Get to Know the Definition of and Risk Factors for Obesity

Most people have a general understanding that obesity refers to a condition marked by excessive body fat. The specifics of how to define obesity, however, along with the notable symptoms, risk factors and treatment options, are poorly understood or completely misunderstood.

The condition is oversimplified when it's categorized as an imbalance in the number of calories consumed versus the number of calories burned.

Many myths and misconceptions surround obesity, and they end up perpetuating harmful stigmas about the disease. People who struggle with obesity can be unfairly and inappropriately maligned as lazy and lacking in discipline and willpower when the truth is there may be a lot more going on with this multifaceted health condition.

What is obesity? What are the symptoms, risk factors and causes?

What is obesity?

Given the prevalence of obesity in the United States—more than 40 percent of U.S. adults are obese—most people know at least one person who is dealing with it. We can recognize obesity in someone who carries excess body fat, but how is obesity defined?

"Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health," said Kimberly Gomer, a registered dietitian and licensed dietitian/nutritionist, and the director of nutrition at Body Beautiful Miami. "There are specific concerns around belly fat, as it is a significant factor for health around where the excess fat is located. A female with a belly circumference of over 35 inches and a male with a circumference over 40 inches are at particular risk for negative health consequences."

From a diagnostic standpoint, obesity is often clinically diagnosed using body mass index (BMI), which is not an indication of your body fat percentage or body composition. Rather, it is a metric that describes the relative relationship between your height and weight.

BMI is a less-than-perfect measurement, Gomer acknowledged. It does not allow for muscle to be analyzed the same as fat weight. It also needs to account for individual situations that are multifaceted.

"[What BMI] does is allow medical professionals to open a conversation about body weight," Gomer said. "If the BMI is 30.0 or higher, the person has fallen into the obesity range. A BMI of 25.0 to 30.0 is considered overweight, while 18.5 to under 25.0 is considered healthy, and less than 18.5 is considered underweight."

Causes and triggers of obesity

People too often think of obesity as just a matter of someone eating too much and/or not being active enough. In actuality, obesity is a complex disease that encompasses numerous risk factors and presents sexual health problems for men and women.

The scientific understanding of obesity has advanced considerably in the past decade, according to Michael L. Glickman, M.D., the founder of Revolution Medicine, Health & Fitness, a Washington, D.C., practice that specializes in a holistic approach to weight management.

We no longer think of obesity as a simple mathematical equation of calories in versus calories out, or a lack of willpower over food choices.

"Obesity is caused by our body having an elevated metabolic setpoint, which is the 'weight thermostat' of our body," explained Glickman, who is double-board-certified in family medicine and obesity medicine. "Our brain dictates what our setpoint weight is and works very hard to maintain that weight through hormonal changes and increasing or decreasing the metabolism. Even if we start a low-calorie diet, our brain recognizes these efforts and slows down our metabolism to fight the body to regain weight."

Glickman added that this adjustment in the metabolic rate is a survival mechanism designed to kick in during times of famine. He listed several risk factors that can cause an increase in the body's metabolic setpoint rate, including:

• Insulin resistance due to eating a diet heavy in processed or refined carbohydrates or sugars
• A genetic predisposition to obesity from parents who are overweight or obese
• Chronic stress
• Lack of sleep
• Illnesses
• Medication side effects
• Changes to the gut microbiome

Risk factors for obesity

Gomer said there are several risk factors for obesity, such as unhealthy eating behaviors, lack of physical activity, high stress, health conditions, genetics, medications, environment and food addiction.

Unhealthy eating behaviors

Unhealthy eating behaviors are by far the main contributor to obesity.

"Along with this comes metabolic damage caused by dieting and restricting that contributes to the obesity problem," Gomer said, adding that a lack of training among medical professionals in the area of adequate nutrition advice to improve food choices doesn't help.

Lack of physical activity

It is easier now than ever to be physically inactive, and many jobs are completely sedentary. Some people have very little time to engage in consistent physical activity. People spend an inordinate amount of time on their phones and other technology, less time outdoors, more time in cars, and less time doing manual activities.

Don't think of planned exercise as the only source of physical activity. Any daily movement of the body adds up in terms of increasing energy expenditure. From household chores to walking to work, any physical activity helps keep your metabolism humming.

And exercise, combined with weight loss, is good for your sex life.

High amounts of stress

"Stress releases cortisol, which is a hormone that stimulates insulin that can cause excessive hunger and carbohydrate cravings," Gomer said. "Also, food and alcohol can be used to relieve stress as habitual behavior."

Health conditions

Gomer said many health problems can lead to food intolerances that encourage unhealthy food choices.

Genetics

We often don't think about the influence of genetics on our body weight and metabolic health, but even your prenatal environment can influence your future body weight.

"Your mother's diet while you were in utero can affect your chances of obesity. Having one [obese] parent—even more so if both parents are obese—increases the risk," Gomer said.

Medications

Certain medications can increase the propensity to gain weight, either by stimulating the appetite or decreasing the metabolic rate. Examples include steroids such as prednisone, antidepressants and other medications used to treat mental health disorders, among others.

Your environment

Unfortunately, when you browse the prices of foods in the grocery store, one trend becomes notably apparent: The healthiest and most nutritious foods are often the most expensive, while junk foods, processed foods and snacks with empty calories cost much less.

Your financial situation and food budget can affect the type and quality of food you purchase.

Depending on where you live, access to fresh produce and organic dairy, meat, eggs, fish and other healthy foods may be limited. Often known as "food deserts," these areas can make it difficult to find or afford the best foods to support optimal health and a healthy body weight.

Food addiction

Most people have experienced at least a time or two when they "ate their feelings," or used food to self-soothe or provide emotional comfort in one way or another. Yes, there are healthier ways to manage difficult emotional issues and mental health disorders, but not everyone has access to affordable mental healthcare. Plus, many stigmas still surround these types of services, particularly in certain cultures.

As a result, many people find other vices and coping mechanisms, including food, to deal with trauma, emotional pain and other mental health struggles.

"Using food as a drug is a self-medicating issue that many people engage in," Gomer said.

It's helpful to bear in mind that obesity is a multifaceted issue, so treatment often requires a multipronged approach.

Make the first step in the treatment path easier by taking advantage of modern technology and telehealth. Video visits have become a viable option for most people, and more physicians and therapists have added them as a service. Giddy telehealth makes it easy to get connected to a qualified healthcare professional who can help with a variety of conditions, including weight issues.