If you have seen the word “obese” in your medical records or heard it from a doctor, do not be surprised or offended. Popular culture and everyday language have sometimes made this medical term a socially sensitive description, regarded by some people as offensive. Medical obesity is not a description of a person’s appearance or the way their clothes fit. It is a medical term with a specific definition and a way to measure it.
A good analogy might be hypertension or ‘high blood pressure.’ Most people have at least a vague idea of what hypertension means and why higher-than-normal blood pressure is a bad thing. There is far less understanding of “medical obesity”, body mass index and why a higher-than-normal BMI is not good. The body mass index is a measure of how much of a person’s body weight is fat tissue. It relates weight to height in an easy to understand numeric measurement.
Most people would say that a six-foot tall person who weighs 165 pounds is lean, while a five foot tall person weighing the same is overweight. However, the words ‘lean’ and ‘overweight’ are not precise. The BMIs of these two people are 22.4 and 32.2 respectively. These two BMI values give physicians a way to tell how much, if any, of a patient’s weight is excess body fat.
A great deal of data has shown that higher-than-normal values for both blood pressure and BMI are associated with lower life expectancy and higher risk of numerous diseases. If a person’s systolic blood pressure (when the heart is fully contracted) is over 140 or their diastolic pressure (when the heart is fully relaxed) is over 90, he or she is said to have stage 1 hypertension. Doctors are much more comfortable when those numbers are below 120 and 70 respectively, which is considered to be normal blood pressure.
Likewise, a BMI of 20 to 25 is considered normal while a value of 30 or more is defined as “medically obese”. This definition is established by the National Institutes of Health (NIH) based on a very large body of data that shows increasing health risk as BMI increases. Saying that a person is “medically obese” is not meant to be offensive any more than saying that a person is “hypertensive.” Unfortunately, because of cultural conditioning, some people might take offense at the word “obese” while they would shrug at being told that they are hypertensive.
There is an overlap between many of the risk factors attributed to hypertension and obesity. In fact, obesity is often a cause of hypertension and a person’s blood pressure will return to normal if the excess weight is lost. There are, however, many people who have hypertension without being obese and that condition should be treated even though the patient is not overweight.
As obesity becomes more severe, the health risks escalate sharply. A BMI of 40 or more is said to be “morbidly obese”, a medical term that indicates an immediate risk of serious problems such as stroke or heart attack. A patient whose BMI is between 35 and 40 may also be diagnosed as morbidly obese if they already have obesity related medical conditions such as diabetes.
You can probably guess that the problem of medical obesity is increasing in the United States. The CDC (Centers for Disease Control) reported in 2000 that approximately one third of all American adults suffered from medical obesity. This is not simply a cause of hurt, self-conscious feelings or “bad fashion days,” it is a major public health concern. It contributes substantially to the increasing cost of healthcare in the United States.
During routine physicals, many people are told that they have ‘borderline’ or mild hypertension and encouraged to get their blood pressure numbers under control. It is less common to be told that their BMI makes them borderline obese and to get that BMI back under 25. An increased awareness of terms like BMI and “medical obesity” would go a long way to making America a healthier nation.
If you or a family member has struggled with medical obesity, bariatric surgery may be one option. Any bariatric clinic or bariatric surgery practice should offer a wide range of medical, surgical, nutritional, diet and other services. Diet, exercise and appropriate weight-loss surgery can combine to help medically obese patients achieve a healthy BMI. When this happens, medical conditions such as heart disease, diabetes, sleep apnea and orthopedic problems may improve or even disappear.
Gastric sleeve and gastric bypass surgery have both proven effective in achieving long term, significant, weight loss. If you need any assistance, contact Dr. Christian Birkedal’s office for assistance in any way, at (386) 231-3530. His offices, located in Daytona, New Smyrna and Palm coast are all part of the Florida Hospital network.
An earlier article in this blog addressed the details of determining your BMI. You can read about it by clicking on this link, “What is the Body Mass Index?” If you are wondering what your own BMI is, go to this National Institutes of Health site to use the BMI Calculator.