Women who carry excess fat around their waists were at greater risk of dying early from cancer or heart disease than were women with smaller waistlines, even if they were of normal weight, reported researchers from Harvard and the National Institutes of Health.

Previous studies have shown that the tendency to deposit fat around the waist increases the risk for health problems. The current study is the largest, most comprehensive of its kind undertaken to show that accumulation of abdominal fat can increase the risk of death.

To conduct the study, the researchers analyzed data from more than 44,000 women in the Nurses’ Health study, which followed the health history of thousands of registered nurses in 11 states.

“As we know from the work of the NIH Obesity Research Task Force, reversing the epidemic of obesity is challenging,” said Elias A. Zerhouni, M.D., Director of the National Institutes of Health. “The current findings highlight the role that research can play in understanding the risks of obesity.”

The research team that conducted the study was led by Cuilin Zhang, M.D., Ph.D., of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Dr. Zhang conducted much of her work on the study while at the Harvard School of Public Health. She concluded her analysis after joining the staff of the NICHD. The study was conducted in the research group of Dr. Frank Hu, M.D., Ph.D., of the Harvard School of Public Health, and by researchers from Brigham and Women’s Hospital and Harvard School of Medicine. Funding for the study was provided by the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute. The Nurse’s Health Study was supported by NIH’s National Heart, Lung and Blood Institute.

The study was published online in Circulation.

There is increasing evidence that excess abdominal fat is a risk factor for long-term conditions like diabetes and heart disease. However, the relationship between abdominal obesity and risk of death has not been widely studied. The current study is one of the largest extended investigations of abdominal obesity and women’s risk of premature death.

Researchers followed more than 44,000 women over the course of 16 years to track their medical history and lifestyle. Because the majority of the women who took part in the study were white, the researchers do not know if their findings pertain to other groups of women or to men.

All the women included in the study were registered nurses. At the beginning of the study the women were asked to measure their waists and hips. Every two years, the women completed questionnaires about their health, providing information about their age, activity level, smoking status, diet, blood pressure and cholesterol levels.

The researchers examined the cause of death for all women who died over the course of the study. In total, 3,507 deaths occurred—of these, 1,748 were due to cancer and 751 were due to heart disease.

The researchers discovered that women with greater waist circumferences were more likely to die prematurely, particularly from heart disease, when compared to women with smaller waists. For example, women with waist size equal to or greater than 35 inches were approximately twice as likely to die of heart disease as were women with a waist size less than 28 inches, regardless of their body mass index. Similarly, women with a waist size equal to or greater than 35 inches also were twice as likely to die of cancer as were women with a waist size less than 28 inches.

Women who had a greater waist circumference and were also obese were at the greatest risk of premature death. Researchers determined if a woman was overweight by calculating her body mass index (BMI), a measure of a person’s weight in relation to height. BMI is used to estimate the proportion of a person’s weight that derives from body fat. A BMI between 18.5 and 24.9 is considered healthy. A BMI of 30.0 - 39.9 is regarded as obese.

Greater waist circumference is a sign of collecting excess fat around one’s midsection, called abdominal obesity. According to the Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults published by NHLBI in cooperation with NIDDK in 1998, a healthy waist limit for women is 35 inches and, for men, 40 inches. Waist circumference is determined by measuring around the waist at the navel line. The NHLBI lists information on waist circumference and BMI at http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/risk.htm

In 2004, over one-half of U.S. adults had abdominal obesity by these standards, said Dr. Zhang.

The researchers also studied waist-to-hip ratio–a measure of the narrowest part of the waist compared to the circumference at the broadest part of the hip–as a potential determinant of mortality risk. Waist-to-hip ratio was found to be as strongly associated with risk of early death as the measurement of waist size alone. However, waist-to-hip ratio requires two measurements and therefore may be less convenient to calculate than measuring waist circumference alone, said Dr. Zhang.

The study authors wrote that results from previous studies have been inconsistent because of the relatively small number of people who took part and the short duration of the studies. The current study provides the strongest evidence so far regarding the adverse effects of abdominal obesity on the risk of death in women. The authors called for future studies to investigate abdominal obesity and the risk of death in men and other ethnic groups.

“Although maintaining a healthy weight should continue to be a corner stone in the prevention of chronic diseases and premature death, maintaining a healthy waist size should also be an important goal,” the study authors wrote.

Source: National Institute of Child Health and Human Development, NIH, DHHS

If you have any specific question, you can ask the doctors at www.mymedexpert.com

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• The terms “overweight” and “obesity” refer to a person’s overall body weight and where the extra weight comes from. Overweight is having extra body weight from muscle, bone, fat, and/or water. Obesity is having a high amount of extra body fat.
• Millions of Americans and people worldwide are overweight or obese.
• Being overweight or obese puts you at risk for many diseases and conditions, including heart disease, high blood pressure, type 2 diabetes, gallbladder disease, breathing problems, and certain cancers.
• A person’s weight is the result of many factors, including environment, family history and genetics, metabolism (the way your body changes food and oxygen into energy), behavior or habits, and other factors.
• For most people, overweight and obesity are caused by not having energy balance. The amount of calories you get from food and drinks is energy IN. The amount of energy your body uses daily is energy OUT. To maintain a healthy weight, energy IN and energy OUT should balance over time.
• Overweight and obesity are calculated using the body mass index (BMI). BMI is an estimate of body fat and a good gauge of your risk for diseases that occur with more body fat. Adults can calculate their BMI using the National Heart, Lung, and Blood Institute’s online calculator, or your health care provider can calculate your BMI.
• Children’s BMI is calculated based on growth charts for their age and sex. This is called BMI-for-age percentile. For more information, go to the Centers for Disease Control and Prevention’s BMI-for-age calculator.
• Treatment for overweight and obesity includes lifestyle changes. These changes mean cutting back on calories, following a healthy eating plan, being physically active, and making behavioral changes.
• When lifestyle changes aren’t enough, other treatment options for some people are weight loss medicines and surgery.
• To manage weight and prevent unhealthy weight gain, adults should aim for 60 minutes of moderate-to-vigorous intensity physical activity most days of the week. To keep up weight loss, aim for 60 to 90 minutes of daily moderate-intensity physical activity.
• Children and teens should strive for 60 minutes of physical activity a day.
• Overweight and obesity in children and teens can be prevented with healthy food choices and more physical activity. Parents and families should create habits that encourage healthful food choices and physical activity early in a child’s life.

If you have any specific question, you can ask the doctors at www.mymedexpert.com

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Successful treatments for weight loss include setting goals and making lifestyle changes such as eating fewer calories and being more physically active. Drug therapy and weight loss surgery are also options for some people if lifestyle changes don’t work.
Set Realistic (“Do-able”) Goals

Setting the right weight loss goals is an important first step to losing and maintaining weight.
For Adults

* Lose just 5 to 10 percent of your current weight over 6 months. This will lower your risk for heart disease and other conditions.
* The best way to lose weight is slowly. A weight loss of 1 to 2 pounds a week is do-able, safe, and will help you keep off the weight. It also will give you the time to make new, healthy lifestyle changes.
* If you’ve lost 10 percent of your body weight, have kept it off for 6 months, and are still overweight or obese, you may want to consider further weight loss.

For Children and Teens

* If your child is overweight or at risk of overweight, the goal is to maintain his or her current weight and to focus on eating healthy and being physically active. This should be part of a family effort to make lifestyle changes.
* If your child is overweight and has a health condition related to overweight or obesity, your doctor should refer you to a pediatric obesity treatment center.

Lifestyle Changes

For long-term weight loss success, it’s important for you and your family to make lifestyle changes:

* Focus on energy IN (calories from food and drinks) and energy OUT (physical activity)
* Follow a healthy eating plan
* Learn how to adopt more healthful lifestyle habits

Over time, these changes will become part of your everyday life.
Calories

Cutting back on calories (energy IN) will help you lose weight. To lose 1 to 2 pounds a week, adults should cut back their calorie intake by 500 to 1,000 calories a day.

* In general, 1,000 to 1,200 calories a day will help most women lose weight safely.
* In general, 1,200 to 1,600 calories a day will help most men lose weight safely. This calorie range is also suitable for women who weigh 165 pounds or more or who exercise routinely.

These calorie levels are a guide and may need to be adjusted. If you eat 1,600 calories a day but don’t lose weight, then you may want to cut back to 1,200 calories. If you’re hungry on either diet, then you may want to boost your calories by 100 to 200 a day. Very low-calorie diets of less than 800 calories a day shouldn’t be used unless your doctor is monitoring you.

For overweight children or teens, it’s important to slow the rate of weight gain; however, reduced-calorie diets aren’t advised before you talk to a health care provider.
Healthy Eating Plan

A healthy eating plan gives your body the nutrients it needs every day. It has enough calories for good health, but not so many that you gain weight.

A healthy eating plan also will lower your risk for heart disease and other conditions. A plan low in total, saturated, and trans fat; cholesterol; and sodium (salt) will help to lower your risk for heart disease. Cutting down on fats and added sugars also can help you eat fewer calories and lose weight. Healthful foods include:

* Fat-free and low-fat milk and milk products such as low-fat yogurt, cheese, and milk.
* Lean meat, fish, poultry, cooked beans, and peas.
* Whole grain foods such as whole wheat bread, oatmeal, and brown rice. Other grain foods like pasta, cereal, bagels, bread, tortillas, couscous, and crackers.
* Fruits, which can be canned (in juice or water), fresh, frozen, or dried.
* Vegetables, which can be canned (without salt), fresh, frozen, or dried.

Canola or olive oils and soft margarines made from these oils are heart healthy. They should be used in small amounts because they’re high in calories. Unsalted nuts, like walnuts and almonds, also can be built into a healthful diet as long as you watch the amount you eat, because nuts are high in calories.

The National Heart, Lung, and Blood Institute’s “Aim for a Healthy Weight” patient booklet provides more information on following a healthy eating plan.

Foods to limit. Foods that are high in saturated and trans fats and cholesterol raise blood cholesterol levels and also may be high in calories. These fats raise the risk of heart disease, so they should be limited.

Saturated fat is found mainly in:

* Fatty cuts of meat such as ground beef, sausage, and processed meats such as bologna, hot dogs, and deli meats
* Poultry with the skin
* High-fat milk and milk products like whole-milk cheeses, whole milk, cream, butter, and ice cream
* Lard, coconut, and palm oils found in many processed foods

Trans fat is found mainly in:

* Foods with partially hydrogenated oils such as many hard margarines and shortening
* Baked products and snack foods such as crackers, cookies, doughnuts, and breads
* Food fried in hydrogenated shortening such as french fries and chicken

Cholesterol is found mainly in:

* Egg yolks
* Organ meats such as liver
* Shrimp
* Whole milk or whole-milk products, including butter, cream, and cheese

Limiting foods and drinks with added sugars, like high-fructose corn syrup, is important. Added sugars will give you extra calories without nutrients like vitamins and minerals. Added sugars are found in many desserts, canned fruit packed in syrup, fruit drinks, and nondiet drinks. Check the nutrition label on food packages for added sugars like high-fructose corn syrup. Drinks with alcohol also will add calories, so it’s a good idea to watch alcohol intake.

Portion size. A portion is the amount of food that you choose to eat for a meal or snack. It’s different from a serving, which is a measured amount of food and is noted on the nutrition label on food packages.

Anyone who has eaten out lately is likely to notice how big the portions are. In fact, they’re oversized. These ever-larger portions have changed what we think of as normal.

Cutting back on portion size is a good way to help you eat fewer calories and balance your energy IN. To quiz yourself on how today’s portions compare to those from 20 years ago, visit the National Heart, Lung, and Blood Institute’s Portion Distortion Web pages.

Food weight. Studies have shown that we all tend to eat a constant “weight” of food. Ounce for ounce, our food intake is fairly constant. Knowing this, you can lose weight if you eat foods that are lower in calories and fat for a given measure of food. For example, replacing a full-fat food product that weighs 2 ounces with one that’s the same weight but lower in fat helps you cut back on calories. Another helpful practice is to eat foods that contain a lot of water like vegetables, fruits, and soups.
Physical Activity

Staying active and eating fewer calories will help you lose weight and keep the weight off over time. Physical activity also will benefit you in other ways. It will:

* Lower the risk of heart disease, diabetes, and cancers (such as breast, uterus, and colon)
* Strengthen your lungs and help them to work better
* Strengthen your muscles and keep your joints in good condition
* Slow bone loss
* Give you more energy
* Help you to relax and cope better with stress
* Allow you to fall asleep more quickly and sleep more soundly
* Give you an enjoyable way to share time with friends and family

In general, adults should follow these guidelines in relation to physical activity.

* For overall health and to lower the risk of disease, aim for at least 30 minutes of moderate-intensity physical activity most days of the week.
* To help manage body weight and prevent gradual weight gain, aim for 60 minutes of moderate-to-vigorous intensity physical activity most days of the week.
* To maintain weight loss, aim for at least 60 to 90 minutes of daily moderate-intensity physical activity.

In general, children and teens should aim for at least 60 minutes of physical activity on most, if not all, days of the week.

Many people lead inactive lives and may not be motivated to do more physical activity. Some people may need help and supervision when they start a physical activity program to avoid injury.

If you’re obese, or if you haven’t been active in the past, start physical activity slowly and build up the intensity a little at a time. When starting out, one way to be active is to do more “everyday” activities such as taking the stairs instead of the elevator and doing household chores and yard work. The next step is to start walking, biking, or swimming at a slow pace, and then build up the amount of time you exercise or the intensity level of the activity.

To lose weight and gain better health, it’s important to get moderate-intensity physical activity. Choose activities that you enjoy and that fit into your daily life. A daily, brisk walk is an easy way to be more active and improve your health. Use a pedometer to count your daily steps and keep track of how much you’re walking. Try to increase the number of steps you take each day.

Other examples of moderate-intensity physical activity include dancing, bicycling, gardening, and swimming. For greater health benefits, try to step up your level of activity or the length of time you’re active. For example, start walking for 10 to 15 minutes three times a week, and then build up to brisk walking for 60 minutes, 5 days a week. You also can break up the amount of time that you’re physically active into shorter amounts such as 15 minutes at a time.
Behavioral Changes

Changing your behaviors or habits around food and physical activity is important for losing weight. The first step is to understand the things that lead you to overeat or have an inactive lifestyle. The next step is to change these habits.

The list below gives you some simple tips to help build healthier habits.

Change your surroundings. You may be more likely to overeat when watching TV, when treats are available in the office break room, or when you’re with a certain friend. You also may not be motivated to take the exercise class you signed up for. But you can change these habits.

* Instead of watching TV, dance to music in your living room or go for a walk.
* Leave the office break room right after you get a cup of coffee.
* Bring a change of clothes to work. Head straight to the exercise class on the way home from work.
* Put a note on your calendar to remind yourself to take a walk or go to your activity class.

Keep a record. A record of your food intake and the amount of physical activity that you do each day will help to inspire you. You also can keep track of your weight. For example, when the record shows that you’ve been meeting your goal to be more active, you’ll want to keep it up. A record is also an easy way to track how you’re doing, especially if you’re working with a registered dietitian or nutritionist.

Seek support. Ask for help or encouragement from your friends, family, and health care provider. You can get support in person, through e-mail, or by talking on the phone. You also can join a support group.

Reward success. Reward your success for meeting your weight loss goals or other achievements with something you would like to do, not with food. Choose rewards that you’ll enjoy, such as a movie, music CD, an afternoon off from work, a massage, or personal time.
Weight Loss Medicines

Weight loss medicines approved by the Food and Drug Administration (FDA) may be an option for some people. If you’re not successful at losing 1 pound a week after 6 months of using lifestyle changes, medicines may help. These medicines should be used only as part of a program that includes diet, physical activity, and behavioral changes.

Weight loss medicines may be suitable for adults who are obese (a BMI of 30 or greater). People who have BMIs of 27 or greater and a risk for heart disease and other health conditions also may benefit from medicines.

The FDA has approved two prescription weight loss medicines for long-term use: sibutramine (Meridia®) and orlistat (Xenical®). These medicines cause a weight loss between 4 and 22 pounds, although some people lose more weight. Most of the weight loss occurs within the first 6 months of taking the medicine.

* Sibutramine (Meridia). This medicine sends signals to your brain to curb your appetite. Sibutramine raises blood pressure and pulse. You shouldn’t take it if you have high blood pressure or a history of heart disease or stroke.
* Orlistat (Xenical). This medicine reduces the absorption of fats, fat calories, and vitamins A, D, E, and K by the body. Orlistat can result in mild side effects such as oily and loose stools.

The FDA also has approved Alli™, an over-the-counter weight loss aid for adults. Alli is the lower dose form of orlistat. It’s meant to be used along with a reduced-calorie, low-fat diet and physical activity. In studies, most people taking Alli lost 5 to 10 pounds over 6 months.

Like orlistat, Alli reduces the absorption of fats, fat calories, and vitamins A, D, E, and K to promote weight loss. It also has similar side effects to orlistat. If you’re taking orlistat or Alli, you should take a multivitamin at bedtime due to the possible loss of some vitamins. You also should talk to your doctor before starting Alli if you’re taking blood-thinning medicines or being treated for diabetes or thyroid disease.

Combined with healthy eating and physical activity, these medicines can help people lose weight. If you think you would benefit from the prescription medicines, sibutramine or orlistat, talk to your doctor. People taking these medicines need regular checkups with their doctors, especially in the first year after starting the medicine. During checkups, your doctor will check your weight, blood pressure, and pulse and order laboratory tests. He or she also will discuss any medicine side effects and answer your questions.
Other Medicines

Some prescription medicines are used to treat weight loss, but aren’t FDA-approved for treating obesity. They include:

* Drugs to treat depression. Some medicines for depression cause an initial weight loss and then a regain of weight while taking the medicine.
* Drugs to treat seizures. Two drugs used for seizures, topiramate and zonisamide, have been shown to cause weight loss. These drugs are being studied to see whether they will be useful in treating obesity.
* Drugs to treat diabetes. Metformin may cause small amounts of weight loss in people with obesity and diabetes. It’s not known how this drug causes weight loss, but it has been shown to reduce hunger and food intake.

Over-the-Counter Products

Over-the-counter (OTC) products often claim that a person taking them will lose weight. The FDA doesn’t regulate these products because they’re considered dietary supplements, not medicines. However, many of these products have serious side effects and aren’t generally recommended. A few OTC products include:

* Ephedra (also called ma-huang). Ephedra comes from plants and has been sold as a dietary supplement. The active ingredient in the plant is called ephedrine. Ephedra can cause short-term weight loss. It also has serious side effects. It causes high blood pressure and stresses the heart. In fact, because ephedra poses a serious health risk, the FDA has advised people to stop using dietary supplements that contain it.
* Chromium. This is a mineral that’s sold as a dietary supplement to reduce body fat. While studies haven’t found any weight loss benefit from chromium, there are few serious side effects from taking it.
* Diuretics and herbal laxatives. These products cause you to lose water weight, not fat. They also can lower your body’s potassium levels, which may cause heart and muscle problems.
* Hoodia. Hoodia is a cactus that is native to Africa. It’s sold in pill form as an appetite suppressant. However, there is no firm evidence that hoodia works. No large-scale research has been done on humans to show whether hoodia is effective or safe.

Weight Loss Surgery

Weight loss surgery may be an option for people with extreme obesity (BMI of 40 or greater) when other treatments have failed. It’s also an option for people with a BMI of 35 or greater who have life-threatening conditions such as:

* Severe sleep apnea (a condition in which your breathing stops or gets very shallow while you’re sleeping)
* Obesity-related cardiomyopathy (diseases of the heart muscle)
* Severe type 2 diabetes

Two common weight loss surgeries include:

* Banded gastroplasty. For this surgery, a band or staples are used to create a small pouch at the top of your stomach. This surgery limits the amount of food and liquids the stomach can hold.
* Roux-en-Y gastric bypass. For this surgery, a small stomach pouch is created with a bypass around part of the small intestine where most of the calories you eat are absorbed. This surgery limits food intake and reduces the calories your body absorbs.

Weight loss surgery can improve your health and weight. However, the surgery can be risky depending on your overall health. There are few long-term side effects with gastroplasty; however, you must limit your food intake dramatically. Roux-en-Y gastric bypass has more side effects. These include nausea, bloating, diarrhea, and faintness (which are all part of a condition called dumping syndrome). After Roux-en-Y gastric bypass, multivitamins and minerals may be needed to prevent nutrient deficiencies.

Lifelong medical followup is needed after both surgeries. A monitoring program both before and after surgery also is advised to help you with diet, physical activity, and coping skills.

If you think you would benefit from weight loss surgery, talk to your doctor. Ask whether you’re a candidate for the surgery and discuss the risks, benefits, and what to expect.
Weight Loss Maintenance

Maintaining your weight loss over time can be a challenge. For adults, weight loss is a success if you lose at least 10 percent of your initial weight and you don’t regain more than 6 or 7 pounds in 2 years. You also must keep a lower waist circumference—at least 2 inches lower than your waist circumference before you lost weight.

After 6 months of keeping off the weight, you can think about losing more if:

* You’ve already lost 5 to 10 percent of your body weight
* You’re still overweight or obese

The key to further weight loss or to maintain your weight loss is to continue with lifestyle changes. Adopt these changes as a new way of life. However, if you want to lose more weight, you may need to eat fewer calories and increase your activity level. For example, if you eat 1,600 calories a day but don’t lose weight, you may want to cut back to 1,200 calories.

Adults should aim for 60 to 90 minutes of daily moderate-intensity physical activity. Children and teens should aim for 60 minutes of physical activity a day.

If you have any specific question, you can ask the doctors at www.mymedexpert.com

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The most common way to find out whether you’re overweight or obese is to figure out your body mass index (BMI). BMI is an estimate of body fat and a good gauge of your risk for diseases that occur with more body fat. The higher your BMI, the higher your risk of disease. BMI is calculated from your height and weight. You or your health care provider can use the chart below or the National Heart, Lung, and Blood Institute’s online BMI calculator to figure out your BMI.

Body Mass Index for Adults

Height	21	22	23	24	25	26	27	28	29	30	31
4′10″	100	105	110	115	119	124	129	134	138	143	148
5′0″	107	112	118	123	128	133	138	143	148	153	158
5′1″	111	116	122	127	132	137	143	148	153	158	164
5′3″	118	124	130	135	141	146	152	158	163	169	175
5′5″	126	132	138	144	150	156	162	168	174	180	186
5′7″	134	140	146	153	159	166	172	178	185	191	198
5′9″	142	149	155	162	169	176	182	189	196	203	209
5′11″	150	157	165	172	179	186	193	200	208	215	222
6′1″	159	166	174	182	189	197	204	212	219	227	235
6′3″	168	176	184	192	200	208	216	224	232	240	248

* Weight is measured with underwear but no shoes.

Use this table to learn your BMI. First, find your height on the far left column. Next, move across the row to find your weight. Once you’ve found your weight, move to the very top of that column. This number is your BMI.

What Does Body Mass Index Mean?

BMI
18.5–24.9	Normal weight
25.0–29.9	Overweight
30.0–39.9	Obese
40.0 and above	Extreme obesity

Although BMI can be used for most men and women, it does have some limits:

• It may overestimate body fat in athletes and others who have a muscular build.
• It may underestimate body fat in older persons and others who have lost muscle.

Body Mass Index for Children and Teens

Overweight is defined differently for children and teens than it is for adults. Because children are still growing and boys and girls mature at different rates, BMIs for children and teens compare their heights and weights against growth charts that take age and sex into account. This is called BMI-for-age percentile. A child or teen’s BMI-for-age percentile shows how his or her BMI compares with other boys and girls of the same age.

For more information about BMI-for-age and growth charts for children, go to the Centers for Disease Control and Prevention’s BMI-for-age calculator.

What Does the BMI-for-Age Percentile Mean?

BMI-for-Age Percentile
Less than 5th percentile	Underweight
5th percentile to less than the 85th percentile	Healthy weight
85th percentile to less than the 95th percentile	Risk of overweight
95th percentile or greater	Overweight

Waist Circumference

Health care professionals also may take your waist measurement. This helps to screen for the possible health risks that come with overweight and obesity in adults. If you have abdominal obesity and most of your fat is around your waist rather than at your hips, you’re at higher risk for heart disease and type 2 diabetes. This risk goes up with a waist size that is greater than 35 inches for women or greater than 40 inches for men.

You too may want to measure your waist size. To do so correctly, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out.

Specialists Involved

A primary care doctor (or pediatrician for children and teens) will assess your BMI, waist measurement, and overall health risk. If you’re overweight or obese, or have a large waist size, your doctor should explain the health risks and find out whether you’re interested and willing to lose weight. If you are, you and your doctor should work together to create a treatment plan. The plan should include weight loss goals and treatment options that are realistic for you.

Your doctor may send you to other health care specialists if you need expert care. These specialists may include:

• An endocrinologist if you need to be treated for type 2 diabetes or a hormone problem such as an underactive thyroid.
• A registered dietitian or nutritionist to work with you on ways to change your eating habits.
• An exercise physiologist or trainer to figure out your level of fitness and show you how to start physical activities suitable for you.
• A bariatric surgeon if weight loss surgery is an option for you.
• A psychiatrist, psychologist, or clinical social worker to help treat depression or stress.

If you have any specific question, you can ask the doctors at www.mymedexpert.com

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Weight gain usually happens over time. Most people know when they’ve gained weight. Some of the signs of overweight or obesity include:

• Clothes feeling tight and needing a larger size.
• The scale showing that you’ve gained weight.
• Having extra fat around the waist.
• A higher than normal body mass index and waist circumference.

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Populations Affected

Overweight and obesity affect Americans of all ages, sexes, racial/ethnic groups, and educational levels. This serious health problem has been growing over the years. In fact, overweight and obesity in adults have doubled since 1980, and overweight in children and teens has tripled.
Adults

According to the National Health and Nutrition Examination Survey (NHANES) 2003–2004, about one-third of adults in the United States are overweight and slightly more than one-third are obese. The survey also shows differences in overweight and obesity according to racial/ethnic groups.

* In women, overweight and obesity are highest for non-Hispanic Black women (about 82 percent), compared to about 75 percent for Mexican American women and 58 percent for non-Hispanic White women.
* In men, overweight and obesity also are higher for minority groups. They’re highest for Mexican American men (about 76 percent), compared to about 71 percent for non-Hispanic White men and about 69 percent for non-Hispanic Black men.

Children and Teens

According to NHANES 2003–2004, overweight and the risk for overweight is rising in children and teens. The survey shows that:

* About 19 percent of school-aged children and about 17 percent of teens are overweight.
* About 18 percent of school-aged children and about 17 percent of teens are at risk for overweight.

There are also some differences in overweight according to racial/ethnic groups.

* In male children and teens, overweight is highest for Mexican Americans (about 22 percent), compared to 17 percent for non-Hispanic Whites and about 16 percent for non-Hispanic Blacks.
* In female children and teens, overweight is highest for non-Hispanic Blacks (23 percent), compared to 16 percent for Mexican Americans and about 14 percent for non-Hispanic Whites.

Income

Overweight and obesity are also common in groups with low incomes. Women with low incomes are about 50 percent more likely to be obese than women with higher incomes. Among children and teens, overweight in non-Hispanic White teens is related to a lower family income.

Low-income families also buy more high-calorie, high-fat foods, which may add to the problem. This is because they tend to cost less than more healthful foods such as fruits and vegetables.

If you have any specific question, you can ask the doctors at www.mymedexpert.com

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