Weight Loss Medications and Bariatric Surgery

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Obesity Date: 2019 From: Gale Opposing Viewpoints Online Collection Publisher: Gale, a Cengage Company Document Type: Topic overview Length: 2,566 words Content Level: (Level 5) Lexile Measure: 1450L

Full Text: Obesity in adults is defined by a body mass index of 30 or above. Body mass index (BMI) is determined using a person’s weight and height to calculate an estimate of the amount of fat in that person’s body. For children and adolescents, the Centers for Disease Control and Prevention (CDC) defines obesity as “a BMI at or above the 95th percentile for children and teens of the same age and sex.” Obesity in adults is not measured against a reference population. Obesity can be taxing on the body and is associated with higher risks for a variety of health problems, such as heart disease, diabetes, liver disease, high blood pressure, infertility, gallbladder disease, depression, several forms of cancer, stroke, and sleep apnea. During pregnancy, obesity and excessive weight gain increase the likelihood of miscarriage, gestational diabetes, preeclampsia, and complications during labor. As stated by the American College of Obstetricians and Gynecologists, children born to obese mothers face an increased likelihood of birth defects and may encounter related issues throughout their development and into adulthood.

According to a 2018 World Health Organization (WHO) report, worldwide obesity has almost tripled since 1975. The WHO report estimates that 1.9 billion adults ages eighteen and older, 340 million children ages five to nineteen, and 41 million children under age five worldwide were overweight or obese in 2016. The CDC reported that more than one-third of US adults (39.8 percent) and more than one-sixth of children ages two to nineteen (18.5 percent) were considered obese in 2016, leading many health care professionals to identify obesity as a national epidemic. Obesity rates have risen substantially since 1990, when no state had an obesity rate over 15 percent. As detailed in the annual report The State of Obesity 2019, a project of the Robert Wood Johnson Foundation, US adult obesity rates exceeded 25 percent in forty-eight states, nine of which recorded rates above 35 percent. According to the CDC, obesity more often affects non-white Americans. In 2018, the highest prevalence of obesity, 39.1 percent, was reported by non-Hispanic African Americans. Prevalence among people of Hispanic ethnicity was 33.3 percent, followed by non- Hispanic whites at 29.3 percent.

In light of the growing incidence of obesity, some health care professionals have warned against normalizing obesity, as doing so can deter obese people from seeking medical help. A 2017 report in the Journal of the American Medical Association (JAMA) found that the number of overweight and obese Americans attempting to lose weight is decreasing. In a study of more than 27,000 overweight and obese US adults, 55.6 percent reported trying to lose weight during the initial time period studied, 1988 to 1994, while only 49.2 percent were trying to lose weight between 2009 and 2014. Other health care professionals discourage a singular focus on weight or body mass, stressing instead the importance of monitoring other health indicators. Many body positivity activists contend that a person can more effectively address health concerns by accepting their size and concentrating on improving overall health.

Main Ideas

Main Ideas

Obesity in adults is determined by calculating body mass index (BMI), which uses weight and height to estimate the amount of fat in a body. Adults with a BMI of 30 or above are classified as obese. Obesity rates have risen substantially since 1990, when no US state’s rate exceeded 15 percent. As of 2019, adult obesity rates exceeded 25 percent in forty-eight US states, nine of which exceeded 35 percent, according to The State of Obesity. Obesity is associated with higher risks of health problems ranging from heart disease, diabetes, liver disease, and high blood pressure to infertility, depression, cancer, and complications during pregnancy and labor. Researchers have determined that obesity results from a combination of biological and social factors but have identified behavioral habits, home environment, race and ethnicity, genetics, and household income as contributing factors. Some health care professionals worry that normalizing obesity deters people from seeking medical help, while others worry that the singular focus on weight or BMI stigmatizes obesity and contributes to weight discrimination. People who are obese confront many types of bias, including hiring, wage, and workplace discrimination. Weight discrimination

 

 

among medical professionals has also emerged as a significant and potentially fatal barrier to providing effective care.

Body Mass Index

Though health care professionals, fitness experts, and nutritionists commonly use BMI to appraise how a person’s body size relates to overall health, BMI, like all measurements, has limitations. Relying too much on BMI can result in misleading conclusions because body fat is stored differently depending on a person’s age, sex, and overall body composition. An adult woman who is five feet, four inches tall would have a BMI of 30 at 175 pounds, placing her in the obese category. In comparison, an adult woman who is five feet, seven inches in height and also 175 pounds would have a BMI of 27 and would be categorized as overweight rather than obese. People with a BMI between 25 and 29.9 are considered overweight, while people with a BMI under 18.5 are considered underweight.

Critics have argued against the use of BMI as a measurement of an individual’s relative health. BMI, they note, is not an accurate measurement of body fat. Muscle is denser than fat, with the volume of a pound of muscle measuring about 80 percent the volume of a pound of fat. This means that many athletes in good health would classify as overweight based on BMI alone. The BMI rating system also does not consider where fat is concentrated in a person’s body. For example, although excess fat around the midsection is associated with more health complications than fat in other areas, this could go unnoticed in a person with a healthy BMI.

A BMI in the healthy range also does not guarantee that a person is protected from the physical health concerns associated with obesity. A 2016 study published in the International Journal of Obesity assessed the health of more than 40,000 adults by examining six different metrics for health, including blood pressure, cholesterol, and blood sugar levels. Of these adults, 47 percent who were classified as overweight by their BMI and 29 percent of those classified as obese were found to be healthy when using the other metrics. Over 30 percent of those classified as having a healthy BMI, meanwhile, were found to be unhealthy according to the other metrics.

Causes and Risk Factors

Obesity is most commonly described as occurring when the body consumes more energy, typically measured in calories, than it expels through normal functioning and physical exercise. However, researchers have noted that obesity results from a combination of factors. Researchers at the National Heart, Lung, and Blood Institute at the National Institutes of Health (NIH) have found that risk factors for obesity include lifestyle and behavioral habits, unhealthy environments, race and ethnicity, use of certain medications, and genetics. A lack of sleep has also been known to slow metabolism and contribute to excessive weight gain. Men and women store fat differently, which can contribute to different susceptibilities to obesity. Additionally, transgender people face higher rates of being overweight or obese, with 72.4 percent of transgender people found to have BMIs equal to or greater than 25 compared to 65.5 percent of cisgender people.

Environmental contributors include a lack of access to affordable healthy foods and a lack of safe places to exercise. Communities with limited food options, commonly referred to as food deserts, experience higher rates of obesity than people in areas with more diverse options. Likewise, obesity rates are higher in food swamps, or areas where retailers selling fast food and junk food outpace those offering healthier options. Sedentary work, including most office work and jobs with low physical demands, contributes to a general lack of exercise. Additionally, long-term unemployment has been linked to obesity.

Researchers have also noted that eating habits and family food culture can affect the likelihood of obesity. Generally, families that eat together and eat without the television on have lower rates of obesity than families that do not eat together or eat with the television on. Links between chronic stress and excessive weight among British men and women ages fifty and older were identified in a 2017 study published in the journal Obesity. The results showed that during extended periods of stress, people reported both overeating and eating more foods high in sugar, fat, and calories. The relationship between stress and eating habits is compounded the fact that cortisol, the stress hormone, slows metabolism and can cause the body to store more fat.

Prevention Strategies and Related Challenges

Preventing obesity can be as complex as identifying its causes, though behavioral and environmental changes can help mitigate excessive weight gain. Health care professionals recommend increasing physical activity, reducing the consumption of unhealthy foods, improving sleep, and reducing stress as means to combat obesity on the individual level. Certain social and economic factors, such as lack of access to affordable and nutritious foods, can present challenges for overcoming obesity. A poor diet can also negatively affect how dopamine, a neurotransmitter associated with pleasure and reward, reacts to food consumption, causing increased cravings for unhealthy foods high in sugar and fat content.

Negative social bias against people who are obese and overweight can commonly result in what has been termed body shaming, also referred to as fat shaming. While some people cite body shaming as a potential factor in motivating people to lose weight, evidence suggests that body shaming can have the opposite effect. In a 2015 study published in the journal Psychological Science, researchers reported that body shaming can increase the likelihood of developing mental health conditions that make it more difficult to lose weight. In addition, increased social acceptance of diverse body types, the development of community initiatives that encourage self-advocacy, and a focus on well-being have been shown to have better outcomes than programs that focus only on weight loss. A 2017 study published in Obesity concluded that people seeking treatment for obesity often internalize prejudices, which could contribute to an increased risk of stroke, heart disease, and diabetes.

Effects of Obesity

 

 

The CDC reports that obesity-related conditions, such as heart disease, stroke, and type 2 diabetes, are among the leading causes of preventable death in the United States. According to WHO, about 2.8 million people die each year from complications related to obesity and excess weight. The Trust for America’s Health and the Robert Wood Johnson Foundation have estimated that more than half of the US population will be obese by 2030. They predict dramatic increases in the prevalence of obesity-related diseases and health care costs as well as significant losses in economic productivity.

To accommodate larger numbers of people with obesity, businesses and public infrastructure will incur additional expenses. For example, hospitals will need to invest in equipment such as larger beds and toilets; schools and offices may require larger seats and desks. According to the 2016 Gallup-Healthways Well-Being Index, medical expenses related to overweight and obese adults in the United States contribute more than $142 billion in annual health care costs. Compared to individuals with lower BMIs, people who are overweight pay an additional $378 in annual health care costs while people with obesity typically pay an additional $1,580 each year.

People classified as obese also often face biases from health care providers and are at an increased risk of suffering from depression and anxiety. An article published in JAMA in 2019 identified pervasive weight bias among medical and health care providers as a serious problem with potentially fatal consequences. Encountering weight bias in health care settings has been shown to have detrimental effects on overweight and obese patients, who may find unhealthy habits harder to break and treatment plans harder to follow. When people with obesity visit a doctor, they are often advised to lose weight and exercise regardless of the complaint that brought them in for a visit. In some instances, this common practice of focusing primarily on weight loss has prevented patients from receiving accurate diagnoses of life-threatening conditions. As evidenced in the JAMA article, medical professionals and educators are beginning to consider weight bias and stigma as barriers to effective clinical practice.

In addition to bias in health care, many obese people experience employment discrimination and encounter weight bias that limits their earning potential. Discrimination in the hiring process results in obese people losing career opportunities and experiencing longer periods of unemployment between jobs. In the workplace, weight discrimination can result in lower wages for obese and overweight workers, particularly women. An analysis by researchers at the University of Florida and the London Business School estimated that, compared to the annual incomes of women of average weight, the incomes of women who were obese or overweight were lower and the incomes of women who were perceived as thin were higher. While Massachusetts state lawmakers considered a bill in 2019 to prohibit employment discrimination on the basis of height and weight, Michigan remains the only state that explicitly prohibits weight discrimination by law.

Critical Thinking Questions

Critical Thinking Questions

What is body shaming, and what is its impact on people who are overweight or obese? Do you think body mass index (BMI) is an adequate tool for assessing people’s health? Why or why not? In your opinion, what could schools, workplaces, and other organizations do to address the problem of weight discrimination? Explain your answer.

Weight Loss Medications and Bariatric Surgery

Weight-loss surgery or medication can assist some people with obesity who wish to lose weight but are not able to do so effectively through diet and exercise alone. Physicians caution, however, that both surgical and pharmaceutical weight-loss interventions carry significant side effects and can lead to adverse events. A landmark example is the once-popular diet medication fen-phen, short for fenfluramine/phentermine, which was linked heart-valve disease and pulmonary hypertension and pulled off the market in 1997. Some weight-loss medications approved by the Federal Drug Administration (FDA) have particularly bothersome or dangerous side effects such as loose stools following high-fat meals, birth defects, and increased suicidality. Health care professionals increasingly believe that weight loss cannot be accomplished by medication alone, and they urge patients to follow instructions precisely and remain in regular contact with their doctors.

Weight loss, or bariatric, surgery has become increasingly popular in the United States, with about 228,000 procedures performed in 2017, up from an average of sixteen thousand performed annually in the early 1990s, according to the American Society for Metabolic and Bariatric Surgery. One of the most well-known forms of bariatric surgery is gastric bypass surgery, where a portion of the stomach is sectioned off into a small pouch and reconnected to the lower part of the small intestine to reduce the amount of food absorbed by the body. After surgery, the patient’s stomach is so small that it can hold only a few ounces of food or liquid at a time. Candidates for gastric bypass must make significant lifestyle changes regarding diet and physical activity both before and after the surgery, and those who do typically lose between 65 and 70 percent of their excess weight in the first year following surgery. Recovering from bariatric surgery, however, can be difficult and painful. Patients must follow strict guidelines to ensure they receive proper nutrients and hydration, and even moderate overeating can cause severe pain and nausea. Other forms of bariatric surgeries, including laparoscopic gastric band surgery and sleeve gastrectomy, also require significant lifestyle and diet changes.

Full Text: COPYRIGHT 2019 Gale, a Cengage Company Source Citation (MLA 8th Edition) “Obesity.” Gale Opposing Viewpoints Online Collection, Gale, 2019. Gale In Context: Opposing Viewpoints, https://link-gale-

com.ezproxy.snhu.edu/apps/doc/PC3010999129/OVIC?u=nhc_main&sid=OVIC&xid=cab06343. Accessed 12 Jan. 2020. Gale Document Number: GALE|PC3010999129

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