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What is obesity?

Obesity, or overweight, is more than just a matter of pounds. In addition to weight, a person's height and build are key considerations in determining whether he or she is obese, since bone weighs more than fat. The body's ratio of muscle to fat is another important consideration. Muscle tissue also weighs more than fat, so normal-weight, physically active people may actually carry more body weight than plump, sedentary people of the same height.

The accompanying height and weight chart, with its different scales for small, medium, and large frames, is a good starting point for defining obesity. Depending upon body frame, if a person is 20 percent or more above the ideal weight on such a chart he or she is probably obese.

To measure body fat, relax the arms and allow them to hang at the sides. Then have someone else pinch the flesh on the back of the upper arm between two fingers. If the distance between the person's fingertips is more than an inch when squeezing slightly, it's a good indication of excessive body fat.

Until fairly recently, scientists (as well as the general public) believed that people with weight problems simply lacked the willpower to stop overeating. Research conducted over the past several years, however, shows that obesity is a much more complex problem than the willpower theory suggests. For one thing, genetic factors play a dramatic role in determining who will gain weight and who will maintain a stable weight, given a predetermined caloric intake. Identical twins raised in separate households — some by lean adoptive parents and others by overweight ones — tend overwhelmingly to have similar body types, further proving that a tendency to become obese (or stay slim) is largely inherited.

In addition, the restrictive diets many overweight people adhere to for long periods actually seem to compound their weight problem. When the body is deprived of adequate calories, its metabolic function slows down, conserving energy. Thus, weight loss becomes a pain­fully slow process and, once the dieter resumes normal eating patterns (by normal standards, not even overeating), excess weight returns rapidly.

How does obesity affect the body?

Obesity can have many serious health consequences. Statistically, persons who weigh as little as 5 percent more than their ideal weight have a lower life expectancy than people who are normal weight. Excess weight can aggravate existing health problems, causing more severe symptoms or the early appearance of disorders that normally develop in late middle age. Conversely, weight loss can increase life expectancy and reduce health problems, as well as improve appearance.

Among the serious disorders associated with and worsened by obesity are:

• Cardiovascular problems, which develop because excess weight forces the heart and lungs to work harder than normal. Obesity is a major cause of high blood pressure, an asymptomatic, dangerous condition that can lead to heart disease, kidney problems, and strokes. An obese person is twice as likely as a normal-weight person to develop high blood pressure. Obesity is also associated with the development of atherosclerosis (the buildup of fatty deposits in arteries), which increases the risk of heart attacks.
• Diabetes (Type 2 or noninsulin dependent), which is caused by the body's resistance to the hormone insulin. Over 80 percent of people with Type 2 diabetes are overweight.
• Cancer, particularly of the breast, uterus, ovaries, and gallbladder in women, and the colon, rectum, and prostate gland in men. Research suggests that either a high-calorie diet or a high proportion of body fat increases the risk of cancer in over­weight individuals.
• Respiratory problems, which result from the strain excess weight places on the lungs. Sleep apnea, a condition marked by the cessation of breathing while

sleeping, commonly develops in overweight men. Extremely obese people may develop a condition called Pickwickian syndrome, a disorder marked by drowsiness, lethargy, and twitching. In the worst cases, this syndrome can lead to congestive heart failure, which can be disabling or even fatal.
• Osteoarthritis, which is exacerbated by the strain excess weight places on the joints, particularly those that bear weight, such as the hips or knees.
• Gallbladder disease, the risk of which increases in direct proportion to weight. One study found that people who were 20 percent above the median weight for the population were twice as likely to develop gallbladder disease as people who weighed less than the median.
• Pregnancy disorders, including pre-eclampsia (a potentially fatal condition marked by high blood pressure and convulsions developing in the third trimester), gestational diabetes, miscarriage, and late fetal death.
• Menstrual irregularities, including cessation of menstruation. These abnormalities are probably due to the alterations in hormone production associated with obesity. Overweight people are also victims of discrimination. Employers, co-workers, and classmates form negative opinions of people with weight problems regardless of their abilities or personality traits. These attitudes, combined with the self-reproach felt by many over-weight people, can lead to depression and other emotional problems. In many cases, the emotional suffering caused by obesity serves
  to perpetuate the condition, since overweight people frequently attempt to soothe their feelings with more food

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