STAGES OF OBESITY The 5 stages of obesity are determined by the Body Mass Index (BMI):

STAGE BMI

Healthy weight................................................................18.5-25 STAGE 1 - Overweight ....................................................26-29.9 STAGE 2 - Obesity I (Mild Obesity) .................................30-34.9 STAGE 3 - Obesity II (Moderate Obesity)..........................35-39.9 STAGE 4 - Obesity III (Morbid Obesity).............................40-44.9

STAGE 5 - Obesity IV (Severely Morbid Obesity)...............over 45

STAGES OF OBESITY

The 5 stages of obesity

STAGE 1: OVERWEIGHT (BMI=26-29)Patient has mild obesity-related changes in his/her exam a) borderline high blood pressure c) high cholesterol

b) rise in blood sugar d) liver changes Mild physical symptoms such as:

>shortness of breath on moderate exertion >occasional aches and pains >fatigue, etc.

Treatment at this stage requires:Identifying risk factors causing increased body weight. Counseling to prevent further weight gain through

lifestyle measures including healthy eating and increased physical activity.

STAGE 2: MILD OBESITY (BMI=30-35)Patient has obesity-related chronic diseases

a) hypertension e)osteoarthritis b) type 2 diabetes f) reflux diseasec) sleep apnea g) anxiety disorderd) polycystic ovarian syndrome

Moderate limitations in daily activitiesTreatment at this stage requires:Investigation for other risk factors. Nutritional therapy, diet and exercise to prevent further

weight gain. Monitoring of risk factors and health status.

STAGE 3: MODERATE (BMI=36-39)Patient’s previous diseases have now progressed to more serious

medical problems such as:a) congestive heart failure b) heart attackc) diabetic complications d) severe osteoarthritis e) psychological problems >depression >mood swings >stress disorder

Treatment at this stage requires:Starting obesity treatments such as behavioral therapy and

medications.Consider surgical treatment. Close monitoring and management of previous diseases.

STAGE 4: MORBID (BMI=40-45) • Patient has severe disabilities from obesity-related

chronic diseases: a) end-stage kidney disease (on dialysis) b) severe respiratory problems needing oxygenc) crippling arthritisd) severe disabling mental problems e) severe functional limitations

Treatment at this stage requires:•More intensive obesity treatment. •Recommendations for surgical treatment.•Aggressive management of previous diseases as indicated.

Patient has potentially life-threatening disabilities from obesity-related chronic diseases which can only be successfully treated with bariatric surgery such as gastric bypass, LAP-BAND, etc.

STAGE 5: SEVERELY MORBID (BMI=>45)

IMPORTANCE OF CONTROLLING OBESITY

Obesity is directly responsible for the following diseases - many of which cause over 300,000 deaths annually in the US: Cardiovascular SystemCor Pulmonale (This condition is also known as right heart failure.)Congestive heart failureEnlarged heartVaricose veinsPulmonary embolism (blood clot in lungs)High blood pressureEdema (swelling usually in legs, feet and ankles)Sudden death (usually due to a heart attack)(continued on next slide)

Endocrine SystemDiabetesMetabolic Syndrome (formerly known as Syndrome X)Polycystic ovarian syndromeMenstrual disordersInfertility

Gastrointestinal Reflux Disease (GERD)Cholelithiasis (gallstones)Hiatal HerniaHemorrhoidsGallstonesNon-alcoholic Fatty Liver Disease (can progress to scarring of the liver, cirrhosis, or liver cancer) (continued on next slide)

Kidney & Bladder Urinary Incontinence (weak bladder)Chronic Renal Failure Reproductive SystemErectile DysfunctionInfertilityStillbirthPolycystic ovarian syndromeMenstrual disordersHypogonadism (decreased production of hormones by the sex glands)(continued on next slide)

Integument System (skin)Acanthosis Nigricans (velvety, light-brown-to-black, discoloration on the neck, underarms or groin.)Cellulitis (skin infection)Carbuncles (boils)Poor wound healing Fungus infectionsStretch Marks Muscles and JointsOsteoarthritis (especially in the knees and hips)GoutLow Back Pain(continued on next slide)

Nervous SystemStrokeMeralgia Paresthetica (numbness or pain in the outer thigh)HeadacheCarpal Tunnel SyndromeDementia Respiratory SystemShortness of breathAsthma Sleep Apnea (breathing stops several times during the night)Frequent respiratory infections (colds, flu, bronchitis, pneumonia)Pickwickian Syndrome (difficulty breathing which causes high levels of carbon dioxide in the blood)(continued on next slide)

PsychologicalDepressionLow Self EsteemBody Dysmorphic DisorderSocial Stigmatization Immune SystemColon and rectal cancer Cancer of uterus and cervixBreast cancerProstate cancer(continued on next slide)

Obesity also causes:Increased risk of death during surgeryIncreased risk of death during pregnancy Therefore, in order to decrease the risk of getting any of the above conditions, it is very, VERY important to focus on controlling obesity.

10REASONS FOR UNCONTROLLED

WEIGHT

After the body gains a certain weight, it will resist all efforts to lose weight. The reason is because the brain is very good at doing it’s job - which is to keep you alive!

IObesity = Energy Efficient

When you cut back on calories, the brain thinks that you are STARVING; therefore it will tell your body to HOLD ON TO THE WEIGHT AT ALL COSTS!

IObesity = Energy Efficient

Your body then becomes very energy "efficient" by burning fat slowly and

carefully.

IObesity = Energy Efficient

Now, if we were air conditioners, hot water heaters or some other electrical

appliance, this efficiency would save us a lot of money on our electric bills!

IObesity = Energy Efficient

/lllllllll

However, with obesity, this peculiar energy efficiency makes our bodies save fat AND FIGHT ALL ATTEMPTS TO LOSE WEIGHT! This fact causes the "yo-yo" effect where the weight that was lost, is gained right back.

IObesity = Energy Efficient

In fact, our bodies are so efficient at saving energy, that our weight normally increases slowly at the rate of about ½ pound per year after the age of 25.

IObesity = Energy Efficient

½ lb

This means that even if we eat the same amount and do the same amount of exercise, WE WOULD STILL WEIGH:

5 MORE lbs 15 MORE lbs 20 MORE lbs

IObesity = Energy Efficient

AT AGE 35 AT AGE 55 AT AGE 65

Now, if we decrease the amount of exercise as we get older (which is what usually happens), we will add on even more pounds.

IObesity = Energy Efficient

HUNGER AND APPETITE ARE NOT THE SAME.

“Hunger” is a compelling need for food. “Appetite” is a desire for certain types of

food.

II HUNGER VS. APPETITE

II HUNGER VS. APPETITE

When you are hungry, any type of food will satisfy you; your body just wants food of any kind in

order to stay alive.

“Appetite” is the reason that OVER 99 MILLION of us are obese. A salad can satisfy our hunger;

but our appetite wants cheeseburgers, milkshakes and fries!

II HUNGER VS. APPETITE

Appetite is acquired after tasting a particular food. If the food stimulates certain chemicals that regulate pleasure (called "endorphins") in our brain, then we

will be HOOKED on that particular food.

II HUNGER VS. APPETITE

These "PLEASURABLE" foods usually contain sugar or fat. After a few years of eating calorie-

rich, flavorful, fattening foods, it will be difficult to change to a more nutritious diet.

II HUNGER VS. APPETITE

In fact, it takes 2 years for the average person to change his/her appetite so that healthy foods are

actually enjoyed.

II HUNGER VS. APPETITE

IIIBODY TYPES

WHAT IS YOUR NATURAL BODY TYPE?

DIFFERENT BODY TYPES HAVE

DIFFERENT RATES OF METABOLISM.

RULER SHAPE

Rulers have a fast metabolism and tend to be “skinny.” However, they will suddenly gain weight in the buttocks and/or stomach as their metabolism slows down, usually

between 40-50 years of age.

CONE

Cones are built like an upside-down triangle. They have an average metabolism but a diet high in starches and sugars will cause weight gain in the chest, breasts and upper back - leading to a deposit of fat called a “buffalo

hump!”

HOURGLASS

Hourglass shapes have an athletic build with a small waist and a moderately fast metabolism. Since their fat is evenly distributed, weight gain will occur in both the

upper and the lower body – especially if their diet is too low in protein.

SPOON

Spoon shapes naturally have a little "extra" padding on the hips, thighs and buttocks due to a moderately slow

metabolism. A diet that is high in fat will cause even more weight gain in the lower half of their bodies.

BALL

Ball shapes gain fat very easily all over their bodies because they have an extremely slow metabolism. Most of their body fat is stored around the middle which can lead to serious health problems such as diabetes and

heart diseases.