Obesity

Causes and Complications

Causes

Obesity is considered a complex and chronic disease with many causes. It is not simply a result of overeating. Research has shown that genetics often play a significant role in determining a person's body weight, particularly for morbidly obese people.

In addition to genetics, factors such as the environment, metabolism, eating disorders and certain medical conditions may contribute to obesity.

Genetics

Research has shown that a person's genes play an important role in their tendency to gain weight. Just as some genes determine eye color or height, others affect appetite, ability to feel full or satisfied, metabolism, fat-storing ability and even natural activity levels.

Environment

Environmental and genetic factors are closely intertwined. If you have a genetic predisposition towards obesity, the modern American lifestyle and environment may make controlling weight more difficult.

Fast food, long days sitting at a desk and suburban neighborhoods that require cars exacerbate hereditary factors such as metabolism and efficient fat storage. For those suffering from morbid obesity, anything less than a total change in environment usually results in failure to reach and maintain a healthy body weight.

Metabolism

We used to think that a person could lose weight if they burned more calories than they consumed. Now we know that for some people, it's not that simple.

Obesity researchers now refer to a theory called the "set point," a sort of thermostat in the brain that makes people resistant to either weight gain or loss. If you try to override the set point by drastically cutting your calorie intake, your brain responds by lowering metabolism and slowing activity. You then gain back any weight you lost.

Complications

Being obese significantly increases your chance of developing chronic, life-threatening diseases. These include:

• Depression -- Depression is very common after repeated failure with dieting and disapproval from family, friends and the public.

• Diabetes -- Obese individuals develop a resistance to insulin, which regulates blood sugar levels. Over time, high blood sugar can cause type 2 diabetes that can lead to serious damage to the body.

• Gastroesophageal Reflux or Heartburn -- When acid escapes from the stomach into the esophagus through a weak or overloaded valve, gastroesophageal reflux can occur, causing "heartburn" and acid indigestion. Gastroesophageal reflux disease can lead to Barrett's esophagus, a pre-cancerous change in the lining of the esophagus and a cause of esophageal cancer.

• High Blood Pressure and Heart Disease -- Excess body weight strains the heart. This may lead to high blood pressure, which can cause strokes as well as heart and kidney damage.

• Incontinence -- In obese people, a large, heavy abdomen may cause the valve on the urinary bladder to weaken, leading to urinary stress incontinence or the leakage of urine with coughing, sneezing or laughing.

• Infertility -- Obese women may experience infertility -- an inability or diminished ability to become pregnant.

• Menstrual Irregularities -- Morbidly obese women may experience disruptions of menstrual cycles as well as abnormal flow and increased pain.

• Osteoarthritis -- The weight placed on joints, particularly knees and hips, results in rapid wear and tear of joints as well as pain caused by inflammation, called osteoarthritis . Excess weight puts a strain on bones and muscles of the back, which can cause disk problems, pain and decreased mobility.

• Sleep Apnea and Respiratory Problems -- Fat deposits in the tongue and neck can cause intermittent obstruction of your air passage, called sleep apnea . Because the obstruction is more severe when sleeping on your back, you may wake frequently to reposition yourself. Loss of sleep often causes drowsiness and headaches.

Diagnosis

During your initial visit at the Weight Management Program, you will meet with a doctor who will carefully assess your total body fat to determine whether you are overweight or obese.

The body mass index (BMI) tool is the medical standard for defining obesity. Body mass index (BMI) is a number based on both your height and weight that can help evaluate the degree to which you are overweight and assess your total body fat.

A formula is used to calculate an adult's BMI:

Normal BMI is 20 to 25. Generally, men with more than 25 percent body fat and women with more than 30 percent body fat are considered obese. Use our Body Mass Index Tool to check your BMI.

Doctors also use weight-for-height tables, which chart acceptable healthy weights for a person of a given height.

Treatment

Our experts work with each patient to develop a customized weight loss and management plan, which depends on a variety of factors, including your level of obesity, age, overall health condition, commitment and motivation to lose weight. Our goal is to help you adapt and maintain a healthy lifestyle, thus greatly improving your health and quality of life.

Treatment may include a combination of exercise, healthful food patterns and cognitive behavioral therapy, as well as support groups and educational lectures to promote long-term weight loss and management. Research has shown that combining different weight loss and management approaches significantly increases a person's long-term weight management success. We also offer bariatric surgery as a treatment for people who are morbidly obese.

Weight Management Plans:

We offer weight management plans that can be customized to fit your individual needs. These include:

• Step-By-Step Program: This is a comprehensive one-year weight loss program that emphasizes aerobic exercise, healthful food patterns and cognitive behavioral therapy to promote long-term weight loss and management.

• Meal Replacement Program: This is a one-year medically supervised rapid weight loss program utilizing a very low calorie diet comprised of meal replacement bars and shakes. The program also emphasizes regular aerobic exercise, healthful food patterns and cognitive behavioral therapy for long-term weight loss and management.

• Individual Consultations: We offer individual consultations and assessments of nutritional intake, energy balance and lifestyle and/or psychological factors that influence health and weight. Counseling and diet and activity plans are individually tailored to meet patients' goals and everyday realities.

Payment

Payment for the Weight Management Program depends on your health insurance coverage. Call your health insurance company for coverage information and the required referral process. Sessions not covered by insurance plans must be paid in full by the patient.

• Brown & Toland patients require authorization from their regular medical doctor for the UCSF Weight Management Program, provider Dr. Robert Baron, director of the program.

• Medicare patients who have type 2 diabetes or renal failure are covered by their insurance for nutrition sessions with a referral from their medical doctor.