Women, Obesity and Weight Loss

How many people in the United States are overweight or obese?

Among U.S. women 20 years and older, over 64 million are overweight and over 34 million are obese.

How do I know if I’m overweight or obese?

Obesity is measured with a body mass index (BMI), a measure of body fat based on height and weight. Individuals with a BMI of 25 to 29.9 are considered overweight, while individuals with a BMI of 30 or more are considered obese.

Body Mass Index

You can find out your BMI using the calculator at www.nhlbisupport.com/bmi, or the chart at http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm.

What causes someone to become overweight or obese?

An unhealthy diet and physical inactivity are contributing factors to becoming overweight or obese. Overweight and obesity are problems that continue to get worse in the United States. Bigger portion sizes, little time to exercise or cook healthy meals, and relying on cars to get around are just a few reasons for this increase.

What are the health effects of being overweight or obese?

An unhealthy diet and physical inactivity can increase your chances of getting heart disease, cancer, stroke, type 2 diabetes, high blood pressure, breathing problems, arthritis, gallbladder disease, and osteoarthritis.

But body weight isn’t the only problem. The places where you store your body fat also affect your health. Women with a “pear” shape tend to store fat in their hips and buttocks. Women with an “apple” shape store fat around their waists.

For most women, carrying extra weight around their waists (larger than 35 inches) raises health risks like heart disease, diabetes, or cancer more than carrying extra weight around the hips or thighs. Obesity can also affect medical care. Too much fat can obscure imaging tests, like X-rays, CT scans, ultrasound, and magnetic resonance imaging (MRI). For example, in an ultrasound, the beam may not be able get through layers of fat to get an image of a person’s appendix, gallbladder, or kidneys. Too much body fat can make it harder for a doctor to make a medical diagnosis and treat a patient.

How do I find out what the best way is for me to lose weight?

Experts agree that the best way to lose weight is to follow a sensible eating plan and engage in regular physical activity. If you’re interested in a weight-loss program, it should encourage healthy behaviors that help you lose weight that you can maintain over time. Before you start a weight-loss program, talk to your doctor.

Safe and effective weight-loss programs should include these components:

• Healthy eating plans that reduce calories but do not rule out specific foods or food groups
• Regular physical activity and/or exercise instruction
• Tips on healthy behavior changes that also consider your cultural needs
• Slow and steady weight loss of about ¾ to 2 pounds per week and not more than 3 pounds per week (weight loss may be faster at the start of a program)
• Medical care if you are planning to lose weight by following a special formula diet, such as a very-low-calorie diet
• A plan to keep the weight off after you have lost it

What steps can I take to have a healthier diet?

Follow these tips on healthy eating:

Focus on fruits. Eat a variety of fruits – whether fresh, frozen, canned, or dried – rather than fruit juice for most of your fruit choices. For a 2,000-calorie diet, you will need 2 cups of fruit each day – like 1 small banana, 1 large orange, and 1/4 cup of dried apricots or peaches.

Vary your veggies. Eat more dark green veggies, such as broccoli, kale, and other dark leafy greens; orange veggies, such as carrots, sweet potatoes, pumpkin, and winter squash; and beans and peas, such as pinto beans, kidney beans, black beans, garbanzo beans, split peas, and lentils.

Get your calcium-rich foods. Get 3 cups of low-fat or fat-free milk – or an equivalent amount of low-fat yogurt and/or low-fat cheese (11/2 ounces of cheese equals 1 cup of milk) – every day. If you don’t or can’t consume milk, choose lactose-free milk products and/or calcium-fortified foods and drinks.

Make half your grains whole. Eat at least 3 ounces of whole-grain cereals, breads, crackers, rice, or pasta every day. One ounce is about 1 slice of bread, 1 cup of breakfast cereal, or 1/2 cup of cooked rice or pasta. Look to see that grains such as wheat, rice, oats, or corn are referred to as “whole” in the list of ingredients.

Go lean with protein. Choose lean meats and poultry. Bake it, broil it, or grill it. Vary your protein choices with more fish, beans, peas, nuts, and seeds.

Limit saturated fats. Get less than 10 percent of calories from saturated fatty acids. Most fats should come from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free.

Limit salt. Get less than 2,300 mg of sodium (approximately 1 teaspoon of salt) each day.

How can physical activity help?

An active lifestyle can help every woman. You don’t have to be as fit as a professional athlete to benefit from physical activity. In fact, 30 minutes of moderate physical activity on most days of the week can greatly improve your health. Most people can get greater health benefits by engaging in physical activity of more vigorous intensity or longer duration. To help manage body weight and prevent gradual, unhealthy body weight gain, get about 60 minutes of moderate- to vigorous-intensity activity on most days of the week, while not exceeding caloric intake requirements. To keep weight loss off, get at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with their doctor before participating in this level of activity. Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance.

Physical activity has these benefits:

• reduces your risk of dying from heart disease or stroke
• lowers your risk of getting heart disease, stroke, high blood pressure, colon cancer, and diabetes
• lowers high blood pressure
• helps keep your bones, muscles, and joints healthy
• reduces anxiety and depression and improves your mood
• helps you handle stress and helps control your weight
• protects against falling and bone fractures in older adults
• may help protect against breast cancer
• helps control joint swelling and pain from arthritis
• helps you feel more energetic and helps you sleep better

Increase your physical activity by taking small steps to change what you do everyday!

If you normally:

• let the dog out back, take the dog for a walk instead
• park as close as possible to the store, park farther away
• take the elevator, take the stairs
• have lunch delivered, walk to pick up lunch
• relax while the kids play, get involved in their activity

What USDA-approved drugs are available for long-term treatment of obesity?

Sibutramine. Also called Meridia, it is used together with a reduced-calorie diet to help you lose weight and keep the lost weight from returning. This medicine is approved for people whose initial body mass index (BMI) is at least 30. Patients with other risk factors, such as high blood pressure or diabetes, can be treated with the drug if their BMI is 27 or higher. It can cause an increase in pulse and blood pressure. While you are taking sibutramine, your doctor will check your blood pressure and heart rate at regular visits. People with uncontrolled high blood pressure should not take sibutramine. Other side effects include dry mouth, headache, constipation, insomnia, anxiety, irritability or unusual impatience, nervousness, stuffy or runny nose, or trouble in sleeping.

Orlistat. Also called Xenical, it prevents the body from absorbing some of the fat in food. It also prevents the body from absorbing some vitamins and beta carotene. Patients should take a vitamin supplement that contains fat soluble (A, D, E, and K) vitamins and beta carotene. The most common side effects of orlistat are gas with discharge, fecal urgency, fatty/oily stools, and frequent bowel movements.

What surgical options are available for weight loss?

Vertical banded gastroplasty (VBG). Surgical staples are used to divide the stomach into two parts. The upper part is small, which limits space for food. Food empties from the upper pouch into the lower pouch through a small opening. A band is put around this opening so it doesn’t stretch. Risks of VBG include wearing away of the band and breakdown of the staple line. In a small number of cases, stomach juices may leak into the abdomen or infection or death from complications may occur.

Laparoscopic gastric banding (Lap-Band). An inflatable band is placed around the upper stomach to create a small pouch and narrow passage into the remainder of the stomach. This limits food consumption and creates an earlier feeling of fullness. Once the band is in place, it is inflated with saline. The band is adjusted over time by increasing or decreasing the amount of salt solution to change the size of the passage. The band is intended for severely obese people — those at least 100 pounds overweight or who are at least twice their ideal body weight — who have failed to lose weight by other methods such as a supervised diet and exercise. The band is intended to remain in place permanently, but it can be removed if necessary. People who get the band will need to diet and exercise in order to maintain their weight loss. Complications may include nausea and vomiting, heartburn, abdominal pain, band slippage, or pouch enlargement.

Roux-en-Y gastric bypass (RGB). The surgeon makes the stomach smaller by using surgical staples to create a small stomach pouch. The pouch is attached to the middle part of a small intestine. Food bypasses the upper part of the small intestine and stomach and goes into the middle part of the small intestine through a small opening. Bypassing the stomach limits the amount of food a person can eat. By bypassing part of the intestine, the amount of calories and nutrients the body absorbs is reduced. The small opening slows down the rate food leaves the pouch. One risk for patients is "dumping syndrome." This happens when the stomach contents move too rapidly through the small intestine. Symptoms may include nausea, weakness, sweating, faintness, and diarrhea after eating. Side effects include infection, leaking, pulmonary embolism (sudden blockage in a lung artery), gallstones, and nutritional deficiency.

Biliopancreatic diversion (BPD). This procedure is not commonly used in the United States. A large part of the stomach is removed. The amount of food is restricted, in addition to stomach acid production. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing other parts of the small intestine. A common channel remains in which bile and pancreatic digestive juices mix prior to entering the colon. Weight loss occurs since most of the calories and nutrients are routed into the colon where they are not absorbed. This procedure is less frequently used than other types of surgery because of the high risk for nutritional deficiencies. A variation of BPD includes a "duodenal switch," which leaves a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine. It also keeps a small part of the duodenum.

Is liposuction a treatment for weight loss?

Liposuction is a procedure for shaping the body and is not recommended for weight loss. It is a surgical procedure in which fat is removed from under the skin with the use of a vacuum-suction canula (a hollow pen-like instrument) or using an ultrasonic probe that breaks up the fat into small pieces and then removes it with suction. Persons with localized fat may decide to have liposuction to remove fat from that area. It doesn’t guarantee permanent weight loss. To avoid weight gain after liposuction, people need to eat right and be physically active. Complications from liposuction may include infection, embolism (fat gets trapped in the blood vessels, gathers in the lungs, or travels to the brain), puncturing of organs, seroma, pain or numbness, swelling, burns, skin problems, and reactions to the anesthesia.

I am concerned about my children’s eating and exercise habits. How can I keep my children healthy?

The things kids learn as children become more difficult to change as they get older. This is certainly true for their eating and physical activity habits. Many children today have a poor diet with little physical activity. They eat foods high in calories and saturated fat and don’t eat enough fruits and vegetables. They watch TV, play video games, or use the computer instead of being active. So kids are becoming overweight or obese and have a higher chance of becoming obese adults. Overweight children face health risks, like diabetes, gallstones, sleep apnea, and high blood pressure.

Help your child become more active:

• Set limits on the amount of time the family watches TV, plays video games, and uses the computer.
• Encourage your children to get one hour of physical activity every day.
• Find out about activity programs in your community.
• Ask your children what they like to do and what they’d like to try, like Little League Baseball or swim team.
• Create family activities that involve physical activity, like hiking, walking, or playing ball.
• Help your children eat right.
• Have your children plan and cook healthy meals with you.
• Don’t do other things while you eat, like watch TV.
• Give your kids healthy snacks, like fruits, whole-grain crackers, and vegetables.
• Limit your trips to fast-food restaurants.
• Involve the whole family in healthy eating. Don’t single out your children by their weight.
• We know children do what they see — not always what they are told. Set a good example for your children. Your kids will learn to eat right and be active by watching you. Setting a good example can mean a lifetime of good habits for you and your kids.

For more information

You can find out more about obesity and weight loss by contacting the National Women's Health Information Center (NWHIC) at (800) 994-WOMAN or the following organizations:

Agency for Healthcare Research and Quality (AHRQ), OPHS, HHS
Phone: (301) 594-1364
Internet Address: http://www.ahrq.gov

Federal Trade Commission (FTC)
Phone: (202) 326-2222
Internet Address: http://www.ftc.gov

Food and Drug Administration (FDA), HHS
Phone: (888) 463-6332 (Consumer Information)
Internet Address: http://www.fda.gov

Food and Nutrition Information Center, USDA
Phone: (301) 504-5414
Internet Address: http://www.nutrition.gov

HealthFinder.gov
http://healthfinder.gov/

National Heart, Lung, and Blood Institute Information Center (NHLBI) NIH, HHS
Phone: (301) 592-8573
Internet Address: http://www.nhlbi.nih.gov

The President’s Council on Physical Fitness and Sports
Phone: (202) 690-9000
Internet Address: http://www.fitness.gov

Weight Control Information Network, NIDDK, NIH, HHS
Phone: (877) 946-4627
Internet Address: http://win.niddk.nih.gov

American Heart Association
Phone: (800) 793-2665
Internet Address: http://www.americanheart.org

American Obesity Association
Phone: (800) 98-OBESE
Internet Address: http://www.obesity.org

International Food Information Council
Phone: (202) 296-6540
Internet Address: http://www.ific.org

Produced by
Office on Women's Health
US Department of Health and Human Services
February 2005