Adult obesity in the U.S. is a serious issue caused by a combination of lifestyle choices and heredity. Between 2017 and 2018, about 42.4 percent of adult Americans were obese, and about 9.2 percent were severely obese. Being overweight is often seen as a cosmetic condition in the U.S. However, obesity is a significant health crisis because it is linked to an increased risk of heart diseases, diabetes, high blood pressure, stroke, and certain cancers.
While obesity can be life-threatening, it is not irreversible. With a healthy diet, physical activity, and lifestyle changes, obese individuals can lose weight, reverse the effects of this condition, and improve their quality of life. In severe cases, prescription medications and medical procedures can enhance weight loss.
Throughout this article, we outline symptoms, causes, complications, and preventative measures associated with obesity.
The most common way of diagnosing obesity is by using body mass index (BMI). If a person’s BMI is between 25 and 29.9, this suggests they are overweight. A BMI of 30 or higher indicates obesity. To determine your BMI, divide your body weight in pounds by your height in inches squared and multiply that number by 703.
Although BMI is often the best way of determining body fat, it is not always a definite sign of obesity. Muscular individuals may have a BMI of 30, even if they don’t have excess body fat.
If you are concerned about your weight and health issues related to obesity, your doctor can help you evaluate your risks and work with you to develop a treatment plan.
Causes and Major Risk Factors
Obesity is most commonly a result of taking in more calories than you burn. The average American diet is high in fat and calories. Plus, stress and anxiety cause many people to overeat. Although diet and lifestyle play a major role in obesity, your genetics, metabolism, hormone levels, and health conditions also contribute.
In addition to a lack of exercise and an unhealthy diet, 40 to 70 percent of obese adults were genetically predisposed to obesity. Genetics can determine the amount of body fat you store, how you carry it, how quickly your body converts food to energy, and the number of calories you burn during exercise.
Additionally, family members who live near one another often have similar diets, behaviors, and exercise habits. This makes it more likely for several members of the family to be obese.
Lifestyle is the most common cause of obesity. A combination of a high-calorie diet and a lack of exercise can lead to rapid weight gain that often results in obesity.
Processed or industrialized foods are low in fiber, vitamins, minerals, and have a high glycemic load. These foods are energy-dense and don’t provide valuable nutrients. Studies show a diet high in processed foods and a lack of vitamins and minerals can lead to the development of obesity.
To maintain a healthy weight, you must burn as many calories as you consume. Weight gain happens when you consistently consume more calories than you burn. Living a sedentary lifestyle without any physical activity can lead to significant weight gain, especially if you are eating a large number of calories.
Social and Economic Influences
Social and economic factors can impact the amount of healthy foods available in certain areas. Research shows many middle-income countries without access to healthy, nutrient-rich foods, such as whole grains, fruits, and vegetables, have higher obesity rates.
Additionally, in poor urban settings, many groups rely on fast food and processed foods that lead to higher BMI rates.
Other Medical Issues and Medications
Certain medical conditions can lead to excess weight gain and decrease physical activity. Those with endocrine disorders that affect the release of certain hormones and thyroid function can contribute to obesity. Additionally, conditions that cause joint inflammation, such as arthritis, can make it challenging to maintain regular physical activity and a healthy weight.
Prescription drugs used to treat depression, diabetes, epilepsy, high blood pressure, and psychosis often lead to obesity and make losing weight difficult.
Although obesity can occur at all ages, specific hormonal changes that occur later in life can increase the risk of weight gain. This is likely due to a loss of muscle mass, decreased metabolism, and less physical activity. Without a healthy, low-calorie diet and regular exercise, older adults are more likely to become obese.
- Stress: Chronic activation of the sympathetic nervous system caused by high-stress levels can lead to enhanced weight gain, fat storage, and poor eating habits. Studies show stress alters our food intake patterns and increases our craving for refined sugars and carbohydrates.
- Sleep Loss: A lack of sleep can disrupt the hormones that control appetite, causing sleep-deprived individuals to consume more calories.
- Microbiome (gut health): Evidence suggests obese individuals often have poor gut health—an imbalance of beneficial and harmful bacteria in the gut. This imbalance can cause damage to the lining of the stomach and lead to increased appetite.
- Rapid weight fluctuation: Several studies point out that the cycle of weight loss followed by weight regain, often referred to as “yo-yo dieting,” can increase fat storage and lead to obesity. These changes are often due to the metabolic changes caused by constant dieting.
- Pregnancy: Weight gain during pregnancy is common; however, for those genetically predisposed to obesity, losing weight after birth can be difficult. Women who gain more than the recommended amount of weight during pregnancy are more likely to become obese.
Obese individuals are more likely to experience many of the following health issues and complications.
- Heart disease: Obesity often leads to insulin resistance, dyslipidemia, high blood pressure, and hypertension, all of which have been shown to cause heart disease.
- Stroke: Excess body weight impedes circulation, leading to secondary medical issues such as high blood pressure, diabetes, obstructive sleep apnea, enlarged heart, and metabolic disorders that put one at an increased risk of stroke.
- Type 2 diabetes: A lack of physical exercise and obesity is known to cause insulin resistance, which, over time, leads to type 2 diabetes.
- Cancer: Certain types of cancers, including colorectal, pancreatic, esophageal, gallbladder, and postmenopausal breast cancer, have been attributed to extreme weight gain and obesity.
- Digestive issues: Acid reflux, also known as GERD (gastroesophageal reflux disease), causes stomach acid to flow back into the esophagus, creating a painful burning sensation. Studies show this condition is more prevalent in severely overweight people.
- Sleep disorders: Obese individuals are more likely to experience sleep disorders such as insomnia and obstructive sleep apnea, a dangerous condition in which breathing stops and starts during sleep.
- Arthritis: Excess weight puts stress on the joints, causing inflammation and pain. Over time, this can lead to arthritis.
- Mental Health Issues: Depression and other mental health issues are associated with obesity. This is likely due to the lack of physical activity and erratic eating patterns.
For those currently overweight or at risk of becoming so, the following measures can reverse the effects of obesity. Those at a healthy weight can also use these steps to prevent excess weight gain.
Eating a Healthy Diet
A healthy diet full of nutritious, low-calorie foods, such as fruits, vegetables, legumes, whole grains, and lean proteins, promotes a safe, healthy weight. Foods with saturated fats and high sugar levels, such as processed foods, should be eaten sparingly. It is also important to eat regularly and have small, healthy snacks between meals.
Regular Physical Activity
Thirty minutes of moderate physical activity a day can prevent weight gain and help obese people lose weight at a healthy pace. Moderate exercise includes brisk walking (3.5 miles per hour), swimming, and biking (less than 10 miles per hour).
There is growing evidence that suggests sleep deprivation leads to obesity. Overly tired people are more likely to avoid physical activity and take in more calories. Additionally, sleep loss causes a hormonal imbalance which could increase appetite and hunger.
Healthy individuals can monitor small fluctuations in weight to prevent obesity. Self-monitoring weight is also part of many successful weight loss plans.
Excess stress often causes irregular eating patterns, a preference for high-fat, high-sugar foods, and the use of food as a reward. These changes often increase weight gain and fat deposits. Chronic stress also increases the risk of dyslipidemia, heart disease, type 2 diabetes, and metabolic syndromes.
Diagnosis of Obesity
The following physical exams and tests can be used to diagnose obesity.
- Calculating BMI: The first step in determining obesity is to check your (body mass index) BMI. A BMI of 30 or higher is typically considered obese and puts you at a high risk of developing serious health complications. Most experts suggest having your BMI checked at least once a year.
- Waist circumference: Visceral fat, fat stored around the waist, is often associated with obesity and secondary health issues, such as heart disease and diabetes. Therefore, when checking BMI, most doctors also measure your waist circumference. On average, women should have a waist circumference measuring no more than 35 inches, while a man’s waist circumference should be no more than 40 inches.
- Blood tests: If you are overweight, a blood test can determine cholesterol levels, liver function, glucose, and thyroid function.
- Overall physical exam: A general physical exam which checks vital signs, heart rate, temperature, blood pressure, height, and weight can be used to determine obesity.
- Heart health tests: Obesity puts stress on the heart; therefore, tests used to measure heart health, such as an electrocardiogram (ECG), exercise stress test, and an echocardiogram (ultrasound), are often used when diagnosing obesity.
- Health history and family history: When determining obesity, doctors ask questions related to physical activity, diet, eating patterns, medications, stress management, and weight loss history. Reviewing the health history of close family members can also suggest conditions you may be at risk of developing.
When to See a Doctor
If you suspect you are obese or are experiencing complications due to excess weight gain, it is important to meet with your doctor to discuss a treatment plan. Your doctor may also be able to refer you to other health care professionals who can aid in your weight loss journey.
Before any health appointments, make a note of your questions to ensure all your concerns are addressed. Be prepared to be honest regarding your weight, eating habits, activity level, mental health, and other symptoms.
The best obesity treatment is weight loss through diet and exercise. However, this can be achieved in many ways. Your doctor, counselors, and dietitians can help you develop a comprehensive weight-loss strategy.
Most doctors recommend an initial weight loss goal of 5 to 10 percent of your overall weight. For example, those who weigh 200 pounds should start by losing 10 to 20 pounds and gradually increase weight loss.
The following treatment plan can improve weight loss success and reverse the effects of obesity.
When it comes to dietary restrictions, it is best to avoid crash diets promising unrealistic goals. Steady weight loss stretched out over a period of time, about 6 to 9 months, is the best way to ensure you don’t put the weight back on. The following changes encourage weight loss and reverse the effects of obesity.
- Reducing calorie intake: The first step in treating obesity is determining how many calories you should eat per day to lose weight. When measuring your BMI, your doctor can help you determine the appropriate number of calories based on your weight. When trying to lose weight, most women should eat between 1,200 and 1,500 calories, while men should eat around 1,500 and 1,800 calories a day.
- Eat more plant-based foods: To lose weight, your diet should consist primarily of fruits, vegetables, whole grains, beans, and lentils. It is best to avoid processed foods with added salt and sugar. When it comes to fats, aim for foods with heart-healthy fats, such as those with omega 3 fatty acids. These foods include avocados, nuts, olive oil, and fish.
- Avoid meal replacements: Some diet plans encourage replacing 1 to 2 meals a day with low-calorie, high protein bars and shakes. Although this may lead to initial weight loss, they don’t encourage long term lifestyle changes. Plus, many of these foods have high levels of sugar which cause insulin resistance.
Burning more calories than you consume is one of the best ways to treat obesity. Overweight individuals should aim to get at least 30 minutes of moderate to intense physical activity each day, about 150 minutes a week. As endurance improves and weight loss increases, exercise should also increase to prevent plateauing. Three hundred minutes of exercise per week is recommended for more significant weight loss.
In addition to regular exercise, calorie burn can also improve by making small changes to your daily routine, such as using the stairs more frequently and walking or biking to work. Using a pedometer can help you track the number of steps you take per day. In general, 10,000 steps per day is a recommended starting goal.
Stress Management and Support
Through stress management and mental health support, overweight individuals can manage the difficulty of weight loss. For example, counseling can help reduce anxiety related to overeating and unhealthy food cravings. Group therapy can also be a source of support and camaraderie for those dealing with the challenges of weight loss.
Diet and exercise is the healthiest, most effective way to lose weight. However, if these measures are not working or if you have a BMI over 30 and other health complications, your doctor may prescribe anti-obesity medications to aid weight loss. Although these medications have a high success rate, many individuals regain weight once they stop taking the prescription.
The following weight loss medications are currently approved by the United States Food and Drug Administration (FDA):
- Saxenda, Victoza – Liraglutide
- Qsymia – Phentermine and Topiramate
- Alli, Xenical – Orlistat
- Contrave – Bupropion and Naltrexone
Before starting you on a weight loss medication, you and your doctor should discuss your health history and possible side effects. Pregnant women and those with certain health conditions may need to avoid certain medications. Your doctor should also monitor your progress and any complications while you are taking the prescription.
Endoscopic procedures involve placing flexible tubes and instruments through the mouth and into the stomach while the patient is under anesthesia. Like anti-obesity medications, if diet and exercise are not working, your doctor may recommend an endoscopic procedure to encourage weight loss.
One common endoscopic procedure involves putting stitches in the stomach to decrease its size and thereby the amount of food it can hold. Another form of endoscopy involves placing a small water-filled balloon into the stomach. Both of these measures help patients feel full quickly and discourage overeating.
Endoscopic procedures are considered invasive and are only approved for individuals with a BMI higher than 30. When accompanied by a healthy diet and exercise, endoscopy has been known to increase weight loss.
Although they can pose a serious health risk, weight-loss surgery may be recommended to those with a BMI over 40 or those with other health concerns. Like endoscopy, these surgeries reduce the amount of food the stomach can comfortably hold, thereby helping the patient feel full to prevent overeating. However, weight loss surgery also decreases the number of calories the body absorbs.
The following are the most common types of weight-loss surgery.
- Gastric bypass: This procedure involves inserting a small pouch above the stomach. Then, the small intestine is cut and connected to this pouch. Instead of flowing directly to the stomach, food and liquid flow into the pouch.
- Adjustable gastric banding: In gastric banding, an inflatable band is used to separate the stomach into two sections or pouches. The band is then pulled tight to create small channels between the two halves of the stomach. The band prevents the channel from expanding. Some adjustable gastric bands are permanent while others are temporary.
- Biliopancreatic diversion: A biliopancreatic diversion is made by closing off the middle section of the intestines and attaching it to the upper section of the small intestine.
- Gastric sleeve: This procedure consists of removing a portion of the stomach to create a smaller storage space for food.
These surgeries have been known to help people lose up to 35 percent of their excess body weight. However, they do not guarantee weight loss, and they can open individuals up to other health complications, such as acid reflux, infection, digestive issues, and chronic nausea. Additionally, if patients do not eat a healthy diet or maintain regular exercise after the surgery, it is common for them to regain weight.
- Set goals and milestones: Having a large amount of weight to lose can feel overwhelming. However, if you set small, realistic goals for yourself, you will be more likely to stay on track. Weekly milestones can also keep you motivated and in control.
- Focus on your goal: Changing life-long habits can be difficult. Even with a plan in place, you may get off track at some point. The important thing is not to let small slip-ups discourage you. If you experience a lapse, do your best to get back on track and stay focused on your goal.
- Find support: Some studies suggest losing weight with a friend or family member can improve your chances of success. It is important to surround yourself with people who will encourage and support your weight loss endeavors.
- Educate yourself: The more you understand about obesity, the more you can help yourself. Be sure to talk to your doctor about reputable sources of information you can turn to.
- Track your progress: Self-monitoring your weight loss can help you stay on track and identify areas for improvement. A food journal can also allow you to identify possible trigger foods and behavior patterns preventing weight loss.
- Understand your food triggers: It is important to understand which foods tempt you, so you can avoid bringing these items into your home.
- Take prescribed medications as directed: If you are prescribed medication for weight-loss, high blood pressure, or type 2 diabetes, be sure to take your prescription regularly to avoid further complications.
- Dietary Supplements: There are several dietary supplements, including herbal remedies, vitamins, and minerals, promising to speed up weight loss. However, dietary supplements do not go through the small extensive testing and trial periods as most prescription medications. Therefore, safe and effective dosing recommendations are not widely available. Additionally, these supplements can affect each person differently.
Although obese individuals are at a much higher risk of developing serious health complications than those at a healthy weight, the effects of obesity are not irreversible. Through diet and exercise, people can lower their BMI and, in turn, decrease blood pressure, cholesterol levels, and their risk of type 2 diabetes. Those who are currently at a healthy weight can prevent obesity by getting at least 30 minutes of physical activity a day and eating a healthy balanced diet.
Frequently Asked Questions
Yes. According to the United States Center for Disease Control and Prevention (CDC), obesity rates in the United States continue to rise each year. Between 1999 – 2000 through 2017 – 2018, the prevalence of obesity rose from 30.5 percent to 42.4 percent.
In 2017 – 2018, 40 percent of all young adults between the ages of 20 and 39 were obese, while 44.8 percent of all middle-aged adults between the ages of 40 and 59 were obese.
Studies show obesity is associated with atrophy or deterioration throughout the brain. These changes can impair cognitive abilities, reaction times, and memory loss. However, these effects are not irreversible. With weight loss, brain function can improve.
A regular walking routine can reduce body weight and waist circumference while also strengthening bones and muscles. Walking is also easy on the joints and can help improve balance and coordination.
Although the fast-food industry is not the only factor contributing to the rising obesity rate, it is a lead cause. Urban areas have a high concentration of fast-food restaurants, where residents are also more likely to have a high BMI percentage.
While several different conditions may cause sleep apnea, it is more common among overweight or obese individuals. Excess body fat around the neck and chest puts pressure on the trachea once muscles fully relax during sleep. This pressure can block the upper airways, making it difficult to breathe.