabetes, high blood pressure, heart disease, stroke, sleep disorders, and even cancer. However, proper lifestyle and diet plans can control obesity and overweight to a great extent.

Obesity and Overweight Sourcebook, First Edition begins with an overview on the medical model of obesity. It also provides information about the evolutionary origin of obesity and the social and moral construct of the obesity epidemic. It discusses the various causes of obesity including genetics, hormone dysfunction, dietary factors, lifestyle, socioeconomic, and environmental factors. It talks about the prevalence of obesity and overweight in the United States and highlights the economic burden of obesity. The health risks associated with obesity and overweight such as type 2 diabetes, cardiovascular diseases, hypertension, stroke, asthma, cancer, etc. are discussed along with the social and psychological impact of obesity. It provides information about the prevention and treatment of obesity. The book concludes with a glossary of terms related to obesity and overweight and a directory of resources for further help and support.

HOW TO USE THIS BOOK

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part 1: The Phenomena of Obesity and Overweight begins with an explanation about the medical model of obesity. It details the evolutionary origin of obesity and explains the social and moral construct of the obesity epidemic. It offers information about obesity’s impact on life expectancy and obesity paradox.

Part 2: Possible Causes of Obesity provides information about various causes of obesity such as genetics, hormone dysfunction, dietary factors, lifestyle, socioeconomic, and environmental factors.

Part 3: Obesity and Overweight in the United States: Prevalence and Screening provides statistical information on obesity and overweight in the United States and highlights the economic burden of obesity. It also talks about obesity among minority populations and among people with disabilities. Details about anthropometric indices of obesity and assessment techniques for body composition and obesity are also provided.

Part 4: Diseases and Metabolic Disorders Associated with Obesity provides information about various diseases associated with obesity such as type 2 diabetes, cardiovascular diseases, hypertension, stroke, asthma, cancer, etc. It also talks about the impact of obesity on women’s reproductive health.

Part 5: Social and Psychological Impact of Obesity explains how obesity impacts the emotional well-being of a person. It talks about constraint on movement and balance control and explains how obesity is linked to suicidal ideation and sexuality.

Part 6: Prevention and Treatment of Obesity talks about various methods to prevent and treat obesity. It focuses on the public-health strategies towards obesity and discusses various treatment methods such as dietary therapy, behavior therapy, pharmacotherapy, and weight-loss surgery. Several facts and myths about weight loss are also discussed.

Part 7: Additional Help and Information includes a glossary of terms related to obesity and overweight and a directory of resources for further help and support.

BIBLIOGRAPHIC NOTE

This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Centers for Disease Control and Prevention (CDC); Economic Research Service (ERS); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); Genetic and Rare Diseases Information Center (GARD); Genetics Home Reference (GHR); Health Resources and Services Administration (HRSA); National Cancer Institute (NCI); National Heart, Lung, and Blood Institute (NHLBI); National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Institute of Environmental Health Sciences (NIEHS); National Institute on Aging (NIA); National Institute on Alcohol Abuse and Alcoholism (NIAAA); National Institutes of Health (NIH); NIH News in Health; Office of Dietary Supplements (ODS); Office of Disease Prevention and Health Promotion (ODPHP); Office of Minority Health (OMH); Office on Women’s Health (OWH); Substance Abuse and Mental Health Services Administration (SAMHSA); U.S. Department of Agriculture (USDA); U.S. Department of Health and Human Services (HHS); U.S. Department of Veterans Affairs (VA); and U.S. Food and Drug Administration (FDA).

It may also contain original material produced by Omnigraphics and reviewed by medical consultants.

ABOUT THE HEALTH REFERENCE SERIES

The Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. Each volume provides comprehensive coverage on a particular topic. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series. The Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a substitute for the physician–patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate healthcare provider.

A NOTE ABOUT SPELLING AND STYLE

Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms and The Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers, and the editor’s primary goal is to present material from each source as accurately as is possible. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).

MEDICAL REVIEW

Omnigraphics contracts with a team of qualified, senior medical professionals who serve as medical consultants for the Health Reference Series. As necessary, medical consultants review reprinted and originally written material for currency and accuracy. Citations including the phrase Reviewed (month, year) indicate material reviewed by this team. Medical consultation services are provided to the Health Reference Series editors by:

Dr. Vijayalakshmi, MBBS, DGO, MD

Dr. Senthil Selvan, MBBS, DCH, MD

Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

OUR ADVISORY BOARD

We would like to thank the following board members for providing initial guidance on the development of this series:

Dr. Lynda Baker, Associate Professor of Library and Information Science, Wayne State University, Detroit, MI

Nancy Bulgarelli, William Beaumont Hospital Library, Royal Oak, MI

Karen Imarisio, Bloomfield Township Public Library, Bloomfield Township, MI

Karen Morgan, Mardigian Library, University of Michigan-Dearborn, Dearborn, MI

Rosemary Orlando, St. Clair Shores Public Library, St. Clair Shores, MI

HEALTH REFERENCE SERIES UPDATE POLICY

The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to:

Managing Editor

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Part 1 | The Phenomena of Obesity and Overweight

Chapter 1 | Understanding the Medical Model of Obesity

Chapter Contents

Section 1.1—The Obesity Epidemic: A Health Crisis

Section 1.2—Body Composition and Body Fat Percentage

Section 1.3—What Is Adult Obesity and Overweight?

Section 1.4—What Is Childhood Obesity and Overweight?

Section 1.5—What Is Obesity and Overweight in Elderly?

Section 1.1 | The Obesity Epidemic: A Health Crisis

This section contains text excerpted from the following sources: Text in this section begins with excerpts from Obesity, National Institute of Environmental Health Sciences (NIEHS), June 3, 2020. Text beginning with the heading What Is the Problem? is excerpted from The Obesity Epidemic and United States Students, Centers for Disease Control and Prevention (CDC), March 16, 2015. Reviewed June 2020.

Millions of Americans and people worldwide are obese or overweight. Obesity is a complex health disorder that affects both adults and children. Childhood obesity is a serious problem in the United States. Obesity means having too much body fat. Obesity occurs over time when a person eats more calories than they can use. Being obese puts people at risk for many health problems. The more body fat a person has and the more they weigh, the more likely they are to develop diseases such as diabetes, heart disease, stroke, arthritis, breathing problems, and some cancers.

Gaining weight and becoming obese is the result of many factors. These factors can include your environment, family history and genetics, metabolism or the way your body changes food and oxygen into energy, behavior or habits, and more. Scientists are even beginning to explore the idea that some chemicals in the environment may be playing in the growing obesity problem.

What Is the Problem?

The 2013 national Youth Risk Behavior Survey (YRBS) indicates that among the U.S. high school students:

Obesity

14 percent were obese (students who were >95th percentile for body mass index (BMI), based on sex- and age-specific reference data from the 2000 Centers for Disease Control and Prevention (CDC) growth charts).

Unhealthy Dietary Behaviors

5 percent did not eat fruit or drink 100 percent fruit juices during the seven days before the survey.

7 percent did not eat vegetables during the seven days before the survey.

11 percent drank a can, bottle, or glass of soda or pop three or more times per day during the seven days before the survey.

19 percent did not drink milk during the seven days before the survey.

14 percent did not eat breakfast during the seven days before the survey.

Physical Inactivity

15 percent did not participate in at least 60 minutes of physical activity on any day during the seven days before the survey.

52 percent did not attend physical education classes in an average week when they were in school.

33 percent watched television three or more hours per day on an average school day.

41 percent used computers three or more hours per day on an average school day.

46 percent did not play on at least one sports team run by their school or community groups during the 12 months before the survey.

What Are the Solutions?

Better health education

More physical education and physical activity programs

Healthier school environments

Better nutrition services

What Is the Status?

The School Health Policies and Practices Study 2014 indicates that among the U.S. high schools:

Health Education

88 percent required students to receive instruction on health topics as part of a specific course.

86 percent required students to receive instruction on nutrition and dietary behavior.

80 percent required students to receive instruction on physical activity.

Physical Education and Physical Activity

96 percent required students to take physical education (PE); among these schools, 51 percent did not allow students to be exempted from taking a required PE course for certain reasons.

4 percent required daily PE or its equivalent for students in all grades in the school for the entire year.

48 percent offered opportunities for students to participate in intramural activities or physical activity clubs.

School Environment

In 12 percent, students could purchase fruits or vegetables.

In 58 percent, students could not purchase soda pop or fruit drinks that are not 100 percent juice.

In 73 percent, students could not purchase chocolate candy.

77 percent did not allow students to purchase foods or beverages high in fat, sodium, or added sugars during school lunch periods.

Nutrition Services

87 percent offered a choice between 2 or more different fruits or types of 100 percent fruit juice each day for lunch.

72 percent did not sell any fried foods as part of school lunch.

84 percent offered lettuce, vegetable, or bean salads a la carte to students during a typical week.

Section 1.2 | Body Composition and Body Fat Percentage

Body Composition and Body Fat Percentage, © 2020 Omnigraphics. Reviewed June 2020.

A body fat percentage is a value that tells how much of an individual’s body weight is made up of fat. A body composition, on the other hand, is a method of differentiating fat, protein, minerals, and body water present in the body to tell the physical health and fitness level of a person.

What Is Body Composition?

A method that defines weight more accurately than the body mass index (BMI), body composition describes what the body is made of namely fat, protein, minerals, and body water. There are various models of body composition. Below are two of the most common models.

2C Model

Fat Mass

The majority of the population always want to reduce body fat. However, body fat is one of the most important substances for the body to function as it allows the body to store energy, protects internal organs, acts as an insulator, and regulates body temperature. No one can have a zero percent body fat and a body fat percentage that is less than four percent is generally inadvisable as it affects the long-term health of a person.

Fat-Free Mass

As the name suggests, this is all the mass in the body that is not associated with fat. A person’s fat-free mass (FFM) consists of various components such as internal organs, skeletal muscle mass, water, etc.

4C Model

A 4 component (4C) model is used for a more detailed body composition analysis where the method breaks the body into the following four components:

Body water

Protein

Minerals

Fat

Measuring Body Fat

There are various ways to find out the body fat percentage of an individual. Calipers, a small clamp-like device, is used in gyms or by dietitians to determine the amount of fat that is lying beneath the skin by taking skinfold measurements in various parts of the body such as the back of the arm and the waistline. This device is widely used since they are cheap, but they are less accurate than the other methods. Other ways to determine body fat include:

Underwater weighing. While in water, lean tissue sinks and fat floats. An individual’s underwater weight can be used to determine the amount of fat mass they are carrying. The underwater weight is highly accurate, but it can be expensive and require special equipment.

Bioelectrical impedance. Through this method, the speed of the electrical current is measured as it passes through the body. This is the least expensive method when compared to other methods and is more accurate than calipers. However, the accuracy depends on various factors such as hydration, the fullness of the stomach, and how recently a person has exercised. A bioelectrical impedance scale can help an individual to keep track of their body fat percentage at home. But, it is necessary to remember that these scales are more suitable to monitor the changes in body fat rather than providing the body weight.

Dual x-ray absorptiometry (DXA) scan. This scan uses low-level x-rays to determine the amount of body fat, muscle, and bone in the body. This is quicker and takes into consideration the bone mass when comparing body fat to muscle.

The Bod Pod. A machine used to measure the amount of air the body displaces. Similar to underwater weighing, the Bod Pod is highly accurate and expensive. But, this is more convenient than the underwater weighing since it does not require underwater submersion and is less time-consuming.

Knowing the body composition and body fat percentage is the first step towards improving health. These can immensely help in understanding an individual’s weight through which the overall health can be improved and the fitness goal can be achieved.

References

Your Body Fat Percentage: What Does It Mean? Winchester Hospital, December 28, 2016.

Denner, Julia. What Does Your Body Composition Mean—Healthy Body Fat Percentage, Runtastic, November 19, 2019.

What Is Body Composition? InBody, May 4, 2018.

Body Composition 101: The Beginner’s Guide, InBody, August 14, 2018.

Section 1.3 | What Is Adult Obesity and Overweight?

This section includes text excerpted from Adult Overweight and Obesity, Centers for Disease Control and Prevention (CDC), April 10, 2020.

Defining Adult OBESITY AND OVERWEIGHT

A weight that is higher than what is considered a healthy weight for a given height is described as overweight or obese. Body mass index, or BMI, is used as a screening tool for obesity or overweight.

Adult Body Mass Index

Body mass index is a person’s weight in kilograms divided by the square of height in meters. A high BMI can be an indicator of high body fatness.

To calculate BMI, see the Adult BMI calculator (www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html) or determine BMI by finding your height and weight in this BMI Index Chart (www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_tbl.htm).

If your BMI is less than 18.5, it falls within the underweight range.

If your BMI is 18.5 to less than 25, it falls within the normal.

If your BMI is 25 to less than 30, it falls within the overweight range.

If your BMI is 30 or higher, it falls within the obese range.

Obesity is frequently subdivided into categories:

Class 1: BMI of 30 to less than 35

Class 2: BMI of 35 to less than 40

Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as extreme or severe obesity.

Body mass index does not measure body fat directly, but research has shown that BMI is moderately correlated with more direct measures of body fat obtained from skinfold thickness measurements, bioelectrical impedance, underwater weighing, dual-energy x-ray absorptiometry (DXA) and other methods. Furthermore, BMI appears to be strongly correlated with various adverse health outcomes consistent with these more direct measures of body fatness.

Adult Obesity Causes and Consequences

Behavior

Healthy behaviors include a healthy diet pattern and regular physical activity. Energy balance of the number of calories consumed from foods and beverages with the number of calories the body uses for activity plays a role in preventing excess weight gain. A healthy diet pattern follows the Dietary Guidelines for Americans which emphasizes eating whole grains, fruits, vegetables, lean protein, low-fat and fat-free dairy products, and drinking water. The Physical Activity Guidelines for Americans recommends adults do at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity, or a combination of both, along with two days of strength training per week.

Having a healthy diet pattern and regular physical activity is also important for long-term health benefits and prevention of chronic diseases, such as type 2 diabetes and heart disease.

Community Environment

People and families may make decisions based on their environment or community. For example, a person may choose not to walk or bike to the store or to work because of a lack of sidewalks or safe bike trails. Community, home, child care, school, healthcare, and workplace settings can all influence people’s daily behaviors. Therefore, it is important to create environments in these locations that make it easier to engage in physical activity and eat a healthy diet.

Genetics

Do Genes Have a Role in Obesity?

Genetic changes in human populations occur too slowly to be responsible for the obesity epidemic. Nevertheless, the variation in how people respond to the environment that promotes physical inactivity and intake of high-calorie foods suggests that genes do play a role in the development of obesity.

How Could Genes Influence Obesity?

Genes give the body instructions for responding to changes in their environment. Studies have identified variants in several genes that may contribute to obesity by increasing hunger and food intake.

Rarely, a clear pattern of inherited obesity within a family is caused by a specific variant of a single gene (monogenic obesity). Most obesity, however, probably results from complex interactions among multiple genes and environmental factors that remain poorly understood (multifactorial obesity).

What about Family History

Healthcare practitioners routinely collect family health history to help identify people at high risk of obesity-related diseases such as diabetes, cardiovascular diseases (CVD), and some forms of cancer. Family health history reflects the effects of shared genetics and environment among close relatives. Families cannot change their genes but they can change the family environment to encourage healthy eating habits and physical activity. Those changes can improve the health of family members—and improve the family health history of the next generation.

Other Factors: Diseases and Drugs

Some illnesses may lead to obesity or weight gain. These may include Cushing disease and polycystic ovary syndrome (PCOD). Drugs, such as steroids and some antidepressants may also cause weight gain. The science continues to emerge on the role of other factors in energy balance and weight gain, such as chemical exposures and the role of the microbiome.

A healthcare provider can help you learn more about your health habits and history in order to tell you whether behaviors, illnesses, medications, and/or psychological factors are contributing to weight gain or making weight loss hard.

Consequences of Obesity

Health Consequences

People who have obesity, compared to those with a normal or healthy weight, are at increased risk for many serious diseases and health conditions, including the following:

All-causes of death (mortality)

High blood pressure (hypertension)

High low-density lipoproteins (LDL) cholesterol, low high-density lipoproteins (HDL) cholesterol, or high levels of triglycerides (dyslipidemia)

Type 2 diabetes

Coronary heart disease (CHD)

Stroke

Gallbladder disease

Osteoarthritis (a breakdown of cartilage and bone within a joint)

Sleep apnea and breathing problems

Many types of cancers

Low quality of life

Mental illness such as clinical depression, anxiety, and other mental disorders

Body pain and difficulty with physical functioning

Economic and Societal Consequences

Obesity and its associated health problems have a significant economic impact on the U.S. healthcare system. Medical costs associated with obesity and overweight may involve direct and indirect costs. Direct medical costs may include preventive, diagnostic, and treatment services related to obesity. Indirect costs relate to morbidity and mortality costs including productivity. Productivity measures include absenteeism (costs due to employees being absent from work for obesity-related health reasons) and presenteeism (decreased productivity of employees while at work) as well as premature mortality and disability.

National Estimated Costs of Obesity

The medical care costs of obesity in the United States are high. In 2008 dollars, these costs were estimated to be $147 billion.

The annual nationwide productive costs of obesity-related absenteeism range between $3.38 billion ($79 per individual with obesity) and $6.38 billion ($132 per individual with obesity).

In addition to these costs, data show the implications of obesity on recruitment by the armed forces. An assessment was performed on the percentage of the U.S. military-age population that exceeds the U.S. Army’s current active duty enlistment standards for weight-for-height and percent body fat, using data from the National Health and Nutrition Examination Surveys (NHANES). In 2007–08, 5.7 million men and 16.5 million women who were eligible for military service exceeded the Army’s enlistment standards for weight and body fat.

Section 1.4 | What Is Childhood Obesity and Overweight?

This section includes text excerpted from Childhood Overweight and Obesity, Centers for Disease Control and Prevention (CDC), September 11, 2018.

Defining Childhood Obesity

Body Mass Index for Children and Teens

Body mass index (BMI) is a measure used to determine childhood obesity and overweight. Overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile for children and teens of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex.

Body mass index is calculated by dividing a person’s weight in kilograms by the square of height in meters. For children and teens, BMI is age- and sex-specific and is often referred to as BMI-for-age. A child’s weight status is determined using an age- and sex-specific percentile for BMI rather than the BMI categories used for adults. This is because children’s body composition varies as they age and varies between boys and girls. Therefore, BMI levels among children and teens need to be expressed relative to other children of the same age and sex.

For example, a 10-year-old boy of average height (56 inches) who weighs 102 pounds would have a BMI of 22.9 kg/m2. This would place the boy in the 95th percentile for BMI, and he would be considered obese. This means that the child’s BMI is greater than the BMI of 95 percent of 10-year-old boys in the reference population.

The Centers for Disease Control and Prevention (CDC) growth charts are the most commonly used indicator to measure the size and growth patterns of children and teens in the United States. BMI-for-age weight status categories and the corresponding percentiles were based on expert committee recommendations and are shown in the following Table 1.1.

Body mass index does not measure body fat directly, but research has shown that BMI is correlated with more direct measures of body fat, such as skinfold thickness measurements, bioelectrical impedance, densitometry (underwater weighing), dual-energy x-ray absorptiometry (DXA) and other methods. BMI can be considered an alternative to direct measures of body fat. A trained healthcare provider should perform appropriate health assessments in order to evaluate an individual’s health status and risks.

Table 1.1. Weight Status Categories in the United States

Childhood Obesity Causes and Consequences

Childhood obesity is a complex health issue. It occurs when a child is well above the normal or healthy weight for her or his age and height. The causes of excess weight gain in young people are similar to those in adults, including factors, such as a person’s behavior and genetics.

Our nation’s overall increase in obesity also is influenced by a person’s community. Where people live can affect their ability to make healthy choices.

Behavior

Behaviors that influence excess weight gain include eating high-calorie, low-nutrient, foods and beverages, not getting enough physical activity, sedentary activities, such as watching television or other screen devices, medication use, and sleep routines.

In contrast, consuming a healthy diet and being physically active can help children grow as well as maintain a healthy weight throughout childhood. Balancing energy or calories consumed from foods and beverages with the calories burned through activity plays a role in preventing excess weight gain. In addition, eating healthy and being physically active also has other health benefits and helps to prevent chronic diseases such as type 2 diabetes, cancer, and heart disease.

Community Environment

It can be difficult for children and parents to make healthy food choices and get enough physical activity when they are exposed to environments that do not support healthy habits. Places such as child care centers, schools, or communities can affect diet and activity through the foods and drinks they offer and the opportunities for physical activity they provide. Other community factors that affect diet and physical activity include the affordability of healthy food options, peer and social supports, marketing and promotion, and policies that determine how a community is designed.

Consequences of Obesity

More Immediate Health Risks

Obesity during childhood can have a harmful effect on the body in a variety of ways. Children who have obesity are more likely to have:

High blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD)

Increased risk of impaired glucose tolerance, insulin resistance, and type 2 diabetes

Breathing problems, such as asthma and sleep apnea

Joint problems and musculoskeletal discomfort

Fatty liver disease, gallstones, and gastroesophageal reflux (GERD) (i.e., heartburn)

Childhood obesity is also related to:

Psychological problems, such as anxiety and depression

Low self-esteem and lower self-reported quality of life (QOL)

Social problems, such as bullying and stigma

Future Health Risks

Children who have obesity are more likely to become adults with obesity. Adult obesity is associated with an increased risk of a number of serious health conditions including heart disease, type 2 diabetes, and cancer.

If children have obesity, their obesity, and disease risk factors in adulthood are likely to be more severe.

Section 1.5 | What Is Obesity and Overweight in Elderly?

This section includes text excerpted from Health Tips for Older Adults, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), October 2019.

Healthy Weight

Why Is Keeping a Healthy Weight Important?

Your body changes as you age. For example, if you are less active, your muscles may not work as well, and that can affect your strength. You may also use fewer calories, especially if you do not get any physical activity. Over time, if you consume more calories from food or beverages than your body uses from physical activity and daily living, your body may store the extra calories leading to weight gain. Extra weight may lead to obesity or overweight.

Obesity and overweight may increase your risk for:

Type 2 diabetes

Heart disease and stroke

High blood pressure

High blood cholesterol

Kidney disease

Fatty liver disease

Certain types of cancer

Alzheimer disease (AD) and other dementias

What Is Healthy Weight for You?

Two measures can help you determine whether you are at a healthy weight.

Body mass index (BMI) is a measure based on your weight in relation to your height. You can use an online tool to calculate your BMI.

Experts recommend that older adults have a BMI between 25 and 27—slightly higher than the recommended range of 18.5 to 24.9 for younger adults. On the other hand, some people, particularly older adults, can have a BMI in the normal range, but still have too much body fat. That is why it is also important to measure your waist size.

Your waist size is a measure that may tell you if you carry too much body fat. Women with a waist size of more than 35 inches and men with a waist size of more than 40 inches may be more likely to develop health problems.

Being underweight can also be a health concern for older adults. It could mean that you:

Have increased risk for weakness and bone loss

Are not eating enough calories to maintain your weight

Do not have access to enough food or foods that meet your nutrient needs

Have an illness or medical condition

Keeping a healthy weight may help improve your health. The weight that is healthiest for you may be higher than that of a younger person. Ask your healthcare professional what a healthy weight for you may be.

Healthy Eating

What Kinds of Foods and Drinks Do You Need to Consume as You Age?

As you get older, your body begins to need fewer calories, but you need just as many nutrients. So, you will want to focus on eating nutrient-dense foods. Nutrient-dense foods pack a lot of vitamins, minerals, and other nutrients your body needs into a smaller number of calories.

Consume more nutrient-dense foods and beverages. Older adults should consume foods from the rainbow because they are rich in nutrients, including:

Fruits and vegetables

Whole grains such as oatmeal, whole-grain bread, and brown rice

Fat-free or low-fat milk; milk products; or nondairy soy, almond, rice, or other drinks with added vitamin D and calcium

Seafood, lean meats, poultry, and eggs

Beans, peas, unsalted nuts, and seeds, if you tolerate them and are not allergic

Consume less of these foods and drinks. Some foods and drinks have many calories but few of the essential nutrients your body needs. Added sugars, solid fats, and salt—such as those in packaged foods—pack a lot of calories but do not provide a healthy amount of nutrients. Limit foods and drinks such as:

Sugar-sweetened drinks and foods

Foods made with solid fats—butter, lard, margarine, and shortening

Foods high in added fat (such as butter or lard) and salt (sodium)

How Can I Follow a Healthy Eating Plan?

How much food and drinks you should consume each day depends on your weight, sex, age, metabolism, and how active you are. In general, men need more calories than women. Younger adults need more calories than adults in midlife and older. At all ages, adults who are more physically active may need to consume more calories than those who are less active.

Control portion sizes. A portion is the amount of food or drink you consume in one sitting. Being aware of food portions, serving sizes, and how often you consume them can help you make healthier food and drink choices.

Many people eat more than they need, especially when eating out or getting takeout. Try these tips:

Remember, restaurants often serve more than one portion. If the portion is bigger than one serving, take home or put away the rest to eat later.

When eating out or getting takeout, share a meal with a friend or save half of your serving for another meal.

Avoid watching TV, your smartphone, or other devices while eating. You may not notice how much you are consuming if you are distracted.

Consume your food and beverages more slowly and enjoy all the flavors and tastes.

The Nutrition Facts label tells you how many calories and servings are in a box, package, or can. The label also shows how many nutrients, such as fat, protein, carbohydrates, fiber, sodium, and sugar—including added sugars—are in one serving of food. You can use these facts to make healthy food choices.

Plan meals and snacks ahead. Consuming healthy meals and snacks may be easier when you plan ahead. Try these tips:

Cook ahead and freeze food for days when you do not want to cook.

Keep low-sodium versions of frozen or canned vegetables and beans on hand for quick and healthy meal add-ons.

Keep frozen or packed-in-juice canned fruits ready for snacks and meals.

Try to share meals with someone whose company you enjoy.

If you cannot cook for yourself, contact local programs that deliver meals in your area.

Do not skip meals. Doing so may make you feel hungrier later.

Healthy Eating Tips

Vitamins and Minerals for Older Adults

Vitamins and minerals are nutrients that help your body stay healthy and work well. Many kinds of vitamins and minerals work together to help you get energy from food. By following a healthy eating plan, you are more likely to get all or most of the vitamins and minerals you need from the food and drink you consume.

Getting enough vitamins B6, B12, D, and folate are considered important to healthy aging. Talk with your healthcare professional about the vitamins you need. Based on your eating plan and health status, your healthcare professional may suggest a supplement to help you get the vitamins and minerals you need.

Tips for Consuming Healthy Food and Beverages on a Budget

Consuming healthy foods and beverages on a fixed or limited income or budget can be very difficult. Here are some ideas that might help.

Buy store brands of whole-grain bread, pasta, cereals, and other healthy items.

Read weekly sales flyers and use coupons or apps to plan healthy meals and snacks at lower prices. Eat what is in season to get the best deals on fresh vegetables and fruits.

Buy low-sodium versions of canned or frozen vegetables. They are healthy, low-cost, and store well until you need them.

Apply for the United States Department of Agriculture’s (USDA) Supplemental Nutrition Assistance Program (SNAP).

Consider joining food voucher programs sponsored by places of worship or food banks to improve your access to healthy foods and beverages.

How Can You Learn More about How to Be Healthy as an Older Adult?

Adults older than 50 years of age may need different nutrients than younger adults. The National Institute on Aging (NIA) has more information on the foods and beverages older adults should have, including sample menus, tips for grocery shopping, and suggestions for overcoming roadblocks to healthy eating.

Physical Activity

Physical activity is good for your health at every age. If you have never been active, starting regular physical activity now may improve your strength, balance, flexibility, and endurance—being able to move for periods of time without stopping.

Being physically active may help you maintain a healthy weight and avoid chronic health problems as you mature. It may help you reduce symptoms of arthritis, anxiety, and depression. It may help keep diabetes and high blood pressure under control. Being active may also help you live on your own longer by keeping you healthy.

All sorts of activities count—even the things you do anyway, such as walking the dog, vacuuming the house, or raking the leaves. Things that do not feel hard or unpleasant—such as dancing or playing jump rope with your grandchild—also count.

Being active can be hard if you are not able to move around well, use a cane or walker, or have serious health problems. But, you can find some activities to help you move more. For example, slowly raising your arms or legs on a regular basis may help you feel more flexible.

When Should I Ask My Healthcare Professional about Being Active?

According to the latest research, healthy older adults who plan to increase physical activity a little at a time generally do not need to talk with a healthcare professional beforehand. However, your healthcare professional might be able to give you information on types of activities to consider and how to progress at a safe and steady pace.

Do check with your healthcare professional:

If you are already being treated for a chronic condition such as type 2 diabetes, heart disease, osteoarthritis, high blood pressure, a physical disability, or are a cancer survivor

If you have chest pain or pressure, dizziness, or joint pain

If you want tips to avoid getting hurt

If you develop new health concerns when increasing your activity level

Your healthcare professional may recommend and help you plan for the types and amounts of physical activity that will suit you.

How Much and What Type of Physical Activity Do I Need?

Keep in mind that some physical activity is better than none. Aim to keep moving as often as you can.

Healthy older adults should regularly do five types of activities:

Aerobic (also called endurance or cardio) activities

Activities to strengthen muscles

Activities to improve balance

Activities to increase flexibility

Activities that combine more than one type of physical activity such as aerobic, muscle strengthening, and balance training (called multicomponent activities)

If you have a serious health problem such as diabetes or heart disease, stay aware of how it might limit how much activity you can do safely.

You can divide your activity throughout the day or week—whatever works best for you. Studies show that spreading activity across at least three days a week can improve your health, lower your chances of getting hurt, and keep you from feeling tired.

Many activities give you more than just one benefit! Water aerobics with weights give you both aerobic and strengthening benefits. Yoga combines aerobics, balance, flexibility, and strengthening. Choose activities you enjoy.

To track your progress and stay aware of how you feel while you are active, you might want to keep an activity log.

Chapter 2 | The Evolutionary Origin of Obesity: From a Biological Adaptation to a Disease

Obesity is not just a cosmetic concern, but a medical problem involving an excessive amount of body fat. This complex condition increases the risk of other health problems such as heart diseases, high blood pressure, diabetes, and certain types of cancers. Obesity typically results from a combination of genetic causes together with the environment and the choice of personal health and exercise. Although the obesity epidemic emerged quite suddenly, it is a result of interaction between human biology and culture over periods of evolution. Human beings have the ability to store body fat when opportunities to consume excess energy arise.

Evolution of Obesity

Paleolithic Era

The period of prehistory from about 2.6 million years ago to around 10,000 years ago is known as Paleolithic era. Paleolithic humans survived as hunters and gatherers using primitive stone tools. The change in climate and environment were the major factors that influenced the source of food for nomads. Paleolithic-era observations of obesity are focused on figurines of the period, of which the most prominent image is of Venus of Willendorf aged more than 30,000 years old, providing the earliest depictions of obesity. This figurine depicts generalized obesity and a large waist circumference. Venus may have been popular among women hunter-gatherers as she was a model representing infertility problems. It is thereby understood that obesity existed during the Paleolithic era as depicted in the arts.

Neolithic Era

The period of age between 10,000 B.C. and 3,000 B.C. is known as Neolithic era. This was the first period of change in food sourcing. The revolution changed the dynamics of society from small hunter-gatherer clusters to a large farmer community. The change had also brought an abundance of food. A female Greek figurine made of clay, dating from 5th Millennium B.C., is an example of the Neolithic period obesity. Shifting from exercise all the time (hunting and gathering) to occasional farm work and sedentary lifestyle and consuming more calories resulted in surplus energy and excessive fat buildup contributing to overweight and ultimately obesity.

Greco-Roman and Byzantine Era

The Greco-Roman period ranged from 332 B.C. to 395 A.D. People began to consider obesity as an imbalance during this period. Physicians started considering the possible treatment options and cure to restore this imbalance of obesity and weight management. They focused on diet, medication, and change in lifestyle to control obesity.

Industrialization and Urbanization

The industrial revolution of the 1850s contributed to a change of fashion to refined food products such as added sugars and high-fat diet. At the same time, the jobs needed less energy to be spent and new technologies allowed those in each occupation to engage in increasingly sedentary work. There was lesser participation in sports and convenient exposure to television and similar media advertising high-fat, and high-carbohydrate food, thus creating an energy imbalance that contributed to obesity.

Influence of Genes on Obesity

Genes can be responsible for sending across instructions to the body to respond to environmental changes. Studies among family members, twins, and adoptees offer evidence that variation in weight among adults is due to genetic factors. Many other studies evaluated people with or without obesity for gene variance that may affect habits (such as an urge to overeat or a sedentary tendency) or metabolism (such as a reduced capacity to consume dietary food or an improved ability to store body fat). These studies have identified variants in many genes through growing appetite and food consumption that may lead directly to obesity.

Obesity as a Disease

The health effects of obesity began to be recognized in the eighteenth-century medical literature. The insurance sector raised the first warning against extra weight. Statistical research started to emerge in the early years of the twentieth century that connected excess weight to increased mortality rate. During 1930s, the medical profession understood the adverse effects of excess flesh and accepted excess fat as a health problem. Nevertheless, the decades that followed have seen the excess shift of fat from being a result of undisciplined actions to a pathological condition. By the 1960s, body fat was identified with its own receptors, genetics, hormones, and cellular biology, rather than just passive storage of energy.

Summary

For much of history, food scarcity had contributed to connotations that being fat was healthy, and that increased flesh was ideal as expressed in the arts, literature, and medical opinion of the period. It was only in the second half of the nineteenth century that fat began being stigmatized for cosmetic purposes and that its correlation with increased mortality was recognized. Research-based on the analysis of fat led to the discovery of various health consequences associated with obesity. This, in turn, triggered the growth of the weight loss industry, which is now worth