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A Label Calls Attention to ObesityBy JANE E. BRODY
Most people know that obesity can result in serious health problems, yet many of us continue to focus on its cosmetic consequences rather than its risks to health.
This distorted view may change now that the American Medical Association has finally labeled obesity a disease, not just a risk factor for other disorders. Last month, the organization recognized that obesity is a verifiable illness that warrants far more attention than physicians, patients and insurers currently give it.
The designation may change how aggressively doctors treat obesity, foster the development of new therapies, and lead to better coverage byinsurers. After all, the price of not treating obesity is now in the stratosphere. Obesity-related health conditions cost the nation more than $150 billion and result in an estimated 300,000 premature deaths each year.
If the population’s weight gain is not soon capped (or better yet, reversed), experts predict that half of adults in America will be obese by 2040. The A.M.A. has said in effect that it is medicine’s responsibility to provide the knowledge and tools needed to curb this runaway epidemic.
On June 19, James Gandolfini, the hefty award-winning actor who portrayed Tony Soprano in “The Sopranos,” died at 51, apparently of a heart attack, while on vacation in Italy. Even if genetics played a role, Mr. Gandolfini’s weight contributed significantly to his risk of sudden cardiac death.
Not a week earlier, a 46-year-old member of my family who weighed over 300 pounds died suddenly of what might have been a heart attack while dozing in front of the television. He had long suffered from sleep apnea (a risk factor for sudden death), high blood pressure and severe gout, all results of his extreme weight.
Fran Saunders, a 62-year-old Brooklynite, is determined to avoid a similar fate. At 4 feet 11 inches tall and 157 pounds, she was clinically obese. She was sent for blood tests when she complained of a vision problem that could have been related to her weight. All her lab readings — total cholesterol, triglycerides, blood sugar — were seriously abnormal. Her doctor said she was a heart attack waiting to happen. But “the bad news was a blessing in disguise,” she told me.
Though she had long been a regular at the gym, she knew it was time to get her diet on a healthier track to lower her cholesterol, her risk of developing diabetes and her chances of dying prematurely.
She now monitors what she eats and how much she exercises with a free cellphone app, My Fitness Pal. Gradual weight loss started almost overnight at a pound or two a week. Although her goal weight is 110 to 115 pounds, her blood test results improved significantly after she lost just seven pounds.
“My doctor told me that every pound I lose lowers my risk,” said Ms. Saunders. “I know it’s possible for some people to be fit and fat, but that wasn’t the case for me, and it was time to stop kidding myself.”
The list of problems obesity can cause should be a call to action for the one-third of American adults who are obese. Heart Disease and Stroke Obesity can raise levels of artery-damaging triglycerides and LDL cholesterol, and lower levels of protective HDL cholesterol. This raises the risk of atherosclerosis tenfold by fostering a buildup of plaque in arteries that feed the heart and brain. The chest pains of angina occur when the heart cannot get enough oxygen-rich blood through plaque-clogged arteries. A piece of plaque can break off at any time and block a narrowed artery, causing a heart attack or stroke.
Obesity also strains the heart and can lead to heart failure — a heart unable to pump the blood necessary to supply the body with adequate oxygen and nutrients.
High Blood Pressure Excess body fat increases the volume of blood the heart must pump to supply all tissues with nutrients and oxygen. This increases the pressure on artery walls, which contributes to heart disease, stroke and kidney failure.
Type 2 Diabetes Obesity impairs the body’s ability to use insulin to maintain normal blood sugar levels. Diabetes, in turn, is a leading cause of heart disease, stroke, kidney disease and blindness. Once a late-in-life disease, Type 2 diabetes now is often seen in overweight children. Even being moderately overweight can lead to insulin resistance, in which the body becomes insensitive to the hormone. The condition can be reversed by weight loss.
Joint Disease The more weight a person carries, the greater the stress on joints and the risk of developing painful, incapacitating osteoarthritis in the knees, hips and lower back. Obesity is a major reason for the sharp rise in costly joint replacements. Excess weight can also cause premature failure of an artificial joint.
Breathing Problems In addition to causing shortness of breath during physical exertion, obesity is the leading cause of obstructive sleep apnea — breathing stops periodically during sleep, followed by an abrupt intake of air and loud snoring. Apnea disrupts sleep and results in daytime drowsiness that can cause accidents.
Cancer People who are obese are at increased risk of developing cancers of the colon, breast, endometrium, esophagus, pancreas, kidney, thyroid and gallbladder. One possible reason: increased amounts of growth factor in obese people may promote tumor development. Metabolic Syndrome One-third of overweight and obese people have a constellation of six factors that seriously raise the risk of cardiovascular disease: abdominal obesity, high blood pressure, high cholesterol, insulin resistance, excessive clotting factors and inflammatory compounds in the bloodstream. Abdominal fat is especially hazardous because it is metabolically active, unlike relatively inert fat on the hips and thighs.
The list of obesity’s hazards goes on: infertility in women, pregnancy problems, gallstones and gout, not to mention emotional disorders, social ostracism and employment discrimination.
The first step toward avoiding all of these is a simple calculation to determine whether you are at risk. The most frequently used measure is body mass index, calculated by dividing weight in kilograms by height in centimeters squared. The National Heart, Lung and Blood Institute, among others, offers a free calculator online. In general, a B.M.I. of 30 or more indicates obesity, but B.M.I. can be misleading if heavy bones and big muscles account for a large portion of someone’s weight.
A simpler measure is a waistline as large as or larger than a person’s hips. Overweight typically starts at a waist of 40 inches for men and 35 inches for women.
The easiest assessment of all? Stand naked in front of a mirror and honestly assess the contribution that fat is making to your body’s composition. It’s not hard to see.