Obesity is a major epidemic in the United States, one rapidly growing and spreading around the world. According to the American Heart Association’s 2014 Heart Disease and Stroke Statistics, 26.7% of Americans are obese, including 27.4% of adult men and 26% of adult women. The Bogalusa Heart Study shows that the rate of obesity in children aged 5 to 17 was five times higher in 2008-09 than in 1973-74. According to the National Health and Nutrition Examination Survey, among men aged 65+, the rate of obesity increases linearly with age. Obesity is especially common among the less educated. It is also prevalent among African Americans and Mexican Americans. The AHA predicts that if current trends continue, 51% of Americans will be obese by 2030 and “total health care costs attributable to obesity could reach $861 to $957 billion” by that date, which would “account for 16% to 18% of U.S. health expenditures.”

 

Is obesity a disease? This has been hotly debated, but in 2013, the AMA recognized it as a disease. Obesity is medically so important because it is a major risk factor for diabetes, coronary heart disease, stroke and some cancers.

 

The AHA notes that the rate of obesity varies by state. According to the Health Council of South Florida, 27.2% of Floridians are obese (and another 37.8% overweight), while 28.1% of Miami-Dade residents are obese (and 28.3% overweight). This is consistent with our own screening findings at Florida Heart Research Institute. From 1998 to 2010, Florida Heart provided free cardiovascular screenings at our office to over 8,000 individuals, including 4,902 non-Mexican Hispanics (Hispanics) and 1,866 non-Hispanic whites (NHWs). We found that 33.6% of Hispanic men and 24.1% of NHW men were obese. Among women, the rates were 27.1% and 21.5%, respectively.

 

All of this means that the new (November 2013) obesity guidelines issued by the American Heart Association, the American College of Cardiology, and the Obesity Society are of major importance for physicians both here and nationally. These guidelines are based on a systematic review of the literature on the risks of obesity, the benefits of weight loss and the efficacy of treatments. Here is a summary of a few of the guidelines’ findings and recommendations:

• The criteria for obesity have been expanded. Under the new guidelines, persons with a body mass index (BMI) of 30 or higher are considered obese as before, as are persons with a BMI of 25 and just one comorbidity factor such as a waistline of 40 or more inches in men or 35 or more in women.

• Obese people cannot easily reduce their weight; they need help and follow-up care. If available, they should be referred to behavioral counseling which should include guidance on physical activities and caloric reduction. If this is unavailable, patients should be referred to web-based, telephone, or even commercial programs.

• While the obese should be able to lose 5% to 10% of their weight over six months in a behavioral counseling program, even more modest losses of 3% to 5% have been shown to have health benefits.

• The guidelines do not endorse any particular diet, but they do recommend that diets be tailored to the food preferences and associated medical conditions of the individual patient.

• Bariatric surgery may be an appropriate option for those with a BMI of 40 or more, or for those with a BMI of 35 or more and one comorbidity.

 

In the past, few physicians have received extensive training on this issue of obesity in medical school, and many believed that providing sound medical advice would suffice. We now know that support and close follow-up are needed to help patients overcome their obesity. Let’s hope that these guidelines prove valuable in this struggle.