Obesity

Obesity is excess body fat. Approximately 33 percent of Americans 20 to 75 years of age are overweight and of these approximately one third are severely obese.

Signs and Symptoms

A person whose BMI is greater than 30 (your weight in kilograms divided by the square of your height in meters).

What Causes It?

Being overweight usually reflects a poor diet poor eating habits and a lack of exercise. Genetics may also play a role. There are a number of rare syndromes that cause obesity. The following factors can put you at risk.

• Other family members are obese
• Overeating or a high-fat diet
• Little or no physical activity
• Some prescription medications
• Psychological factors (such as death of a loved one)

What to Expect at Your Provider's Office

Your health care provider will give you a thorough physical examination and will take blood samples to measure blood sugar and cholesterol levels. He or she will also check your blood pressure.

Treatment Options

Treatment Plan

Lifestyle changes such as eating better and exercising more are essential. Your health care provider will treat any underlying disease that may be occurring with your obesity. Your provider also may suggest you take a drug to help you lose weight. However no drug is safe or effective for long-term use. Surgery for severe obesity includes gastric bypass and stapling or liposuction to redistribute some of the fat.

Drug Therapies

Prescription

• Diuretics—for temporary use to reduce water retention; do not reduce stores of fatty tissue

Over the Counter

• Ephedrine plus caffeine—increases your metabolism helping you to lose weight; do not use if you have high blood pressure heart or thyroid disease diabetes or an enlarged prostate

Complementary and Alternative Therapies

Alternative therapies can help stabilize blood sugars promote a customize-tailored exercise plan and treat emotional well-being. Mind/body techniques can be helpful.

Nutrition

• Protein: You may do better with a high protein low carbohydrate diet.
• Fluid: 6 to 8 glasses daily of nonsugared caffeine-free drinks.
• Fiber: increasing dietary fiber (for example fruits and vegetables)promotes weight loss.
• Allergies: Many people find that avoiding allergenic foods (wheat dairy soy peanuts eggs and citrus) improves digestion.
• Multiple vitamin to address dietary imbalances.
• Chromium picolinate (200 to 500 mcg once or twice per day): increases insulin sensitivity and stabilizes blood sugars.
• Vitamin C (3 000 to 6 000 mg per day): speeds up metabolism and is needed for cholesterol metabolism.
• Essential fatty acids (primrose oil 2 to 4 g per day; flaxseed oil): one study showed reduction in appetite and some weight loss.
• Lecithin choline methionine (1 g per day of each): aids proper fat metabolism and decreases fat cravings.
• Thiamine (2.5 mg per day): plays a role in fatty-acid metabolism and may decrease ketone formation; increased ketones may play a role in hunger; to avoid imbalance supplement with a B-complex: B₁ (50 to 100 mg) B₂ (50 mg) B₃ (25 mg); B₅ (100 mg); B₆ (50 to 100 mg) B₁₂ (100 to 1 000 mcg) folate (400 mcg) per day.
• Kelp (1 000 to 2 000 mg per day equivalent to 250 to 500 mcg of iodine per day): may aid in weight loss because it provides nutrients for thyroid functioning.
• L-glutamine (1 000 mg three times per day): may blunt carbohydrate craving.
• Coenzyme Q10 is important in fatty-acid metabolism may help break down fat into energy.
• 5-Hydroxytryptophan (5-HTP; 100 to 300 mg per day): reduces food intake by making you feel full. It acts as an anti-depressant.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Unless otherwise indicated teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

A combination of four to six of the following herbs can be taken three times per day before meals (1 cup tea or 30 drops tincture):

• Peppermint (Mentha piperita) helps relieve gas relieves spasms historically to reduce appetite
• Bladder wrack (Fucus vesiculosus) historic use in obesity
• Parsley (Petroselinum crispum) diuretic for gastrointestinal needs
• Dandelion (Taraxacum officinale) diuretic dyspepsia
• Hawthorne (Cretaegus oxyacantha) good for blood vessels
• St. John's wort (Hypericum perforatum) antidepressant
• Valerian (Valeriana officinalis) bitter spasmolytic sedative
• Milk thistle (Silybum marianum) dyspepsia for liver and gallbladder
• Lavender (Lavendula officinalis) reduces gas relieves spasms
• Gentian (Gentiana Lutea) reduces gas digestive stimulation

Homeopathy

Homeopathy may be useful as a supportive therapy.

Physical Medicine

Exercise is critical. While 20 minutes of aerobic exercise per day is ideal as little as 10 minutes per day can help stabilize blood sugar and thereby reduce cravings. Gentle exercise (walking yoga swimming biking) can increase cardiovascular health without great stress on joints.

Acupuncture

Acupuncture can be used to help balance the body's metabolism stabilize blood sugar correct digestive disorders control certain eating disorders aid in elimination and relieve stress anxiety and depression.

Massage

May be beneficial. By decreasing stress cortisol is decreased which will help to stabilize blood sugar and prevent or treat diabetes.

Following Up

Your health care provider may also suggest counseling to help you along as you lose weight.

Special Considerations

If you are obese you are at risk for diabetes heart problems and other conditions. Obesity during pregnancy can put you and your baby at risk.

Supporting Research

Balch JF Balch PA. Prescription for Nutritional Healing. 2nd ed. Garden City Park NY: Avery Publishing; 1997:406–412.

Bartram T. Encyclopedia of Herbal Medicine. Dorset England: Grace Publishers; 1995:315.

Blumenthal M ed. The Complete German Commission E Monographs. Boston Mass: Integrative Medicine Communications; 1998:125–126 169–170 179–181.

Branch Jr WT. Office Practice of Medicine. 3rd ed. Philadelphia Pa: WB Saunders; 1994:1053–1065.

Cangiano C Ceci F Cascino A et al. Eating behavior and adherence to dietary prescriptions in obese adult subjects treated with 5-hydroxytryptophan. J Clin Nutr. 1992;56:863–867.

Fauci AS Braunwald E Isselbacher KJ et al. eds. Harrison's Principles of Internal Medicine. 14th ed. New York NY: McGraw-Hill; 1998:454–462.

Gruenwald J Brendler T Jaenicke C et al eds. PDR for Herbal Medicines. Montvale NJ: Medical Economics Company; 1998:779–780 1022–1024 1138–1139.

Mowrey DB. The Scientific Validation of Herbal Medicine. New Canaan Conn: Keats Publishing; 1986:277–282.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin Calif: Prima Publishing; 1998:437–446 680–694.

Nestel PJ et al. Arterial compliance in obese subjects is improved with dietary plant n-3 fatty acid from flaxseed oil despite increased LDL oxidizability. Arterioscler Thromb Vasc Biol. 1997;17:1163–1170.

Uusitupa M. New aspects in the management of obesity: operation and the impact of lipase inhibitors. Curr Opin Lipidol. 1999;10:3–7.

Wyngaarden JB Smith LH Jr Bennett JC. Cecil Textbook of Medicine. 19th ed. Philadelphia Pa: WB Saunders; 1992:1162–1169.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.