Body mass index

    Obesity.

   What is obesity?

   Obesity is having too much body fat. Obesity causes health problems. The fatter you are, the higher your risk of health problems.

·         Obesity is caused by eating more calories than your body needs

·         Being obese increases your chances of getting many diseases, such as diabetes, high blood pressure, heart disease, and certain cancers

·         Losing even a little weight can lessen your chances of having health problems

·         To lose weight, you should eat less and be more active (get exercise)

·         Medicine or surgery can sometimes help with weight loss

   Obesity can cause problems in almost any organ.

   Obesity is more and more common throughout the world. In the United States, about 1 in 3 adults is obese. Obesity in childhood is also a problem.

   What causes obesity?

   Obesity is caused by taking in more calories than your body needs. Diet, genes, lifestyle, and use of certain drugs are some factors in obesity.

   The following increase your chance of being obese:

·         Not getting enough physical activity, such as through sports or workouts, or having a job where you sit most of the time

·         Eating high-calorie foods (for example, from vending machines or fast food restaurants) or eating too much food for a long period of time

·         Having family members who are obese (obesity runs in families)

·         Having been obese as a child

·         Not losing pregnancy weight after having children

·         Hormonal changes such as menopause (when a woman stops having periods and can no longer get pregnant)

·         Having certain eating disorders, such as binge eating disorder

·         Taking certain medicines

·         Sleeping less than 6 hours a night

·         Changes in the normal germs (bacteria) in the intestines—research about this is new, so not much is known or understood about it.

   What are the symptoms of obesity?

   Obesity may cause symptoms besides looking overweight. You may have:

·         Trouble breathing

·         Snoring

·         Skin problems including stretch marks

·         Joint and back pain

   How can doctors tell if I am obese?

   Doctors can tell if you're obese by:

·         Calculating your BMI (body mass index)

·         Measuring how thick the fat is on your waist and on the back of your upper arm

·         Sometimes doing a test that measures how much fat is in your whole body (body composition test)

   Your BMI is your weight (in kilograms) divided by your height (in meters). You're obese if your BMI is 30 or higher. You're overweight if your BMI is over 25.

   Doctors may also:

·         Check for diabetes and high cholesterol with blood tests

·         Check for high blood pressure with an arm cuff

·         Check for other diseases that happen more often in people with obesity, such as sleep apnea, fatty liver, and depression

   How do doctors treat obesity?

   Obesity is much easier to prevent than treat. Once you gain weight, your body resists losing weight. For example, when you go on a diet, you feel hungrier and burn less energy when you’re resting.

   Doctors treat obesity by helping you change some of your habits:

·         Eat healthier foods (high in fibre, low in sugar)

·         Put smaller portions on your plate so you're not tempted to eat as much

·         Eliminate high-calorie drinks, such as soda, juice, or alcohol

·         Exercise more and be more active (for example, take the stairs instead of the elevator, or walk instead of driving or taking the bus)

   Going to group meetings with other people trying to lose or control their weight may help you keep your healthy eating and exercise habits on track.

   For people with a lot of weight to lose, doctors may offer:

·         Medicines

·         Weight-loss surgery (bariatric surgery)

   Metabolic Syndrome.

   What is metabolic syndrome?

   Metabolism refers to all the different chemical processes that go on in your body. A metabolic syndrome is a group of health problems that involve your metabolism and give you a higher chance of having heart disease, stroke, and diabetes.

   Metabolic syndrome is very common in the United States. People with metabolic syndrome have:

·         A lot of fat around their waist

·         High blood pressure

·         High blood sugar (including diabetes)

·         High levels of fats in their blood

   What causes metabolic syndrome?

   The cause of the metabolic syndrome isn't known.

   You're more likely to get metabolic syndrome if you store fat around your belly (you're apple-shaped) instead of your hips (you're pear-shaped). This happens in:

·         Most men

·         Women after menopause

   Metabolic syndrome can affect children and teens as well.

   What are the symptoms of metabolic syndrome?

   Metabolic syndrome itself causes no symptoms. But you may have symptoms of its complications, such as:

·         Coronary artery disease

·         High blood pressure

·         Diabetes

   How can doctors tell if I have metabolic syndrome?

   Doctors diagnose you with metabolic syndrome if you have a large waist—40 inches (102 centimetres) or more in men and 35 inches (89 centimetres) or more in women—and 2 or more of the following:

·         High fasting blood sugar level (100 or higher)

·         High blood pressure (130/85 or higher OR you are taking blood pressure medicine)

·         The high amount of fats in your blood (triglycerides of 150 or higher)

·         A low level of HDL ("good" cholesterol)

   How do doctors treat metabolic syndrome?

   Doctors will help you lose weight by having you eat a healthier diet and exercise more. They'll also give you medicines to treat any diseases you have, such as:

·         Diabetes or high blood sugar

·         High blood pressure

·         High-fat levels in your blood

·         Heart disease

   Weight-Loss Surgery (Bariatric Surgery).

   What is weight-loss surgery?

   Weight-loss surgery is surgery to the stomach or intestine (or both) to help you lose weight. It's also called bariatric surgery.

·         Doctors sometimes recommend weight-loss surgery for people who are very overweight (obese), particularly if they have weight-related health problems

·         There are many different surgical procedures

·         After surgery, you'll still need to make lifelong changes to what and how much you eat

·         Weight-loss surgery can lessen weight-related health problems, such as diabetes

·         Weight loss surgery can be more effective than dieting but has a higher risk of side effects

   To qualify for weight-loss surgery, you must:

·         Have tried other ways of losing weight

·         Be physically and mentally able to have surgery

·         Be ready to follow your doctors’ instructions after surgery about what to eat, how much to exercise, and when to get follow-up tests

   How do doctors do weight-loss surgery?

   Your stomach is where food first goes when you swallow it. The stomach starts digesting food and then passes it into the intestines. The intestines finish digesting food and take the nutrients into your body. Weight-loss surgery does one or both of the following:

·         Makes your stomach smaller to limit the amount of food you can eat

·         Bypasses part of your intestines so less food can be absorbed

   The most common weight-loss surgeries include:

·         Sleeve gastrectomy: Removing part of your stomach so what remains is a thin, small tube

·         Gastric bypass: Making a small stomach pouch and connecting it to the middle part of your small intestine

·         Adjustable gastric banding: Putting a band around your stomach to restrict its size

   Gastric bypass is the most common type of surgery. After this surgery, your stomach can hold only a small amount of food. Food that leaves the stomach bypasses the first part of the small intestine.

   Your doctor will recommend the type of weight-loss surgery best for you.

   Doctors can do some weight-loss surgery with laparoscopy. Instead of cutting your belly open, doctors put a viewing tube (laparoscope) and surgical tools in through small cuts in your belly. Laparoscopy is generally safer and you recover quicker than with regular (open) surgery.

   How should I eat after weight-loss surgery?

   You may have to wait about 4 weeks to eat solid food. For the first 2 weeks, you'll drink protein drinks. For the next 2 weeks, you may start eating some soft, mushy, or pureed foods.

   When you start eating solid foods, your doctor may recommend:

·         Taking small bites of food

·         Chewing food carefully

·         Not eating high-fat and high-sugar foods, such as fast food, cakes, and cookies

·         Eating only small meals

·         Not drinking liquids when eating solid foods

   Even though having a smaller stomach makes it easier to eat less, some people still eat too much. Some people drink lots of shakes or other high-calorie liquids. Others keep eating even when they're full and gradually stretch out their smaller stomach. Even though you had surgery, you still have to watch what you eat so you lose weight and don't gain it back.

   Also, because you aren't absorbing food normally, you have to be careful you get enough vitamins, minerals, proteins, and other important nutrition.

   Changing how you eat can be hard. Counselling or a support group may help.

   What are the benefits of weight-loss surgery?

   Weight-loss surgery may help you lose weight that you couldn't lose by dieting or taking diet pills. Also, you usually lose a lot more weight with surgery than with dieting.

   Weight loss can help with weight-related health problems, including:

·         Sleep apnea

·         Diabetes

·         High blood pressure

·         Heart problems

·         Depression

    How safe is weight-loss surgery?

    All surgeries have a chance of:

·         Infections near the site of surgery

·         Blood clots in your lungs

·         Lung infection (pneumonia)

   Weight-loss surgeries also have a small chance of:

·         Blocked intestines (affects 2 to 4 people out of 100)

·         Leaking from one of the surgical connections, which can cause belly infection (affects 1 to 3 people out of 100)

·         Bleeding from the stomach or intestine, or in the belly area

·         Gallstones or gallbladder problems (affects about 15 people out of 100)

·         Kidney stones

·         Gout

·         Not getting enough nutrition from your food

·         Death (affects about 20 out of 1000 for open surgery and 2 out of 1000 for laparoscopy)

   Because of these risks, doctors do weight-loss surgery only for people who are dangerously obese or who are very overweight and have a serious weight-related health problem. Talk to your doctors about the risks of surgery.

   Call your doctor right away if you have signs of infection around your wound, such as:

·         Redness

·         Severe pain

·         Swelling

·         Bad smell

·         Oozing

   Call your doctor right away if you have these warning signs after surgery:

·         Severe belly pain

·         Fever or chills

·         Throwing up

·         Bleeding

·         Fast or skipping heartbeats

·         Diarrhoea

·         Dark, tarry, bad-smelling stools

·         Shortness of breath

·         Sweating

·         Sudden paleness

·         Chest pain