OBESITY (http://www.nhs.uk/Conditions/Obesity/Pages/Introduction.

aspx)

Obesity is a term used to describe somebody who is very overweight, with a lot of body fat.

It's a common problem, estimated to affect around one in every four adults and around one in
every five children aged 10 to 11 in the UK.

Defining obesity

There are many ways in which a person's health in relation to their weight can be classified, but
the most widely used method is body mass index (BMI).

BMI is a measure of whether you're a healthy weight for your height. You can use the BMI
healthy weight calculator to work out your score.

For most adults:

a BMI of 25 to 29.9 means you are considered overweight

a BMI of 30 to 39.9 means you are considered obese
a BMI of 40 or above means you are considered severely obese

BMI is not used to definitively diagnose obesity as people who are very muscular sometimes
have a high BMI, without excess fat but for most people, it can be a useful indication of
whether they may be overweight.

A better measure of excess fat is waist circumference, and can be used as an additional measure
in people who are overweight (with a BMI of 25 to 29.9) or moderately obese (with a BMI of 30
to 34.9).

Generally, men with a waist circumference of 94cm or more and women with a waist circumfe

rence of 80cm or more are more likely to develop obesity-related health problems.

Risks of obesity

Taking steps to tackle obesity is important because, in addition to causing obvious physical
changes, it can lead to a number of serious and potentially life-threatening conditions, such as:

type 2 diabetes
coronary heart disease
some types of cancer, such as breast cancer and bowel cancer
stroke
Obesity can also affect your quality of life and lead to psychological problems, such as low self-
esteem or depression.

Causes of obesity

Obesity is generally caused by consuming more calories particularly those in fatty and sugary
foods than you burn off through physical activity. The excess energy is then stored by the body
as fat.

Obesity is an increasingly common problem, because many modern lifestyles often promote
eating excessive amounts of cheap, high-calorie food and spending a lot of time sitting at desks,
on sofas or in cars.

There are also some underlying health conditions that can occasionally contribute to weight gain,
such as an underactive thyroid gland (hypothyroidism), although conditions such as this dont
usually cause weight problems if they are effectively controlled with medication.

Obesity is generally caused by eating too much and moving too little.

If you consume high amounts of energy from your diet, particularly from fat and sugars, but do
not burn off the energy through exercise and physical activity, much of the surplus energy is then
stored by the body as fat.

Calories

The energy value of food is measured in units called calories. The average physically active man
needs about 2,500 calories a day to maintain a healthy weight, and the average physically active
woman needs about 2,000 a day.

This may sound high, but it can be easy to reach this limit if you eat certain types of food. For
example, eating a large takeaway hamburger, fries and a milkshake can total 1,500 calories and
that's just one meal.

Another problem is that many people are not physically active, so lots of the calories they
consume end up being stored in the body as fat.

Poor diet

Obesity does not happen overnight. It develops gradually over time, as a result of poor diet and
lifestyle choices, such as:

eating large amounts of processed or fast food that is high in fat and sugar
drinking too much alcohol alcohol contains a lot of calories, and people who drink heavily are
often overweight
eating out a lot you may be tempted to also have a starter or dessert in a restaurant, and the
food can be higher in fat and sugar
 eating larger portions than you need you may be encouraged to eat too much if your friends
or relatives are also eating large portions
drinking too many sugary drinks including soft drinks and fruit juice
comfort eating if you feel depressed or have low self-esteem, you may eat to make yourself
feel better

Unhealthy eating habits tend to run in families, as you learn bad eating habits from your parents
when you are young and continue them into adulthood.

Lack of physical activity

Lack of physical activity is another important factor related to obesity. Many people have jobs
that involve sitting at a desk for most of the day. They also rely on their cars, rather than walking
or cycling.

When people relax, they tend to watch TV, browse the internet or play computer games, and
rarely take regular exercise.

If you are not active enough, you do not use the energy provided by the food you eat, and the
extra energy you consume is stored by the body as fat.

The Department of Health recommends adults do at least 150 minutes of moderate-intensity

aerobic activity, such as cycling or fast walking, every week. This doesnt need to be done in one
go, but can be broken into smaller periods. For example, you could exercise for 30 minutes a day
for five days.

If you are obese and trying to lose weight, you may need to do more exercise than this. It may
help to start off slowly and gradually increase the amount of exercise you do each week.

Read more about the physical activity guidelines for adults.

Genetics

Some people claim there is no point in trying to lose weight because "it runs in my family" or
"it's in my genes".

While there are some rare genetic conditions that can cause obesity, such as Prader-Willi
syndrome, there is no reason why most people cannot lose weight.

It may be true that certain genetic traits inherited from your parents such as having a large
appetite may make losing weight more difficult, but it certainly doesn't make it impossible.

In many cases, obesity is more to do with environmental factors, such as poor eating habits
learned during childhood.

Medical reasons
In some cases, underlying medical conditions may contribute to weight gain. These include:

an underactive thyroid gland (hypothyroidism) where your thyroid gland does not produce
enough hormones
Cushing's syndrome a rare disorder that causes the over-production of steroid hormones

However, if conditions such as these are properly diagnosed and treated they should pose less of
a barrier to weight loss.

Certain medicines, including some corticosteroids, medications for epilepsy and diabetes, and
some medications used to treat mental illness including antidepressants and medicines
for schizophrenia can contribute to weight gain. Weight gain can also sometimes be a side
effect of stopping smoking

Treating obesity

The best way to treat obesity is to eat a healthy, reduced-calorie diet and to exercise regularly. To
do this you should:

eat a balanced, calorie-controlled diet as recommended by your GP or weight loss

management health professional (such as a dietitian)
join a local weight loss group
take up activities such as fast walking, jogging, swimming or tennis for 150-300 minutes
a week
eat slowly and avoid situations where you know you could be tempted to overeat

You may also benefit from psychological support from a trained healthcare professional, to help
change the way you think about food and eating.

If lifestyle changes alone don't help you lose weight, a medication called orlistat may be
recommended. If taken correctly, this medication works by reducing the amount of the fat you
absorb during digestion. Your GP will know whether orlistat is suitable for you.

If you are obese, speak to your GP for advice about losing weight safely.

Your GP can advise you on the type of diet you should be following and how you can much
exercise you should do.

They can also let you know about other services, such as:

local weight loss groups these could be provided by the NHS or may be commercial services
you have to pay for
exercise on prescription where you are referred to a local active health team for a number of
sessions under the supervision of a qualified trainer
If you have underlying problems associated with obesity, such as polycystic ovary syndrome
(PCOS), high blood pressure, diabetes or obstructive sleep apnoea, your GP may recommend
further tests or specific treatment. In some cases, they may refer you to a specialist.

Read more about how your GP can help you lose weight.

Diet

While there is no single rule that applies to everybody, most obese people are advised to reduce
the energy intake from their diet by 600 calories a day.

The best way to achieve this is to swap unhealthy and high-energy food choices such as fast
food, processed food and sugary drinks (including alcohol) for healthier choices.

A healthy diet should consist of:

plenty of fruit and vegetables

plenty of potatoes, bread, rice, pasta and other starchy foods (ideally you should choose
wholegrain varieties)
some milk and dairy foods
some meat, fish, eggs, beans and other non-dairy sources of protein
just small amounts of food and drinks that are high in fat and sugar

Try to avoid foods containing high levels of salt as these can raise your blood pressure, which
can be dangerous in people who are already obese. Read some tips for a lower-salt diet.

You will also need to check calorie information for each type of food and drink you consume, to
make sure you do not go over your daily limit.

Some restaurants, cafs and fast food outlets provide calorie information per portion, but
providing this information is not compulsory. Be careful when eating out, as some foods can
quickly take you over the limit, such as burgers, fried chicken and some curries or Chinese
dishes.

Read more about calorie counting.

Diet programmes and fad diets

You should avoid fad diets that recommend unsafe practices, such as fasting (going without food
for long periods of time) or cutting out entire food groups. These can make you feel ill and are
not sustainable, because they dont teach you long-term healthy eating habits.

This is not to say that all commercial diet programmes are unsafe. Many are based on sound
medical and scientific principles and can work well for some people. A responsible diet
programme should:
 educate you about issues such as portion size, making changes to behaviour and healthy eating
not be overly restrictive in terms of the type of foods you can eat
be based on achieving gradual sustainable weight loss rather than short-term rapid weight loss,
which is unlikely to last

On average, people attending a lifestyle weight management programme lose around 3% of their
body weight, although this varies considerably.

Read about the pros and cons of different diets.

Very low calorie diets

A very low calorie diet (VLCD) is where you consume less than 1,000 calories a day.

These diets can lead to rapid weight loss, but they are not a suitable or safe method for everyone.
VLCDs are usually only recommended if you have an obesity-related complication that would
benefit from rapid weight loss, such as severe sleep apnoea.

VLCDs should usually not be followed for any longer than 12 weeks at a time, and they should
only be adopted under the supervision of a suitably qualified healthcare professional.

Further information

For more information on diet and weight loss read about:

how to start losing weight

healthy food swaps
eight tips for healthy eating
food labels

Exercise

Reducing the amount of calories in your diet will help you lose weight, but if you want to keep
off the weight, you have to combine a calorie-controlled diet with regular exercise.

Your GP or weight loss adviser can provide an exercise plan suited to your circumstances, which
will probably involve several hours of moderate-intensity physical activity a week.

Moderate-intensity physical activity is any activity that increases your heart and breathing rate,
and may make you sweat, but still allows you to hold a normal conversation. Examples include:

fast walking
jogging
swimming
tennis
using a step-trainer (or similar) at the gym
Choose physical activities that you enjoy, as you are more likely to continue doing them.

You should aim to start gradually. For example, start off by doing 15 to 20 minutes of exercise
five times a week and then build on it.

The Department of Health recommends most adults should do at least 150 minutes of moderate-
intensity exercise every week. However, if you are obese and trying to lose weight, or have
successfully lost weight and want to keep it off, you probably need to do more exercise. In most
cases, up to five hours a week is recommended.

Further information

For more information on exercise, see:

health and fitness

get active your way
get running with Couch to 5K
gym-free exercises
the 10,000 step challenge

Other useful strategies

Evidence has shown that weight loss can be more successful if it involves other strategies, in
addition to diet and lifestyle changes. This could include things like:

setting realistic weight loss goals even losing just 3% of your original body weight can
significantly reduce your risk of obesity-related complications
eating more slowly and being mindful of what and when you are eating (for example, not being
distracted by watching TV)
avoiding situations where you know you may be tempted to overeat
involving your friends and family with your weight loss efforts, as they can motivate you
monitoring your progress for example, weigh yourself regularly and note your weight in a diary

You may also find psychological support from a trained healthcare professional helps you
change the way you think about food and eating, through techniques such as cognitive
behavioural therapy (CBT).

Medication

Many different types of anti-obesity medication have been tested in clinical trials, but only one
has proved to be both safe and effective: orlistat.

Orlistat works by preventing around a third of the fat from the food you eat from being digested.
This undigested fat is not absorbed into your body and is passed out with your faeces (stools).
This will help you avoid gaining weight, but will not necessarily cause you to lose weight.
Therefore, it's still important to stick to your recommended diet and exercise plan.

When medication is used

Orlistat is usually only recommended if you have made a significant effort to lose weight
through diet, exercise or changing your lifestyle.

Even then, orlistat is only prescribed if you have:

a body mass index (BMI) of 28 or more and other conditions related to weight, such as high
blood pressure
a BMI of 30 or more

Treatment with orlistat must be combined with a low-fat diet and other weight loss strategies,
such as doing more exercise. If you are prescribed orlistat, you will also be offered advice and
support about diet, exercise and making lifestyle changes.

Orlistat is not usually recommended for pregnant or breastfeeding women.

Dosage and duration of treatment

One orlistat capsule is taken with each main meal (up to a maximum of three capsules a day).
You can take the capsule either before, during or up to one hour after each meal.

If you miss a meal or the meal does not contain any fat, you may not need to take the orlistat
capsule. Your GP should explain this to you, or you can check the patient information leaflet that
comes with your medication.

Treatment with orlistat should only continue beyond three months if you have lost 5% of your
body weight. It usually starts to affect how you digest fat within one to two days. If orlistat has
not worked after three months, it is unlikely to be an effective treatment for you.

If you have type 2 diabetes, it may take you longer to lose weight using orlistat, so your target
weight loss after three months may therefore be slightly lower.

If orlistat is successful after three months, your prescription may be continued for up to a year.
After that, your GP will review your condition and decide whether you should continue with
orlistat.

Side effects

Common side effects of orlistat include:

fatty or oily stools

needing the toilet urgently
 passing stools more frequently
oily discharge from your rectum (you may have oily spots on your underwear)
flatulence (wind)
stomach pain
headaches
upper respiratory tract infections, such as a cold

These side effects are much less likely to occur if you stick to a low-fat diet.

Women taking the oral contraceptive pill are advised to use an additional method of
contraception, such as a condom, if they experience severe diarrhoea while taking orlistat. This is
because the contraceptive pill may not be absorbed by your body if you have diarrhoea, so it may
not be effective.

Surgery

Weight loss surgery, also called bariatric surgery, is sometimes used to treat people who are
severely obese.

This type of surgery is usually only available on the NHS to treat people with severe obesity that
have not responded to other measures.

Severe obesity is defined as:

having a body mass index (BMI) of 40 or above

having a BMI of 35 or above and having another serious health condition that could be improved
if you lose weight, such as type 2 diabetes, obstructive sleep apnoea or high blood pressure

In rare cases, surgery may be recommended as the first treatment if your BMI is 50 or above.

Read more about weight loss surgery.

Treating obesity in children

Treating obesity in children is based on much the same principles as treating obesity in adults
by combining a calorie-controlled diet with regular exercise.

The amount of calories your child should eat every day will depend on their age and height. Your
GP should advise a recommended daily limit.

Children should ideally get at least one hour of moderately-intense exercise a day, such as
running, playing football or netball.

You should restrict sedentary activities, such as watching television or playing computer games,
to less than two hours a day (14 hours a week).
Referral to a specialist in treating childhood obesity may be recommended if your child
develops an obesity-related complication, or there is thought to be an underlying medical
condition causing the obesity.

The use of orlistat in children is only recommended in exceptional circumstances for example,
if a child is severely obese and has an obesity-related complication

Complications of obesity

Obesity can cause a number of further problems, from difficulties with daily activities
to serious health conditions.

Some of the day-to-day problems that can be caused by obesity include:

breathlessness
increased sweating
snoring
difficulty doing physical activity
feeling very tired a lot of the time
joint and back pain
low confidence and self-esteem
feeling isolated

You may also find that some of the psychological problems associated with being obese affect
your relationships with family members and friends, and may lead to depression.

Further health problems

Being obese can also increase your risk of many potentially serious health conditions, including:

type 2 diabetes a condition that causes a person's blood sugar level to become too high
high blood pressure
high cholesterol and atherosclerosis (where fatty deposits narrow your arteries), which can lead
to coronary heart disease and stroke
asthma
metabolic syndrome a combination of diabetes, high blood pressure and obesity
several types of cancer, including bowel cancer, breast cancer and womb cancer
gastro-oesophageal reflux disease (GORD) where stomach acid leaks out of the stomach and
into the oesophagus (gullet)
gallstones small stones, usually made of cholesterol, that form in the gallbladder
reduced fertility
osteoarthritis a condition involving pain and stiffness in your joints
sleep apnoea a condition that causes interrupted breathing during sleep, which can lead to
daytime sleepiness with an increased risk of road traffic accidents, as well as a greater risk of
diabetes, high blood pressure and heart disease
liver disease and kidney disease
 pregnancy complications, such as gestational diabetes or pre-eclampsia (when a woman
experiences a potentially dangerous rise in blood pressure during pregnancy)

Obesity reduces life expectancy by an average of 3 to 10 years, depending on how severe the
problem is. It's estimated that being overweight or obese contributes to at least 1 in every 13
deaths in Europe

Outlook

There is no "quick fix" for obesity. Weight loss programmes take time and commitment, but they
work best when people are able to complete the programmes fully and are offered advice about
maintaining the weight loss achieved.

Regularly monitoring your weight, setting realistic goals and involving your friends and family
with your attempts to lose weight can also help.

Remember that even losing what seems like a small amount of weight (such as 3% or more of
your original body weight), and maintaining this for life, can significantly reduce your risk of
obesity-related complications like diabetes and heart disease.
OBESITY (http://www.patient.co.uk/health/obesity-and-overweight-in-adults)

If you are obese or overweight, you have an increased risk of developing various health
problems. Even a modest amount of weight loss can help to reduce your increased health risks.
The best chance of losing weight and keeping the weight off, is to be committed to a change in
lifestyle. This includes eating a healthy diet and doing some regular physical activity. See also
separate leaflet called Obesity and Overweight in Children.

Are you obese or overweight?

If you are obese or overweight, this means that you are carrying excess body fat. Being
overweight or obese is not just about how you look. Over time, it means that you have an
increased risk of developing various health problems. As an adult, you can find out whether you
are overweight or obese and whether your health may be at risk, by calculating your body mass
index (BMI) and measuring your waist circumference.

Body mass index (BMI)

People are different heights and builds, so just weighing yourself cannot be used to decide if
your weight is healthy. BMI is used by healthcare professionals to assess if someone's weight is
putting their health at risk. It is a measure of your weight related to your height.

To calculate your BMI, you divide your weight (in kilograms) by the square of your height (in
metres). So, for example, if you weigh 70 kg and are 1.75 metres tall, your BMI is 70/(1.75 x
1.75), which is 22.9.

If you do not have scales at home, your practice nurse can measure your height, weigh you and
calculate your BMI or use our calculator to work out your BMI.

The table below shows how to interpret your BMI. In general, the more your BMI is over 25, the
more overweight or obese you are and the greater the risk to your health.

BMI Classed As Health Risk

Less than 18.5 Underweight Some health risk

18.5 to 24.9 Ideal Normal

25 to 29.9 Overweight Moderate health risk

30 to 39.9 Obese High health risk

40 and over Very obese Very high health risk

On the whole, BMI is a good estimate of how much of your body is made up of fat. However,
BMI may be less accurate in very muscular people. This is because muscle weighs heavier than
fat. So, someone who is very muscular may have a relatively high BMI due to the weight of their
muscle bulk but actually have a proportionally low and healthy amount of body fat.

Weight Tracker App

UW

Get the weight tracker app

With our free app, you can track your weight and share results with your friends.

See more mobile apps

Waist circumference

If you are overweight, measuring your waist circumference can also give some information about
your risk of developing health problems (particularly coronary heart disease and type 2 diabetes).
If two overweight or obese people have the same BMI, the person with a bigger waist
circumference will be at a greater risk of developing health problems due to their weight. This is
because it is not just whether you are carrying excess fat but where you are carrying it. The risks
to your health are greater if you mainly carry a lot of extra fat around your waist ('apple-shaped'),
rather than mainly on your hips and thighs ('pear-shaped').

The easiest way to measure your waist circumference is to place the tape measure around your
waist at belly button level.

As a rule for a man:

If you have a waist measurement of 94 cm or above, the risk to your health is increased.
If you have a waist measurement of 102 cm or above, the risk is even higher.

As a rule for a woman:

If you have a waist measurement of 80 cm or above, the risk to your health is increased.
If you have a waist measurement of 88 cm or above, the risk is even higher.

Note: for people from Asian backgrounds, the increased health risks may start at a lower waist
circumference. Your doctor or practice nurse can advise.
What are the health risks of being overweight or obese?

If you are overweight or obese, from day to day you may:

Feel tired and lacking in energy.

Experience breathing problems (for example, shortness of breath when moving around, or not
being able to cope with sudden bursts of physical activity like running across the road).
Feel that you sweat a lot compared with other people.
Develop skin irritation.
Have difficulty sleeping.
Get complaints from your partner that you snore.
Experience back and joint pains which can affect your mobility.

You may also have an increased risk of developing:

Impaired glucose tolerance (pre-diabetes).

Type 2 diabetes.
High cholesterol or triglyceride levels.
High blood pressure.
Coronary heart disease.
Stroke.
Sleep apnoea (this is when your breathing patterns are disturbed while you are sleeping, due to
excess weight around your chest, neck and airways).
Fertility problems.
Complications in pregnancy (including an increased risk of high blood pressure during
pregnancy, diabetes during pregnancy, preterm labour, caesarean section).
Stress incontinence (leaking urine when you are, for example, laughing, coughing, etc).
Gallstones.
Cancers (including colon, breast and endometrial (womb) cancer).
Gout.
Fatty liver.

Many people can also develop psychological problems because of being overweight or obese.
For example: low self-esteem; poor self-image (not liking how you look); low confidence;
feelings of isolation. These feelings may affect your relationships with family members and
friends and, if they become severe, may lead to depression.

Being obese (having a BMI >30) can also affect your overall life expectancy: you are more likely
to die at a younger age. An analysis in 2009 of almost one million people from around the world
showed that if you have a BMI between 30 and 35, you are likely to die 2-4 years earlier than
average. If your BMI is between 40 to 45, you are likely to die 8-10 years earlier than average.

Another analysis showed that if you are a woman who is obese at the age of 40, you are likely to
die 7.1 years earlier than average. If you are a man who is obese at the age of 40, you are likely
to die 5.8 years earlier than average. If you smoke as well, your life expectancy is reduced even
further.
How common are obesity and overweight?

Overweight and obesity are common. In the UK:

Between 6 and 7 out of 10 men have a BMI >25 and so are overweight or obese.
Between 5 and 6 out of 10 women have a BMI >25 and so are overweight or obese.
Around 1 in 4 men and 1 in 4 women in the UK have a BMI >30 and so are obese.
Around 2 in 100 adults are severely (also called morbidly) obese (BMI >40).

The number of obese people in the UK is rising, particularly among young adults. Since 1980,
the number of obese adults in the UK has nearly tripled and the UK now has the highest rate of
obesity in Europe . This has been called the obesity epidemic.

What is the cause of being overweight or obese?

In some respects, the cause sounds quite simple. Your weight depends on how much energy you
take in (the calories in food and drink) and how much energy your body uses (burns) up:

If the amount of calories that you eat equals the amount of energy that your body uses up, then
your weight remains stable.
If you eat more calories than you burn up, you put on weight. The excess energy is converted
into fat and stored in your body.
If you eat fewer calories than you burn up, you lose weight. Your body has to tap into its fat
stores to get the extra energy it needs.

A common wrong belief is to think that if you are overweight or obese, you have a low
metabolic rate. (Your metabolic rate or metabolism is the amount of energy that your body needs
to keep going.) In fact, if you are obese or overweight you have a normal, or even high,
metabolic rate (as you use up more energy carrying the extra weight).

The reasons why energy taken in may not balance energy used up and may lead to weight gain,
include the following.

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How much you eat and drink

Most people in the UK live where tasty food can be found at almost any time of day or night.
Many of the foods that people eat are those higher in calories (particularly fatty and sugary
foods), so-called energy-dense foods. Although your body gives you a feeling of fullness after
eating enough (satiety), you can easily ignore this feeling if you are enjoying tasty foods. Food
portion sizes in general have increased. There has also been a tendency to eat out more over
recent years. If you eat out, you are more likely to eat food that is more energy-dense than you
would eat at home. The amount of processed foods and ready-made meals available has also
increased in response to our busy lives. These are often foods that are more energy-dense as well.
However, even healthy foods contain calories and can tip the energy balance if we eat too much
of them.

What you drink is also important. Alcohol and sugary drinks contain a lot of calories. Even fresh
fruit juices that you may think are healthy can make up a significant part of your daily calorie
intake if you drink too much of them.

In short, many people are overweight or obese simply because they eat and drink more than their
body needs.

Your physical activity levels

Where does physical activity fit in to your current lifestyle? Most people in the UK do not do
enough physical activity. Fewer people these days have jobs which are energetic. The variety of
labour-saving devices and gadgets in most homes and the overuse of cars, means that most
people end up using up much less energy compared with previous generations. The average
person in the UK watches 26 hours of television per week and many even more (the couch potato
syndrome).

A lack of physical activity by many people is thought to be a major cause of the increase in
obesity in recent years.

Genetics

You are more likely to be obese if one of your parents is obese, or both of your parents are obese.
This may partly be due to learning bad eating habits from your parents. But, some people
actually inherit a tendency in their genes that makes them prone to overeat. So, for some people,
part of the problem is genetic.

It is not fully understood how this genetic factor works. It has something to do with the control
of appetite. When you eat, certain hormones and brain chemicals send messages to parts of your
brain to say that you have had enough and to stop eating. In some people, this control of appetite
and the feeling of fullness (satiety) may be faulty, or not as good as it is in others.

However, if you do inherit a tendency to overeat, it is not inevitable that you will become
overweight or obese. You can learn about the power of your appetite, ways to resist it, be strict
on what you eat and do some regular physical activity. But you are likely to struggle more than
most people where your weight is concerned. You may find it more difficult to stop yourself
from gaining weight or to lose weight.

Medical problems

Less than 1 person in 100 obese people has a 'medical' cause for their obesity. For example,
conditions such as Cushing's syndrome and an underactive thyroid are rare causes of weight
gain. Women with polycystic ovary syndrome may also be overweight. (See separate leaflets
called Cushing's Syndrome and Polycystic Ovary Syndrome for further details on these
conditions.)

Some medicines such as steroids, some antidepressants, sulfonylureas and sodium valproate may
contribute to weight gain. If you give up smoking, your appetite may increase and, as a result,
you may put on weight. People with low mood or depression may also have a tendency to eat
more energy-dense 'comfort' foods and so gain weight.

Dr. Sarah Jarvis

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What are the benefits of losing weight and how much weight should I lose?

It is difficult to measure how much quality of life is improved if you lose some weight. Many
people feel better, and have more energy. Some people notice an improvement in their self-
esteem. But there are also definite health benefits from losing some weight. As explained above,
many diseases are more common in obese and overweight people and you are less likely to
develop them if you lose some weight.

What is more, if your BMI is between 25 to 35, much of the health benefits come with losing the
first 5-10% of your weight. (For example, if you weigh 90 kg and you lose 9 kg, this would be
10% of your original weight.) If your BMI is between 25 to 35, on average, if you reduce your
weight by 10%:

You are much less likely to develop the health problems listed above, such as diabetes.
If you already have problems such as high blood pressure, high cholesterol, osteoarthritis, or
diabetes, these are likely to improve. If you are taking medication for these problems, you may
need a reduced dose.
Your chance of dying at any given age is reduced. This is mainly because you are less likely to die
from heart disease, stroke, diabetes, or obesity- related cancers.

If your BMI is more than 35, you are more likely already to have health problems related to
being overweight. You will probably need to lose between 15-20% of your original weight to
have sustained improvements in these health problems and other health benefits.

How do I know if my weight is already affecting my health?

If you are worried that you are overweight or obese, you should discuss this with your practice
nurse or doctor. They may be able to determine if your weight is already affecting your health.
For example, they may start by checking whether you have any symptoms of coronary heart
disease such as chest pains, particularly on exertion. They may also ask about any symptoms of
osteoarthritis such as back pain or joint pains, or any symptoms of sleep apnoea this is when your
breathing patterns are disturbed while you are sleeping, due to excess weight around your chest,
neck and airways. They may suggest some tests to screen for any underlying health problems
that may be caused by your weight. For example, they may suggest:

A blood test for type 2 diabetes.

A blood test to look at your cholesterol and triglyceride levels.
A blood pressure check.

Other blood tests are sometimes suggested to look for other problems such as an underactive
thyroid gland or liver problems.

As mentioned above, quite often it can also be the case that if someone is overweight or obese,
this can lead to psychological problems. So, your doctor or nurse may also ask you questions to
look for any signs of these.

Note: your doctor or practice nurse may also be a source of help if you would like to lose weight
(see below).

How can I lose weight?

Decision aids

Doctors and patients can use Decision Aids together to help choose the best course of action to
take.
Compare the options

Some people lose weight by strict dieting for a short period. However, as soon as their diet is
over, they often go back to their old eating habits and their weight goes straight back on. Losing
weight and then keeping it off, needs a change in your lifestyle for life. This includes such things
as:

The type of food and drink that you normally buy.

The type of meals that you eat.
Your pattern of eating.
The amount of physical activity that you do.

Another separate leaflet in this series, called Weight Reduction - How to Lose Weight provides
more details. Below is a brief summary of the principles in losing weight.

Before you start

 Motivation is crucial: no weight loss plan will work unless you have a serious desire to lose
weight. You need to be ready and motivated.
Monitor your current food intake: it is helpful to know exactly how much you currently eat.
Keeping a detailed diary of everything that you eat and drink over an average week is more
helpful.
Aim to lose weight gradually: it is best not to lose weight too fast. Aim to lose an average of 0.5
to 1 kg per week (about 1-2 lb per week).
Set clear goals with a realistic timescale: it is important to set a clear and realistic weight loss
goal. As mentioned above, in most cases, health benefits can be gained from losing the first 5-
10% of your weight.

Aim to eat a healthy balanced diet

Special diets which are often advertised are not usually helpful. This is because after losing
weight, if your old eating habits remain, the weight often goes straight back on. It is usually not a
special diet that is needed but changing to a healthy balanced diet, for good.

Briefly, a healthy diet means:

Making up a third of most meals with starch-based foods (such as cereals, bread, potatoes, rice,
pasta). Wholegrain starch-based foods are preferable.
Eating plenty of fibre in your diet. Foods rich in fibre include wholegrain bread, brown rice and
pasta, oats, peas, lentils, grain, beans, fruit, vegetables and seeds.
Having at least five portions, or ideally 7-9 portions, of a variety of fruit and vegetables per day.
These should be in place of foods higher in fat and calories. For example, fruit makes a good,
healthy snack if you feel hungry.
Limiting fatty food such as fatty meats, cheeses, full-cream milk, fried foods, butter, etc. Use
low-fat options where possible. Examples are:
o Skimmed or semi-skimmed instead of full-cream milk.
o Using low-fat, monounsaturated or polyunsaturated spreads instead of butter.
o If you eat meat, eating lean meat or poultry such as chicken.
o Try to grill, bake or steam rather than fry food. If you do fry food, choose a vegetable oil
such as sunflower, rapeseed or olive.
Avoiding sugary drinks and sugary foods such as chocolate, sweets, biscuits, cakes, etc.
Limiting other foods likely to be high in fat or sugar such as some takeaway or fast foods.
Eating three meals a day and not skipping meals. Always have breakfast. Eat each meal slowly.
Skipping meals will just make you feel more hungry, make you think more about food and make
you more likely to overeat in the evening or snack between meals.
Trying not to add salt to food and avoiding foods that are salty.
Including 2-3 portions of fish per week, at least two of which should be 'oily' (such as herring,
mackerel, sardines, kippers, pilchards, salmon, or fresh tuna).

Another separate leaflet called Healthy Eating gives more details.

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Look at your eating habits

For example:

Plan your meals ahead of time so you know what you will be eating.
Be careful that your food portion sizes are not too big.
Avoid second helpings when you are already full.
Switch unhealthy snacks and desserts to healthy ones.
Eat slowly.
Don't skip meals.

Be careful about what you drink

Many people use drinks full of calories to quench their thirst. Sugary drinks such as cola, tea and
coffee with milk and sugar, milk and alcoholic drinks, all contain calories. One of the easiest
ways to cut back on calories is simply to drink water as your main drink.

Increase your physical activity levels

It is recommended that all adults should aim for 150 minutes of exercise a week. One way to do
this is to do 30 minutes of moderate-intensity exercise in bouts of 10 minutes for five days of the
week. Another method is to do 75 minutes of vigorous-intensity activity spread throughout the
week or a combination of moderate and vigorous activity.

Moderate physical activity includes: brisk walking, jogging, dancing, swimming, badminton,
tennis, etc. In addition, try to do more in your daily routines. For example, use stairs instead of
lifts, walk or cycle to work or school, etc. Avoid sitting for too long in front of the television or a
computer screen. Take regular breaks whilst working. The good news is that you don't have to do
this physical activity all in one chunk. You can break it up into blocks of 10-15 minutes. See
separate leaflet called Physical Activity for Health, which gives more details.

Build your exercise levels up gradually. If you are not used to physical activity, try starting with
a 30-minute brisk walk every day and then building up from there.

Monitor your behaviour and progress

Just as keeping a food diary can be helpful at the beginning of a weight loss programme, it can
be useful as a way to monitor your eating during your weight loss. You can use the same diary to
keep a track of your physical activity levels as well. It is also important to weigh yourself
regularly to monitor your progress. Once weekly is recommended. However, don't be
disheartened by minor weight increases or levelling off for a few days. Look for the overall trend
over several months.

Get help and support

Some people may feel motivated enough and feel that they have all of the information that they
need in order to lose weight without any help from others. However, you don't have to try to lose
weight alone. There is a wealth of help available. Ask your doctor or practice nurse for advice. A
referral to a dietician may be helpful. One-on-one counselling or group counselling may be
available in your area on the NHS. Ask about groups or programmes to increase your physical
activity levels. There are also a number of commercial weight loss groups that run in the UK as
well as internet-based programmes and self-help books that can help you with your weight loss.

Treatment with medication to help with weight loss

Medication to help with weight loss may be an option for some people who want to lose weight.
However, there are no wonder drugs available. Lifestyle changes to improve diet and increase
physical activity are still important.

A medication called orlistat is available on prescription from your doctor and low-dose orlistat is
also available to buy over-the-counter in pharmacies. Doctors and pharmacists are given specific
guidelines on when orlistat should be used. A separate leaflet called Orlistat - Help With Weight
Loss gives further details.

Surgery to help with weight loss

This may be an option if you are very obese. However, surgery is usually only offered if you
have already tried other ways to lose weight which have not worked (including diet, increasing
your physical activity levels and orlistat). Surgery usually has very good results and most people
do lose a lot of weight. However, this is specialist surgery and it is a major undertaking. Surgery
to help weight loss is called bariatric surgery. For further information about surgery to help with
weight loss, see separate leaflet called Surgery for Obesity.

Keeping the weight off

Many people lose weight but at the end of their diet, the weight goes back on. The main reason
this happens is because their weight-reducing diet was only a temporary change to their
unhealthy diet and lifestyle. To keep your weight off, it is important that you make permanent
changes. This usually means:

Keeping to a healthy diet.

Exercising regularly.
A change for the whole household. It is difficult for one member of a household to shop and eat
differently to the rest. It is best that the whole household should eat a healthy diet.
It does not mean less enjoyment of food. However, it may take a while to learn to enjoy different
foods, meals and recipes. Some people need more support to keep to their new weight than when
they were actually dieting and losing weight. A local support group may be able to help.

Can overweight and obesity be prevented?

Yes. You can help to prevent becoming overweight or obese by:

Following the healthy eating guidelines outlined above.

Doing 150 minutes of physical activity according to the guidelines above.
Spending less time being sedentary (for example, less time in front of your computer or
watching TV).
Weighing yourself from time to time so that you become more aware of your weight and you
can do something about your weight if you start to put some on.
Encouraging a healthy lifestyle for your whole family.