What is gross obesity?

Gross obesity is defined as weighing more than twice your ideal weight or being more than 100 pounds overweight.

How does it occur?

The reasons for obesity are not clear. Although obesity occurs when the number of calories consumed is greater than the amount of energy spent, not all obese people overeat. They may have a slower rate of metabolism, the amount of energy needed to maintain the basic body functions when at rest. Obese people also use up fewer calories because it's harder for them to be physically active.

Heredity is a contributing factor. Children who have obese parents are 10 times more likely to become obese adults than children who have parents of normal weight. There is also an environmental factor because unhealthy eating habits may be reinforced in families. A few obese people have an imbalance of hormones. Emotional problems, such as depression, anger, and anxiety can occasionally be a cause. Emotional problems can contribute to the obesity or can result from it.

What are the risks?

Obesity is a more serious condition than being overweight because there is a greater risk for serious illnesses. Excess weight in all parts of the body puts an added burden on all body functions. The most common complications are the following:

• high blood pressure

• stroke

• heart disease

• diabetes mellitus

• osteoarthritis, a disease of the joints causing pain, swelling, and stiffness

• impaired functioning of the heart and lungs

• gallbladder disease

• hyperlipidemia, or increased fats in the body, often associated with higher cholesterol levels resulting in heart disease and/or stroke.

If you are grossly obese, it will be more difficult for you to obtain such health care services as good physical exams, x-rays, and surgeries.

In men, obesity can lead to increased risk of cancer of the colon, prostate, and rectum. In women, obesity can lead to increased risk of cancer of the breast, uterus, and cervix.

How is it evaluated?

To evaluate an individual for gross obesity, the doctor will take a medical history, do a physical exam, and may order the following tests:

• thyroid functions

• electrolyte levels (blood chemistry)

• blood glucose

• cholesterol level

• glucose tolerance

• urine.

The doctor may also order these additional tests:

• ECG (to measure your heart activity)

• oral cholecystogram or ultrasound (an x-ray procedure for examining the gallbladder and common bile duct 25% of obese people have gallstones)

• a mental health evaluation

• chest x-ray.

How is it treated?

The first step in the treatment of obesity is a weight reduction diet based on low-calorie foods. The doctor may refer you to a dietitian. The diet is prepared to allow a weight loss of 1 to 2 pounds a week.

With the doctor's approval, you can begin a modest physical activity program. Weight loss support groups can help to keep you motivated.

If there are concerns about any emotional problems, the doctor may also refer you to a mental health professional for counseling.

Surgery is performed in the management of gross obesity after careful consideration and discussion of risks and benefits. It is only considered for people who have no serious medical or psychosocial problems and who have not been able to lose significant weight by low calorie diets and behavior modification. It is often risky.

For the doctor to consider you for surgery, you should meet the following criteria:

• no signs of mental illness, depression, or alcoholism

• no self-destructive tendencies

• no heart, liver, or kidney disease

• no metabolism problems

• adequate financial support to pay for the surgery and follow-up care

• under 50 years of age.

Gastric reduction operations involve shortening the digestive tract so some of the food does not have time to be absorbed into the body. This allows the person to feel full and reduces the need to eat more. You must eat small amounts of food only when you are hungry and chew the food very well. An excessive amount of liquids should not be taken with meals. This operation is uncommon because of the many risks.

Gastroplasty is a simpler operation and has greater benefits than gastric reduction surgery. It also involves making the stomach smaller by placing a small pouch in the stomach, or stapling or sewing part of the stomach closed. This causes the person to feel full after eating a small amount of food.

Suction lipectomy is a cosmetic procedure for removing fat that has accumulated in particular areas of the body. However, it is not generally done for grossly obese persons.

Follow-up is necessary for both diet management and postsurgical care. The doctor will check you for vitamin deficiencies, amount of weight loss, and speed of weight loss. The doctor may also continue to check you for high blood pressure and diabetes.

How long will the effects last?

The effects last as long as the excess weight. How quickly you can lose the weight depends on the diet you are on, how well you follow the diet, and how physically active you are able to be.

How can I take care of myself?

You should follow the full treatment prescribed by your doctor. In addition, you can:

• Follow your diet.

• Keep a daily log of what foods you eat. Write down everything you eat and drink.

• Keep a physical activity log recording how many minutes you exercise a day.

• Exercise in moderation if you are just beginning.

• Make an effort to discuss your feelings, challenges, and successes at your support group or with your doctor.

• Learn relaxation techniques.

• Drink at least six 8-ounce glasses of water a day. Drink low-calorie beverages.

• Avoid alcohol.

• Stop smoking.

To help you to stay motivated, follow these guidelines:

• Set realistic goals for yourself.

• Set multiple short-term goals. Establish nonfood rewards for attaining your goals.

• Talk to people and stay in environments that keep you motivated.

• Take classes on preparing low-calorie meals.

• Use low-calorie cookbooks.

• Find an exercise partner to work out with.

• Read books, articles, or watch TV shows that discuss weight reduction.

• Be diligent about your diet and continue reducing fat and counting calories.

What can be done to help prevent gross obesity?

The best way to prevent obesity and gross obesity problems is to manage weight gain as it occurs. Managing the type and amount of food you eat and exercising daily are the best prevention methods.