1. What is Obesity?

2. Obesity - A Global Epidemic

3. Women and Obesity

4. Obesity in Youth

5. Health Effects of Obesity

6. Obesity and Consumer Protection

What is Obesity?

Obesity is a disease that affects nearly one-third of the adult American population (approximately 60 million). The number of overweight and obese Americans has continued to increase since 1960, a trend that is not slowing down. Today, 64.5 percent of adult Americans (about 127 million) are categorized as being overweight or obese. Each year, obesity causes at least 300,000 excess deaths in the U.S., and healthcare costs of American adults with obesity amount to approximately $100 billion.

Obesity is the second leading cause of unnecessary deaths.

• Despite its toll taken in death and disability, obesity does not receive the attention it deserves from government, the health care profession or the insurance industry.

• Research is severely limited by a shortage of funds.

• Inadequate insurance coverage limits access to treatment.

• Discrimination and mistreatment of persons with obesity is widespread and often considered socially acceptable.

Did You Know?

• Obesity is a chronic disease with a strong familial component.

• Obesity increases one's risk of developing conditions such as high blood pressure, diabetes (type 2), heart disease, stroke, gallbladder disease and cancer of the breast, prostate and colon.

• Health insurance providers rarely pay for treatment of obesity despite its serious effects on health

• The tendency toward obesity is fostered by our environment: lack of physical activity combined with high-calorie, low-cost foods.

• If maintained, even weight losses as small as 10 percent of body weight can improve one's health.

• The National Institutes of Health annually spends less than 1.0 percent of its budget on obesity research.

• Persons with obesity are victims of employment and other discrimination, and are penalized for their condition despite many federal and state laws and policies.

What is BMI?
Body Mass Index (BMI) is a mathematical calculation used to determine whether a patient is overweight.

BMI is calculated by dividing a person's body weight in kilograms by their height in meters squared (weight [kg] height [m]²) or by using the conversion with pounds (lbs) and inches (in) squared as shown below, This number can be misleading, however, for very muscular people, or for pregnant or lactating women.

Being obese and being overweight are not the same condition. A BMI of 30 or more is considered obese and a BMI between 25 to 29.9 is considered overweight.

There are many factors that impact a person's health risk relative to their BMI such as a waist size, smoking, the types of foods someone eats regularly, exercise, and medical conditions associated with obesity including diabetes, high blood pressure, high cholesterol, and coronary heart disease.

Obesity - A Global Epidemic

The prevalence of overweight and obesity is increasing worldwide at an alarming rate in both developing and developed countries. Environmental and behavioral changes brought about by economic development, modernization, and urbanization have been linked to the rise in global obesity. Obesity is increasing in children and adults, and true health consequences may become fully apparent in the near future.

Social Structure

• Developed countries have high obesity rates, food deprivation is unusual, and physical activity levels have decreased greatly. Lower income households are reported to feature diets composed of foods that tend to be high in calories and fat - contributors to overweight and obesity - since vegetables, fruits and whole grain cereals are more expensive.

• Developing countries have lower obesity rates, particularly in areas of lower SES populations. People who live in these areas are limited in their ability to provide enough food, have little access to public transportation and engage in moderate to heavy manual labor.

General Trends

• In many developing countries, obesity co-exists with under-nutrition – a Body Mass Index (BMI) less than 18.5.

• In economically advanced regions of developing countries, prevalence rates of obesity may be as high as in industrialized countries.

• Globally, women generally have higher rates of obesity than men do, although men may have higher rates of overweight.

• Prevalence of obesity in children and adolescents is on the rise in both developed and developing regions.

Regional Trends

• Obesity is relatively uncommon in African and Asian developing countries, although when present, it is more prevalent in urban than in rural populations.

• In the region of the Americas, obesity rates for both men and women are increasing in both developed and developing countries as well as countries in transition.

• Many South-East Asian countries are presently undergoing a “nutrition transition” involving a shift in the structure of diet, decreased physical activity and rapid increases in the prevalence of obesity.

• Some countries in the Eastern Mediterranean region report high obesity prevalence in adults, particularly women. The prevalence rates for women in this region are generally higher than for women in most industrialized countries.

• The prevalence of obesity has increased by about 10% to 40% in the majority of European countries over 10 years.

• The prevalence of obesity in the Western Pacific region is highest in the urban areas of the Pacific islands such as Samoa. Although obesity prevalence is low in China, in areas where obesity does exist it is most common among women and in urban areas.

Socioeconomic Transition

• Economic development leads to a shift in BMI in developing countries. As the proportion of under-nutrition decreases, the proportion of the overweight population increases.

• In the initial stages of economic transition, the proportion of people with high BMI’s increase in wealthier sections of society, while among the less wealthy, under-nutrition remains a concern.

• At the mid point of the transition, overweight and underweight can co-exist in the population, presenting a double burden of disease.

• Toward the later stages of the transition, the prevalence of high BMI increases among the poor population.

Modernization & Urbanization

• Modernization, the growth of industry and technology, was introduced over 50 years ago in the Western world. Modernization has led to an abundance of food (particularly high caloric intake) and a decrease in overall physical activity, contributing to increased rates of obesity.

• Urbanization, population growth in large cities, is associated with changes in diet (more reliance on non-traditional foods) and a more sedentary lifestyle, as shown in Table 1.

• The number of women entering the job market has increased with economic development, and contributed to an increased dependence on convenience foods and the use of labor saving devices such as microwaves.

• Ethnic groups in many industrialized countries appear to be affected by obesity as a result of modernization and urbanization. Genetic predisposition for obesity is suggested to be a factor that only becomes apparent after exposure to a more Western lifestyle. For example:

  • Australian Aborigines have been reported to develop high prevalence rates of obesity, hypertension, and type 2 diabetes after transitioning to a Western lifestyle from their traditional “hunter-gatherer” lifestyle (high physical activity and low-calorie, low-fat, high fiber diet).

  • The Pima Indians of Arizona have a very high prevalence of obesity and type 2 diabetes. Obesity and type 2 diabetes have been found to be less prevalent among Pima Indians living in Mexico compared to Pimas living in Arizona. The Pimas in Mexico have maintained a traditional lifestyle of higher physical activity and a diet including less fat and more complex carbohydrates.

  • Native Hawaiians have demonstrated a reduction in obesity and cardiovascular disease by returning to a traditional diet from a modern diet.

Table 1. The impact of modern society on increased inactivity

Note: The generally accepted definitions for overweight as a Body Mass Index (BMI) of 25 to 29.9 and obesity as a BMI of 30 or above have been applied to this fact sheet.

Women and Obesity

Obesity plays a significant role in causing poor health in women, negatively affecting quality of life and shortening quantity of life. More than half of adult U.S. women are overweight, and more than one-third are obese. The life expectancy of women in the U.S. is approaching 80 years of age, and more women than ever are expected to turn 65 in the second decade of the new millennium. Prevention and early treatment of obesity are crucial to ensuring a healthy population of women of all ages.

Prevalence

• For women, ages 20 to 74, 62 percent are overweight (Body Mass Index (BMI) of 25 or more) and about half of that population (34 percent) is obese (BMI of 30 or more).

Socioeconomic Status (SES)

• Obesity appears to have a strong inverse relationship with SES (obesity increases as income level decreases) among women in developed societies such as the U.S.

• Low-income women in minority populations appear most likely to be overweight.

Age

• Women are more likely to become overweight (BMI of 25 or more) as they become older.

• Obesity (BMI of 30 or more) has increased among U.S. women of all age groups over the last decade.

• Middle-age women are at a particularly high risk of becoming obese. The prevalence of obesity among middle-age women (ages 35 to 64) has increased at a minimum of 2 percentage points per year over a 40-year time period from 1960 to 2000. Table 4 indicates prevalence changes in obesity (BMI of 30 or more) between 1960 and 2000 for U.S. women in various middle-age groups.

Race

• Among U.S. adults, black (non-Hispanic) women have the highest prevalence of overweight (78 percent) and obesity (50.8 percent).

• Table 5 shows the discrepancy in overweight and obesity prevalence among U.S. women (ages 20 to 74) by racial / ethnic group.

Mortality

• A direct association has been found between body weight and deaths from all-causes in women, ages 30 to 55.

• When BMI exceeds 30, the relative risk of death related to obesity increases by 50 percent.

Health Effects

• There are many obesity-related conditions, which uniquely or mostly affect women, including those detailed below.

Arthritis

• Women with obesity have almost four times the risk of osteoarthritis as non-obese women.

• A stronger association between osteoarthritis and obesity has been observed in women than in men.

Birth Defects

• Maternal obesity (BMI > 29) has been associated with an increased incidence of neural tube defects (NTD) in several studies, although variable results have been found in this area.

• Folate intake, which decreases the risk of NTD’s, was found in one study to have a reduced effect with higher pre-pregnancy weight.

Breast Cancer

• After menopause, women with obesity have a higher risk of developing breast cancer. In addition, weight gain after menopause may also increase breast cancer risk.

• Women who gain about 45 pounds or more after age 18 are twice as likely to develop breast cancer after menopause than women with no weight gain.

• Before menopause, high BMI has been associated with a decreased risk of breast cancer. However, a recent study found an increased risk of the most lethal form of breast cancer, called inflammatory breast cancer (IBC), in women with BMI as low as 26.7 regardless of menopausal status.

• Before menopause, women who are overweight and have breast cancer appear to have a shorter life span than women with lower BMI.

Endometrial Cancer (EC)

• Women with obesity have three to four times the risk of EC than women with lower BMI.

• An estimated 34 to 56 percent of EC risk can be attributed to overweight.

• Body size is a risk factor for EC regardless of where fat is distributed in the body. Women with obesity and diabetes have a 3-fold increase in risk for EC above the risk of obesity alone.

Cardiovascular Disease (CVD)

• In middle and older age groups, heavier weight is associated with CVD and its risk factors, particularly for women.

Gallbladder Disease

• Obesity is the best-established predictor of gallbladder disease in women.

• Women with obesity have at least twice the risk of gallstone disease than women of normal weight.

Infertility

• Obesity has been found to affect ovulation, response to fertility treatment, pregnancy rates and pregnancy outcome.

• Infertile women with obesity who lose weight have shown improvement in becoming pregnant and reaching full term.

Obstetric & Gynecological Complications

• In addition to infertility, excess body fat can lead to complications such as menstrual abnormality, miscarriage and difficulties in performing assisted reproduction.

• The frequency of menstrual disturbance in women with severe obesity is three times greater than for women of normal weight.

• High pre-pregnancy weight is associated with an increased risk of pregnancy hypertension, gestational diabetes, urinary infection, Cesarean section delivery and toxemia.

• Women with obesity are 13 times more likely to have overdue births, longer labors, induced labor and blood loss.

• Complications after childbirth, related to obesity, include an increased risk of wound and endometrial infection, endometritis and urinary tract infection.

Urinary Stress Incontinence

• Obesity is a well-documented risk factor for the involuntary loss of urine as well as urgency.

• Obesity has been found to be a strong risk factor for women of several urinary symptoms after childbirth.

Stigma & Discrimination

• Women with obesity appear to have much more prejudice and discrimination directed against them than men with obesity.

• Obesity contributes to unemployment for women. After undergoing surgery to reduce obesity, a drop in unemployment rate from 84 to 64 percent was reported for women.

• Women with obesity face significant barriers in establishing and maintaining social relationships in a society that emphasizes thinness as physical attractiveness.

• Women with obesity have reported attending fewer years of college and receiving less financial support for higher education than women who are non-obese.

Obesity in Youth

Diabetes, hypertension and other obesity-related chronic diseases that are prevalent among adults have now become more common in youngsters. The percentage of children and adolescents who are overweight and obese is now higher than ever before. Poor dietary habits and inactivity are reported to contribute to the increase of obesity in youth.

Today's youth are considered the most inactive generation in history caused in part by reductions in school physical education programs and unavailable or unsafe community recreational facilities. In the U.S., only the state of Illinois requires daily physical education for students in grades K to 12.

This fact sheet outlines many factors related to obesity in youth that make it the major health care challenge for the 21^st century.

Overweight and Obesity Defined

• Overweight and obesity for children and adolescents are defined respectively in this fact sheet as being at or above the 85th and 95th percentile of Body Mass Index (BMI).

• Some researchers refer to the 95th percentile as overweight and other as obesity. The Centers for Disease Control and Prevention (CDC), which provides national statistical data for weight status of American youth, avoids using the word "obesity," and identifies every child and adolescent above the 85th percentile as "overweight."

• The AOA uses the 95th percentile as criteria for obesity because it:

  • corresponds to a BMI of 30 which is obesity in adults. The 85th percentile corresponds to a BMI of 25, adult overweight.

  • is recommended as a marker for when children and adolescents should have an in-depth medical assessment.

  • identifies children that are very likely to have obesity persist into adulthood.

  • is associated with elevated blood pressure and lipids in older adolescents, and increases their risk of diseases.

  • is a criteria for more aggressive treatment.

  • is a criteria in clinical trials of childhood obesity treatments.

Prevalence and Trends

• Approximately 30.3 percent of children (ages 6 to 11) are overweight and 15.3 percent are obese. For adolescents (ages 12 to 19), 30.4 percent are overweight and 15.5 percent are obese.

• Excess weight in childhood and adolescence has been found to predict overweight in adults. Overweight children, aged 10 to 14, with at least one overweight or obese parent (BMI> 27.3 for women and > 27.8 for men in one study), were reported to have a 79 percent likelihood of overweight persisting into adulthood.

Gender

• Overweight prevalence is higher in boys (32.7 percent) than girls (27.8 percent). In adolescents, overweight prevalence is about the same for females (30.2 percent) and males (30.5 percent).

• The prevalence of obesity quadrupled over 25 years among boys and girls.

• Obesity prevalence more than doubled over 25 years among adolescent males and females

Race

• African American, Hispanic American and Native American children and adolescents have particularly high obesity prevalence.

• Among female youth, the highest overweight and obesity prevalence is found in black (non-Hispanic) girls (ages 6 to 11), 37.6 percent and 22.2 percent respectively, and black (non-Hispanic) adolescent females (ages 12 to 19), 45.5 percent and 26.6 percent respectively.

• Among male youth, the highest overweight and obesity prevalence is found in Mexican American boys (ages 6 to 11), 43 percent and 27.3 percent respectively, and Mexican American adolescent males (ages 12 to 19), 44.2 percent and 27.5 percent respectively.

• Overweight prevalence for Native American children and adolescents (ages 5 to 17) was reported in a 1999 study as 39 percent for males and 38 percent for females in the Aberdeen area Indian Health Service.

• Asian American adolescents (ages 13 to 18) were reported to have an overweight prevalence of 20.6 percent in the 1996 National Longitudinal Study of Adolescent Health.

• Asian-American and Hispanic-American adolescents born in the U.S. to immigrant parents are more than twice as likely to be overweight as foreign born adolescents who move to the U.S.

Health Effects

Many adverse health effects associated with overweight are observed in children and adolescents. Overweight during childhood and particularly adolescence is related to increased morbidity and mortality in later life.

Asthma

• Prevalence of overweight is reported to be significantly higher in children and adolescents with moderate to severe asthma compared to a peer group.

Diabetes (Type 2)

• Type 2 diabetes in children and adolescents has increased dramatically in a short period. The parallel increase of obesity in children and adolescents is reported to be the most significant factor for the rise in diabetes.

• Type 2 diabetes accounted for 2 to 4 percent of all childhood diabetes before 1992, but skyrocketed to 16 percent by 1994.

• Obese children and adolescents are reported to be 12.6 times more likely than non-obese to have high fasting blood insulin levels, a risk factor for type 2 diabetes.

• Type 2 diabetes is predominant among African American and Hispanic youngsters, with a particularly high rate among those of Mexican descent.

Hypertension

• Persistently elevated blood pressure levels have been found to occur about 9 times more frequently among obese children and adolescents (ages 5 to 18) than in non-obese.

• Obese children and adolescents are reported to be 2.4 times more likely to have high diastolic blood pressure and 4.5 times more likely to have high systolic blood pressure than their non-obese peers.

Orthopedic Complications

• Among growing youth, bone and cartilage in the process of development are not strong enough to bear excess weight. As a result, a variety of orthopedic complications occur in children and adolescents with obesity. In young children, excess weight can lead to bowing and overgrowth of leg bones.

• Increased weight on the growth plate of the hip can cause pain and limit range of motion. Between 30 to 50 percent of children with this condition are overweight.

Psychosocial Effects & Stigma

• Overweight children are often taller than the non-overweight.

• White girls, who develop a negative body image, are at a greater risk for the subsequent development of eating disorders.

• Adolescent females who are overweight have reported experiences with stigmatization such as direct and intentional weight-related teasing, jokes and derogatory name calling, as well as less intentional, potentially hurtful comments by peers, family members, employers and strangers.

• Overweight children and adolescents report negative assumptions made about them by others, including being inactive or lazy, being strong and tougher than others, not having feelings, and being unclean.

Sleep Apnea

• Sleep apnea, the absence of breathing during sleep, occurs in about 7 percent of children with obesity. Deficits in logical thinking are common in children with obesity and sleep apnea.

Health Effects of Obesity

Persons with obesity are at risk of developing one or more serious medical conditions, which can cause poor health and premature death.   Obesity is associated with more than 30 medical conditions, and scientific evidence has established a strong relationship with at least 15 of those conditions. Preliminary data also show the impact of obesity on various other conditions. Weight loss of about 10% of body weight, for persons with overweight or obesity, can improve some obesity-related medical conditions including diabetes and hypertension.

Arthritis

Osteoarthritis (OA)

• Obesity is associated with the development of OA of the hand, hip, back and especially the knee.

• At a Body Mass Index (BMI) of > 25, the incidence of OA has been shown to steadily increase.

• Modest weight loss of 10 to 15 pounds is likely to relieve symptoms and delay disease progression of knee OA.

Rheumatoid Arthritis (RA)

• Obesity has been found related to RA in both men and women.

Birth Defects

• Maternal obesity (BMI > 29) has been associated with an increased incidence of neural tube defects (NTD) in several studies, although variable results have been found in this area.

• Folate intake, which decreases the risk of NTD’s, was found in one study to have a reduced effect with higher pre-pregnancy weight.

Cancers

Breast Cancer

• Postmenopausal women with obesity have a higher risk of developing breast cancer. In addition, weight gain after menopause may also increase breast cancer risk.

• Women who gain nearly 45 pounds or more after age 18 are twice as likely to develop breast cancer after menopause than those who remain weight stable.

• High BMI has been associated with a decreased risk of breast cancer before menopause. However, a recent study found an increased risk of the most lethal form of breast cancer, called inflammatory breast cancer (IBC), in women with BMI as low as 26.7 regardless of menopausal status.

• Premenopausal women diagnosed with breast cancer who are overweight appear to have a shorter life span than women with lower BMI.

• The risk of breast cancer in men is also increased by obesity.

Cancers of the Esophagus and Gastric Cardia

• Obesity is strongly associated with cancer of the esophagus and the risk becomes higher with increasing BMI.

• The risk for gastric cardia cancer rises moderately with increasing BMI.

Colorectal Cancer

• High BMI, high calorie intake, and low physical activity are independent risk factors of colorectal cancer.

• Larger waist size (abdominal obesity) is associated with colorectal cancer.

Endometrial Cancer (EC)

• Women with obesity have three to four times the risk of EC than women with lower BMI.

• Women with obesity and diabetes are reported to have a 3-fold increase in risk for EC above the risk of obesity alone.

• Body size is a risk factor for EC regardless of where fat is distributed in the body.

Renal Cell Cancer

• Consistent evidence has been found to associate obesity with renal cell cancer, especially in women.

• Excess weight was reported in one study to account for 21% of renal cell cancer cases.

Cardiovascular Disease (CVD)

• Obesity increases CVD risk due to its effect on blood lipid levels.

• Weight loss improves blood lipid levels by lowering triglycerides and LDL (“bad”) cholesterol and increasing HDL (“good”) cholesterol.

• Weight loss of 5% to 10% can reduce total blood cholesterol.

• The effects of obesity on cardiovascular health can begin in childhood, which increases the risk of developing CVD as an adult.

• Overweight and obesity increase the risk of illness and death associated with coronary heart disease.

• Obesity is a major risk factor for heart attack, and is now recognized as such by the American Heart Association.

Carpal Tunnel Syndrome (CTS)

• Obesity has been established as a risk factor for CTS.

• The odds of an obese patient having CTS were found in one study to be almost four times greater than that of a non-obese patient.

• Obesity was found in one study to be a stronger risk factor for CTS than workplace activity that requires repetitive and forceful hand use.

• Seventy percent of persons in a recent CTS study were overweight or obese.

Chronic Venous Insufficiency (CVI)

• Patients with CVI, an inadequate blood flow through the veins, tend to be older, male, and have obesity.

Daytime Sleepiness

• People with obesity frequently complain of daytime sleepiness and fatigue, two probable causes of mass transportation accidents.

• Severe obesity has been associated with increased daytime sleepiness even in the absence of sleep apnea or other breathing disorders.

Deep Vein Thrombosis (DVT)

• Obesity increases the risk of DVT, a condition that disrupts the normal process of blood clotting.

• Patients with obesity have an increased risk of DVT after surgery.

Diabetes (Type 2)

• As many as 90% of individuals with type 2 diabetes are reported to be overweight or obese.

• Obesity has been found to be the largest environmental influence on the prevalence of diabetes in a population.

• Obesity complicates the management of type 2 diabetes by increasing insulin resistance and glucose intolerance, which makes drug treatment for type 2 diabetes less effective.

• A weight loss of as little as 5% can reduce high blood sugar.

End Stage Renal Disease (ESRD)

• Obesity may be a direct or indirect factor in the initiation or progression of renal disease, as suggested in preliminary data.

Gallbladder Disease

• Obesity is an established predictor of gallbladder disease.

• Obesity and rapid weight loss in obese persons are known risk factors for gallstones.

• Gallstones are common among overweight and obese persons. Gallstones appear in persons with obesity at a rate of 30% versus 10% in non-obese.

Gout

• Obesity contributes to the cause of gout -- the deposit of uric acid crystals in joints and tissue.

• Obesity is associated with increased production of uric acid and decreased elimination from the body.

Heat Disorders

• Obesity has been found to be a risk factor for heat injury and heat disorders.

• Poor heat tolerance is often associated with obesity.

Hypertension

• Over 75% of hypertension cases are reported to be directly attributed to obesity.

• Weight or BMI in association with age is the strongest indicator of blood pressure in humans.

• The association between obesity and high blood pressure has been observed in virtually all societies, ages, ethnic groups, and in both genders.

• The risk of developing hypertension is five to six times greater in obese adult Americans, age 20 to 45, compared to non-obese individuals of the same age.

Impaired Immune Response

• Obesity has been found to decrease the body’s resistance to harmful organisms.

• A decrease in the activity of scavenger cells, that destroy bacteria and foreign organisms in the body, has been observed in patients with obesity.

Impaired Respiratory Function

• Obesity is associated with impairment in respiratory function.

• Obesity has been found to increase respiratory resistance, which in turn may cause breathlessness.

• Decreases in lung volume with increasing obesity have been reported.

Infections Following Wounds

• Obesity is associated with the increased incidence of wound infection.

• Burn patients with obesity are reported to develop pneumonia and wound infection with twice the frequency of non-obese.

Infertility

• Obesity increases the risk for several reproductive disorders, negatively affecting normal menstrual function and fertility.

• Weight loss of about 10% of initial weight is effective in improving menstrual regularity, ovulation, hormonal profiles and pregnancy rates.

Liver Disease

• Excess weight is reported to be an independent risk factor for the development of alcohol related liver diseases including cirrhosis and acute hepatitis.

• Obesity is the most common factor of nonalcoholic steatohepatitis, a major cause of progressive liver disease.

Low Back Pain

• Obesity may play a part in aggravating a simple low back problem, and contribute to a long-lasting or recurring condition.

• Women who are overweight or have a large waist size are reported to be particularly at risk for low back pain.

Obstetric and Gynecologic Complications

• Women with severe obesity have a menstrual disturbance rate three times higher than that of women with normal weight.

• High pre-pregnancy weight is associated with an increased risk during pregnancy of hypertension, gestational diabetes, urinary infection, Cesarean section and toxemia.

• Obesity is reportedly associated with the increased incidence of overdue births, induced labor and longer labors.

• Women with maternal obesity have more Cesarean deliveries and higher incidence of blood loss during delivery as well as infection and wound complication after surgery.

• Complications after childbirth associated with obesity include an increased risk of endometrial infection and inflammation, urinary tract infection and urinary incontinence.

Pain

• Bodily pain is a prevalent problem among persons with obesity.

• Greater disability, due to bodily pain, has been reported by persons with obesity compared to persons with other chronic medical conditions.

• Obesity is known to be associated with musculoskeletal or joint-related pain.

• Foot pain located at the heel, known as Sever’s disease, is commonly associated with obesity.

Pancreatitis

• Obesity is a predictive factor of outcome in acute pancreatitis. Obese patients with acute pancreatitis are reported to develop significantly more complications, including respiratory failure, than non-obese.

• Patients with severe pancreatitis have been found to have a higher body-fat percentage and larger waist size than patients with mild pancreatitis.

Sleep Apnea

• Obesity, particularly upper body obesity, is the most significant risk factor for obstructive sleep apnea.

• There is a 12 to 30-fold higher incidence of obstructive sleep apnea among morbidly obese patients compared to the general population.

• Among patients with obstructive sleep apnea, at least 60% to 70% are obese.

Stroke

• Elevated BMI is reported to increase the risk of ischemic stroke independent of other risk factors including age and systolic blood pressure.

• Abdominal obesity appears to predict the risk of stroke in men.

• Obesity and weight gain are risk factors for ischemic and total stroke in women.

Surgical Complications

• Obesity is a risk factor for complications after a surgery.

• Surgical patients with obesity demonstrate a higher number and incidence of hospital acquired infections compared to normal weight patients.

Urinary Stress Incontinence

• Obesity is a well-documented risk factor for urinary stress incontinence, involuntary urine loss, as well as urge incontinence and urgency among women.

• Obesity is reported to be a strong risk factor for several urinary symptoms after pregnancy and delivery, continuing as much as 6 to 18 months after childbirth.

Other

• Several other obesity-related conditions have been reported by various researchers including:

  • abdominal hernias, acanthosis nigricans, endocrine abnormalities, chronic hypoxia and hypercapnia, dermatological effects, depression, elephantitis, gastroesophageal reflux, heel spurs, hirsutism, lower extremity edema, mammegaly (causing considerable problems such as bra strap pain, skin damage, cervical pain, chronic odors and infections in the skin folds under the breasts, etc.), large anterior abdominal wall masses (abdominal paniculitis with frequent panniculitis, impeding walking, causing frequent infections, odors, clothing difficulties, low back pain), musculoskeletal disease, prostate cancer, pseudo tumor cerebri (or benign intracranial hypertension), and sliding hiatil hernia.

Consumer Protection

Weight Management Products & Services

It’s everywhere - on TV and radio, on the Internet, in magazines, and on flyers posted on your car windshield and telephone polls - ads describing a miraculous way to lose weight quickly. The truth is that if there really is a miracle cure, 64.5 percent of adult Americans would not be overweight. But, that is a fact. Even more eye opening are trends indicating that prevalence rates of overweight and obesity are likely to increase. Numerous products and programs offering weight loss solutions are available to consumers, who must be properly educated on how to evaluate which ones are effective, safe and offer realistic results.

Consumer and Market Trends

• Approximately 40 percent of women and 25 percent of men attempt to lose weight at any given time.
• Nationwide, 55 percent of Americans are actively trying to maintain current weight.
• Approximately 45 million Americans diet each year.
• Consumers spend about $30 billion per year trying to lose weight or prevent weight gain. This figure includes spending on diet sodas, diet foods, artificially sweetened products, appetite suppressants, diet books, videos and cassettes, medically supervised and commercial programs, and fitness clubs.
• Spending on weight loss programs is estimated at $1 to 2 billion per year.
• U.S. food manufacturers are estimated to have spent $7 billion on advertising of highly processed and packaged foods in 1997.

Partnership for Healthy Weight Management

• The Federal Trade Commission (FTC) has brought 150 cases of deceptive advertising over the years against providers of diet pills, potions, and devices, and against commercial diet clinics.
• The Partnership for Healthy Weight Management, a group of representatives from government, academia, industry groups and organizations promoting the public interest, including AOA, was formed in 1997.
• The purpose of the Partnership is to help the public improve their understanding of obesity and make informed decisions on weight loss products and programs.

Informing Consumers

• In 1999, the Partnership released voluntary guidelines for providers of weight loss products to disclose certain information to consumers. Read a portion of the Voluntary Guidelines below and read the entire Voluntary Guidelines for Providers of Weight Loss Products or Services at the Partnership's website.
• Consumers are encouraged to look for program and product information regarding outcome (average weight loss and weight loss maintained), although providers who follow the guidelines need not voluntarily disclose this information.

Voluntary Guidelines: Choosing a Weight Loss Product or Program

Consumers should ask about:

• staff qualifications and key components of the program
• risks associated with overweight and obesity
• risks associated with the products or services
• costs of the program
• advice on the difficulty of maintaining weight loss and how to increase the probability of success.