Overview

Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through typical daily activities and exercise. Your body stores these excess calories as fat.

In the United States, most people’s diets are too high in calories — often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

Many people who live in Western countries now have jobs that are much less physically demanding, so they don’t tend to burn as many calories at work. Even daily activities use fewer calories, courtesy of conveniences such as remote controls, escalators, online shopping, and drive-through restaurants and banks.

Risk Factors

Obesity often results from a combination of causes and contributing factors:

  • Family inheritance and influences: The genes you inherit from your parents may affect the amount of body fat you store, and where that fat is distributed. Genetics also may play a role in how efficiently your body converts food into energy, how your body regulates your appetite and how your body burns calories during exercise. Obesity tends to run in families. That’s not just because of the genes they share. Family members also tend to share similar eating and activity habits.
  • Lifestyle choices:
    • Unhealthy diet. A diet that’s high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain.
    • Liquid calories. People can drink many calories without feeling full, especially calories from alcohol. Other high-calorie beverages, such as sugared soft drinks, can contribute to weight gain.
    • Inactivity. If you have an inactive lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Looking at computer, tablet and phone screens is inactivity. The number of hours spent in front of a screen is highly associated with weight gain.
  • Certain diseases and medications: In some people, obesity can be traced to a medical cause, such as hypothyroidism, Cushing syndrome, Prader-Willi syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain. Some medicines can lead to weight gain if you don’t compensate through diet or activity. These medicines include steroids, some antidepressants, anti-seizure medicines, diabetes medicines, antipsychotic medicines and certain beta blockers.
  • Social and economic issues: Social and economic factors are linked to obesity. It’s hard to avoid obesity if you don’t have safe areas to walk or exercise. You may not have learned healthy ways of cooking. Or you may not have access to healthier foods. Also, the people you spend time with may influence your weight. You’re more likely to develop obesity if you have friends or relatives with obesity.
  • Age: Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. The amount of muscle in your body also tends to decrease with age. Lower muscle mass often leads to a decrease in metabolism. These changes also reduce calorie needs and can make it harder to keep off excess weight. If you don’t consciously control what you eat and become more physically active as you age, you’ll likely gain weight.
  • Other factors:
    • Pregnancy. Weight gain is common during pregnancy. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
    • Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain to qualify as obesity. Often, this happens as people use food to cope with smoking withdrawal. But overall, quitting smoking is still a greater benefit to your health than is continuing to smoke. Your health care team can help you prevent weight gain after quitting smoking.
    • Lack of sleep. Not getting enough sleep can cause changes in hormones that increase appetite. So can getting too much sleep. You also may crave foods high in calories and carbohydrates, which can contribute to weight gain.
    • Stress. Many external factors that affect mood and well-being may contribute to obesity. People often seek more high-calorie food during stressful situations.
    • Microbiome. The make-up of your gut bacteria is affected by what you eat and may contribute to weight gain or trouble losing weight.

Even if you have one or more of these risk factors, it doesn’t mean that you’re destined to develop obesity. You can counteract most risk factors through diet, physical activity and exercise. Behavior changes, medicines and procedures for obesity also can help.

Complications

People with obesity are more likely to develop a number of potentially serious health problems, including:

  • Heart disease and strokes: Obesity makes you more likely to have high blood pressure and unhealthy cholesterol levels, which are risk factors for heart disease and strokes.
  • Type 2 diabetes: Obesity can affect the way the body uses insulin to control blood sugar levels. This raises the risk of insulin resistance and diabetes.
  • Certain cancers: Obesity may increase the risk of cancer of the uterus, cervix, endometrium, ovary, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate.
  • Digestive problems: Obesity increases the likelihood of developing heartburn, gallbladder disease and liver problems.
  • Sleep apnea: People with obesity are more likely to have sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts during sleep.
  • Osteoarthritis: Obesity increases the stress placed on weight-bearing joints. It also promotes inflammation, which includes swelling, pain and a feeling of heat within the body. These factors may lead to complications such as osteoarthritis.
  • Fatty liver disease: Obesity increases the risk of fatty liver disease, a condition that happens due to excessive fat deposit in the liver. In some cases, this can lead to serious liver damage, known as liver cirrhosis.
  • Severe COVID-19 symptoms: Obesity increases the risk of developing severe symptoms if you become infected with the virus that causes coronavirus disease 2019, known as COVID-19. People who have severe cases of COVID-19 may need treatment in intensive care units or even mechanical assistance to breathe.

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Diagnosis

To diagnose obesity, your health care professional may perform a physical exam and recommend some tests.

These exams and tests often include:

  • Taking your health history. Your health care team may review your weight history, weight-loss efforts, physical activity and exercise habits. You also may talk about your eating patterns and appetite control. Your health care professional may ask about other conditions you’ve had, medicines you take, your stress levels and other issues about your health. They may also review your family’s health history to see if you may be more likely to have certain conditions.
  • A general physical exam. This includes measuring your height; checking vital signs, such as heart rate, blood pressure, and temperature; listening to your heart and lungs; and examining your abdomen.
  • Calculating your BMI. Your health care professional checks your body mass index, called BMI. A BMI of 30 or higher is considered obesity. Numbers higher than 30 increase health risks even more. Have your BMI checked at least once a year. This can help pinpoint your overall health risks and what treatments may be right for you.
  • Measuring your waist size. The distance around your waist is known as the circumference. Fat stored around the waist, sometimes called visceral fat or abdominal fat, may further increase the risk of heart disease and diabetes. Women with a waist that measures more than 35 inches (89 centimeters) and men with a waist that’s more than 40 inches (102 centimeters) around may have more health risks than do people with smaller waist measurements. Like the BMI measurement, waist circumference should be checked at least once a year.
  • Checking for other health problems. If you have known health problems, your health care team will evaluate them. Your health care professional also will check for other possible health problems, such as high blood pressure, high cholesterol, underactive thyroid, liver problems, and diabetes.

Gathering this information will help you and your health care team choose the type of treatment that will work best for you.

Treatment

The goal of obesity treatment is to reach and stay at a healthy weight. This improves overall health and lowers the risk of developing complications related to obesity.

You may need to work with a team of health professionals — including a dietitian, behavioral counselor, or an obesity specialist — to help you understand and make changes in your eating and activity habits.

The first treatment goal is usually a modest weight loss — 5% to 10% of your total weight. That means that if you weigh 200 pounds (91 kilograms), you’d need to lose only about 10 to 20 pounds (4.5 to 9 kilograms) for your health to begin to improve. But the more weight you lose, the greater the benefits.

All weight-loss programs require that you change your eating habits and get more active. The treatment methods that are right for you depend on your weight, your overall health, and your willingness to participate in a weight-loss plan.

Dietary changes

Reducing calories and practicing healthier eating habits are key to overcoming obesity. Although you may lose weight quickly at first, steady weight loss over the long term is considered the safest way to lose weight. It’s also the best way to keep weight off permanently.

There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include:

  • Cutting calories. The key to weight loss is reducing how many calories you take in. The first step is to review your typical eating and drinking habits. You can see how many calories you usually consume and where you can cut back. You and your health care professional can decide how many calories you need to take in each day to lose weight. A typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men.
  • Feeling full on less. Some foods — such as desserts, candies, fats, and processed foods — contain a lot of calories for a small portion. In contrast, fruits and vegetables provide a larger portion size with fewer calories. By eating larger portions of foods that have fewer calories, you can reduce hunger pangs and take in fewer calories. You also may feel better about your meal, which contributes to how satisfied you feel overall.
  • Making healthier choices. To make your overall diet healthier, eat more plant-based foods. These include fruits, vegetables, and whole grains. Also emphasize lean sources of protein — such as beans, lentils, and soy — and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as olive, canola, and nut oils.
  • Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods. Ask your health care professional which diet plans are effective and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume more calories than you intended. Limiting these drinks or eliminating them altogether is a good place to start cutting calories.
  • Meal replacements. These plans suggest replacing one or two meals each day with their products — such as low-calorie shakes or meal bars — and eating healthy snacks. Then you have a healthy, balanced third meal that’s low in fat and calories. In the short term, this type of diet can help you lose weight. But these diets likely won’t teach you how to change your overall lifestyle. So you may have to stay on the diet if you want to keep your weight off.

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