Obesity

Obesity (to be) ______ a condition in which the natural energy reserve, stored in the fatty tissue of humans and other mammals, (to increase) _______________________ to a point where it (to associate) ______________________ with certain health conditions or increased mortality.

Obesity (to be) _____ both an individual clinical condition and (to view) ____increasingly _______________ as a serious public health problem. Excessive body weight (to show) _____________________________ to predispose to various diseases, particularly cardiovascular diseases, diabetes mellitus type 2, sleep apnea, and osteoarthritis.

Many negative stereotypes (to associate) _______ commonly _________________ with obese people, such as the belief that they (to be) _________ lazy, stupid, or even evil. Obesity in adulthood can (to lead) ______________ to a slower rate of career advancement. Most obese people have experienced negative thoughts about their body image, and many take drastic steps to try to change their shape.

Obesity, especially central obesity (male-type or waist-predominant obesity), (to be) ______an important risk factor for the "metabolic syndrome", the clustering of a number of diseases and risk factors that heavily (to predispose) ___________________ for cardiovascular disease. These (to be) ______ diabetes mellitus type 2, high blood pressure, high blood cholesterol, and triglyceride levels (combined hyperlipidemia). An inflammatory state (to be) _____ present, which — together with the above — (to implicate) ___________________________________ in the high prevalence of atherosclerosis (fatty lumps in the arterial wall), and a prothrombotic state may further worsen cardiovascular risk.

Apart from the metabolic syndrome, obesity (to correlate) _____ also ______________ (in population studies) with a variety of other complications.

• Cardiovascular: congestive heart failure, enlarged heart and its associated arrhythmias and dizziness, cor pulmonale, varicose veins, and pulmonary embolism

• Endocrine: polycystic ovarian syndrome, menstrual disorders, and infertility

• Gastrointestinal: gastroesophageal reflux disease (GERD), fatty liver disease, cholelithiasis (gallstones), hernia, and colorectal cancer

• Renal and genitourinary: urinary incontinence, glomerulopathy, breast cancer (female), uterine cancer (female), stillbirth

• Musculoskeletal: hyperuricemia (which predisposes to gout), immobility, osteoarthritis, low back pain

• Neurologic: stroke, headache

• Respiratory: dyspnea, obstructive sleep apnea, hypoventilation syndrome, asthma

• Psychological: Depression, low self esteem

In the clinical setting, obesity (to evaluate) ____ typically ________________ by measuring BMI (body mass index), waist circumference, and evaluating the presence of risk factors. In epidemiological studies, BMI alone (to use) ____________ to define obesity.

BMI, or Body Mass Index, (to develop) ___________________ by the Belgian statistician and anthropometrist Adolphe Quetelet.

The current definitions commonly in use (to establish) ________________________ the following values, agreed in 1997 and published in 2000:

• A BMI less than 18.5 (to be) ____ underweight

• A BMI of 18.5 - 24.9 (to be) ____ normal weight

• A BMI of 25.0 - 29.9 (to be) ____ overweight

• A BMI of 30.0 - 39.9 (to be) ____ obese

• A BMI of 40.0 or higher (to be) ____ severely (or morbidly) obese

BMI is a simple and widely used method for estimating body fat.^[9] In epidemiology BMI alone is used as an indicator of prevalence and incidence.

The absolute waist circumference (>102 cm in men and >88 cm in women) or waist-hip ratio (>0.9 for men and >0.85 for women) (to use) _____both ____________ as measures of central obesity.

An alternative way to determine obesity (to be) _____ to assess percent body fat. Doctors and scientists generally (to agree) _____________ that men with more than 25% body fat and women with more than 30% body fat (to be) _______ obese. However, it (to be) ____ difficult to measure body fat precisely.

In its simplest conception, obesity (to make) ____only ____________ possible when the lifetime energy intake exceeds lifetime energy expenditure by more than it does for individuals of "normal weight".

When food energy intake (to exceed) ______________ energy expenditure, fat cells (and to a lesser extent muscle and liver cells) throughout the body (to take) ______________ in the energy and (to store) ________________ it as fat.

Factors that (to suggest) _____________________________________to contribute to the development of obesity (to include) ______________________:

• Genetic factors and some genetic disorders

• Underlying illness (e.g., hypothyroidism)

• Eating disorders

• Certain medications

• Sedentary lifestyle

• A high glycemic diet

• Weight cycling, caused by repeated attempts to lose weight by dieting

• Stressful mentality

• Insufficient sleep

• Smoking cessation