Since the 1960s, the US has seen a significant rise in the obese and extremely obese population. According to the CDC, approximately 50 percent of Americans will be obese by 2030.
Obesity is classified using the body mass index (BMI), a measure of body fat based on height and weight. Under this classification, a BMI of 18-25 is normal, 25-30 is overweight, 30-35 is class I obesity, 35-40 is class II obesity, and a BMI over 40 is class III obesity.
Obesity is expensive; it raises the annual cost of medical care in the US by approximately $316 billion (2010 values). An obese individual will, on average, pay approximately $1,470 more per year for health care than an average-weight person.
Obesity is also costly to one’s health. All-cause mortality increases in individuals with higher BMI. Diseases
associated with obesity are numerous and include, but are not limited to, hypertension, dyslipidemia, diabetes, coronary artery disease, gallbladder disease, gout, reproductive abnormalities, obstructive sleep apnea, nonalcoholic fatty liver disease (which can lead to cirrhosis), stroke and cancers of the breast, uterus, liver, colon, esophagus, pancreas, kidney and prostate.
It is for such reasons that the US Preventative Services Task Force recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults.
The etiology of obesity is multifactorial but may be linked to both genetic and environmental factors. There are some indications that alterations in the gut microbiome may contribute to obesity. The intake of high calorie/high sugar beverages is a significant contributor, as is the US culture of eating on the run. Individuals tend to overeat when eating rapidly, as the stretch receptors in the stomach which are partially responsible for satiety have not had appropriate time to accommodate. Some studies have also shown that when patients are deprived of sleep, have been fasting, or are under stress, they have decreased activity in their prefrontal cortex, the area responsible for inhibition, and tend to crave high sugar, high calorie foods.
MULTIPLE WEIGHT LOSS OPTIONS
The optimum approach to weight loss is through behavioral modification, smarter food choices and better access to healthy, whole foods. In regard to a specific diet, many experts suggest the best diet is one that the individual can adhere to, be it Jenny Craig, Atkins or Weight Watchers. Smarter food choices—such as adding more fruits and vegetables to the diet and consuming fewer processed carbohydrates—will often help reduce caloric intake.
There are other options—such as pharmacotherapy and bariatric surgery—for patients who fail conventional weight loss. The FDA has approved several medications for weight loss, but they can have significant side effects. Patients with a BMI higher than 40 or those with a BMI higher than 35 who have significant comorbidities are candidates for bariatric surgery. The International Diabetes Federation has recommended consideration of bariatric surgery for patients with a BMI of 30–35 if traditional medical management is unable to achieve adequate diabetic control.
Bariatric surgery rates in the US have increased over the past few years and 193,000 bariatric procedures were performed in 2014. The most common types of bariatric surgery include the Roux-en-Y gastric bypass, gastric banding and sleeve gastrectomy. These surgeries induce weight loss by different mechanisms, including restriction of food intake and malabsorption.
A NEW APPROACH
Two minimally invasive procedures approved by the FDA in 2015 utilize gastric balloons that are placed in the stomach via endoscope. ReShape Integrated Dual Balloon System and Orbera Intragastric Balloon System both take up space in the stomach to induce satiety and constrain calorie intake.
It is important to note that many studies have shown that bariatric surgery is more successful at inducing and maintaining weight loss, as well as bringing improvement to comorbid conditions such as diabetes, than lifestyle modifications alone.