What is obesity?

Obesity is an ongoing disease, not a cosmetic problem. It means that you have excess body fat that is putting your health at risk.

Having too much body fat affects you in many ways. It influences how you look and feel. But it also is linked to many health problems, including type 2 diabetes, heart disease, high blood pressure, arthritis, sleep apnea, and stroke.

Although obesity is a complicated disease, there are many ways to treat it. Work with your doctor and other health professionals to find a treatment plan that works best for you.

How do I know if I am obese?

People who have a body mass index (BMI) of 30 or higher are considered obese. The body mass index compares your height and weight. Along with your waist size, it is used to check whether your weight increases your risk for disease. The higher your BMI is, the greater your risk for disease is.

Use this interactive tool to check your body mass index:

Interactive Tool: Weight and Health Risks

Where you carry your body fat may be as important as how many extra pounds you have. People who carry too much fat around the middle, rather than the hips, are more likely to have weight-related health problems. In women, a waist size of 35 or more inches increases the chance for disease. In men, a waist size of 40 inches or more increases risk. 1

What causes obesity?

When you take in more calories than you burn off, you gain weight. How you eat, how active you are, and other things affect how your body uses calories and whether you gain weight.

Family: If your family members are obese, you may have a genetic tendency to gain weight. But genetics alone do not determine your weight. Your family also influences diet and lifestyle habits that can lead to obesity.

Environment: Our busy lifestyles make it harder to plan and cook nutritious meals. It is easier to reach for prepared foods, go out to eat, or go to the drive-through. But these foods are often high-fat and high-calorie. Portion sizes are often too large. One fast-food or restaurant meal can contain all of the calories you need for an entire day. And work schedules, long commutes, and other commitments cut into the time people can schedule for physical activity.

I've tried diets, but I always gain the weight back. What can I do?

Most people regain weight when they stop dieting and return to how they ate before. After many cycles of this, it is easy to become frustrated and to give up and maybe even turn to food for emotional comfort.

Diets are hard to maintain and are often counterproductive. Extremely low-calorie diets and restrictive eating patterns are very hard to stick with for a long time. Without making permanent lifestyle changes to achieve the right balance of calories and activity, most people cannot keep weight off. The key is to make balanced and realistic choices that work for you.

Make a plan for change. Work with your doctor to develop a reasonable plan for change. Ask family members and friends for help in sticking with your plan.

Ask your doctor to recommend a dietitian to help with meal planning and ideas for finding filling, low-calorie foods that you enjoy. For more information, see the topic Healthy Eating.

Do not focus on a particular diet; focus on lifestyle changes to improve your health and achieve the right balance of energy and calories. To lose weight, you need to consistently burn more calories than you take in.

Research shows that people who keep track of what they eat and drink each day are more successful at losing weight. Start a food journal, and record everything you eat and drink. Pay attention to portion sizes, and use a calorie counter to check calories. You can find a calorie counter at a bookstore or online (see http://www.caloriecontrol.org, http://www.nutritiondata.com, or http://www.calorieking.com). People often convince themselves that they don't overeat. Documenting your daily food intake can be eye-opening.

As you keep track of calories, look at whether you skip meals, when you eat, how often you eat out, and how many fruits and vegetables you eat. This will help you identify patterns that you may want to change.

You may want to write down the amount of physical activity you've had each day and compare the calories you've burned to those you've taken in. Use this interactive tool to see how many calories you burn through daily activities and exercise.

Interactive Tool: Calories Burned

Focus on health, not diets. A lifestyle of healthy eating and regular physical activity will improve your health and quality of life, no matter what you weigh. For more information, see the topic Healthy Weight.

How can I stick with all the changes?

Losing weight and maintaining your new healthier weight is hard. Moving from a lifestyle that has led to obesity to one that promotes weight loss and better health can seem monumental. To make such significant changes in your life, you have to be ready. Make sure this is the right time for you. Are you ready to make a plan and stick to it? Do you have the support of your family and friends? Have you talked with your doctor, and do you know what your first steps will be?

If you are ready, start by making small changes one step at a time. Anything you can do today that was healthier than yesterday is a step in the right direction. Don't expect immediate results, and try not to get discouraged.

Base your success on setting and meeting small daily goals. Eat an extra piece of fruit, walk 10 minutes more, or add more vegetables to meals.

Think about a time that you were successful in making a change, and remember what motivated you. Try to draw on a similar motivation. Experiencing success, no matter how small, is important. And each time you meet one of your goals, set another one.

Can I take medicines or have surgery?

Because the causes of obesity are complex, there is no single cure or quick fix. Neither surgery nor medicines alone will work. For most people, a significant lifestyle change is also needed.

Before your doctor will prescribe medicines or surgery for weight loss, he or she will probably want you to work on diet and lifestyle changes for at least 6 months. Even if your doctor gives you medicines or recommends surgery, you will need to stick with these changes permanently.

  • Medicines: The medicines used most often for obesity work in two ways. Sibutramine (Meridia) works on the part of your brain that makes you feel full after a meal. Taking this medicine should make you feel fuller sooner. Orlistat (Xenical) blocks some of the fat that the body absorbs from food.
  • Surgery: Your doctor may recommend surgery if your BMI is 40 or above or if it is 35 or above and you have diabetes or another serious weight-related problem. Surgery has risks, is expensive, and may not be covered by insurance. However, for some severely obese people, it can be a lifesaving option and a very effective way to lose weight.

Even if you have surgery, you will need to make lifestyle changes, especially in how you eat. Surgery makes your stomach smaller and forces you to eat less.

Because you can only eat very small amounts of food after surgery, you may have problems getting enough nutrients from food. You will need to work with your doctor or a dietitian to avoid nutrition problems.