TYCON MEDICAL INCORPORATED Home Medical & Respiratory Equipment

Help for Patients and Caregivers : Obesity

What is obesity? How is obesity measured? Body Mass Index Body Fat Distribution: "Pears" vs. "Apples" Causes of Obesity Genetic factors Environmental factors Psychological factors Other causes of obesity Consequences of Obesity Health Risks Psychological and social effects Who should lose weight? How is obesity treated? Additional Reading More than 60 percent of Americans aged 20 years and older are overweight. One-quarter of American adults are also obese, putting them at increased health risk for chronic diseases such as heart disease, type 2 diabetes, high blood pressure, stroke, and some forms of cancer. This fact sheet provides basic information about obesity: What is it? How is it measured? What causes it? What are the health risks? What can you do about it?

What is obesity? To most people, the term "obesity" means to be very overweight. Health professionals define "overweight" as an excess amount of body weight that includes muscle, bone, fat, and water. "Obesity" specifically refers to an excess amount of body fat. Some people, such as bodybuilders or other athletes with a lot of muscle, can be overweight without being obese.

How is obesity measured? Everyone needs a certain amount of body fat for stored energy, heat insulation, shock absorption, and other functions. As a rule, women have more body fat than men. Most health care providers agree that men with more than 25 percent body fat and women with more than 30 percent body fat are obese. Measuring the exact amount of a person's body fat is not easy. The most accurate measures are to weigh a person underwater or to use an X-ray test called Dual Energy X-ray Absorptiometry (DEXA). These methods are not practical for the average person, and are done only in research centers with special equipment. There are simpler methods to estimate body fat. One is to measure the thickness of the layer of fat just under the skin in several parts of the body. Another involves sending a harmless amount of electricity through a person's body. Both methods are used at health clubs and commercial weight loss programs. Results from these methods, however, can be inaccurate if done by an inexperienced person or on someone with severe obesity. Because measuring a person's body fat is difficult, health care providers often rely on other means to diagnose obesity. Weight-for-height tables, which have been used for decades, usually have a range of acceptable weights for a person of a given height. One problem with these tables is that there are many versions, all with different weight ranges. Another problem is that they do not distinguish between excess fat and muscle. A very muscular person may appear obese, according to the tables, when he or she is not. In recent years, body mass index (BMI) has become the medical standard used to measure overweight and obesity.

Body Mass Index BMI uses a mathematical formula based on a person's height and weight. BMI equals weight in kilograms divided by height in meters squared (BMI = kg/m2). The BMI table that follows has already calculated this information. Although the BMI ranges shown in the table are not exact ranges of healthy and unhealthy weight, they are useful guidelines. A BMI of 25 to 29.9 indicates a person is overweight. A person with a BMI of 30 or higher is considered obese. Like the weight-to-height table, BMI does not show the difference between excess fat and muscle. BMI, however, is closely associated with measures of body fat. It also predicts the development of health problems related to excess weight. For these reasons, BMI is widely used by health care providers. Find your weight on the bottom of the graph. Go straight up from that point until you come to the line that matches your height. Then look to find your weight group.

Body Fat Distribution: "Pears" vs. "Apples" Health care providers are concerned not only with how much fat a person has, but also where the fat is located on the body. Women typically collect fat in their hips and buttocks, giving them a "pear" shape. Men usually build up fat around their bellies, giving them more of an "apple" shape. Of course some men are pear-shaped and some women become apple-shaped, especially after menopause. If you carry fat mainly around your waist, you are more likely to develop obesity-related health problems. Women with a waist measurement of more than 35 inches or men with a waist measurement of more than 40 inches have a higher health risk because of their fat distribution.

Causes of Obesity In scientific terms, obesity occurs when a person consumes more calories than he or she burns. What causes this imbalance between calories in and calories out may differ from one person to another. Genetic, environmental, psychological, and other factors may all play a part. Genetic factors Obesity tends to run in families, suggesting a genetic cause. Yet families also share diet and lifestyle habits that may contribute to obesity. Separating these from genetic factors is often difficult. Even so, science shows that heredity is linked to obesity. In one study, adults who were adopted as children were found to have weights closer to their biological parents than to their adoptive parents. In this case, the person's genetic makeup had more influence on the development of obesity than the environment in the adoptive family home. Environmental factors Genes do not destine people to a lifetime of obesity, however. Environment also strongly influences obesity. This includes lifestyle behaviors such as what a person eats and his or her level of physical activity. Americans tend to eat high-fat foods, and put taste and convenience ahead of nutrition. Also, most Americans do not get enough physical activity. Although you cannot change your genetic makeup, you can change your eating habits and levels of activity. Try these techniques that have helped some people lose weight and keep it off: Learn how to choose more nutritious meals that are lower in fat. Learn to recognize and control environmental cues (like inviting smells) that make you want to eat when you're not hungry. Become more physically active. Keep records of your food intake and physical activity. Psychological factors Psychological factors may also influence eating habits. Many people eat in response to negative emotions such as boredom, sadness, or anger. Most overweight people have no more psychological problems than people of average weight. Still, up to 10 percent of people who are mildly obese and try to lose weight on their own or through commercial weight loss programs have binge eating disorder. This disorder is even more common in people who are severely obese. During a binge eating episode, people eat large amounts of food and feel that they cannot control how much they are eating. Those with the most severe binge eating problems are also likely to have symptoms of depression and low self-esteem. These people may have more difficulty losing weight and keeping it off than people without binge eating problems. If you are upset by binge eating behavior and think you might have binge eating disorder, seek help from a health professional such as a psychiatrist, psychologist, or clinical social worker. Other causes of obesity Some illnesses can lead to obesity or a tendency to gain weight. These include hypothyroidism, Cushing's syndrome, depression, and certain neurological problems that can lead to overeating. Also, drugs such as steroids and some antidepressants may cause weight gain. A doctor can tell whether there are underlying medical conditions that are causing weight gain or making weight loss difficult.

Consequences of Obesity Health Risks Obesity is more than a cosmetic problem; it is a health hazard. Approximately 280,000 adult deaths in the United States each year are related to obesity. Several serious medical conditions have been linked to obesity, including type 2 diabetes, heart disease, high blood pressure, and stroke. Obesity is also linked to higher rates of certain types of cancer. Obese men are more likely than non-obese men to die from cancer of the colon, rectum, or prostate. Obese women are more likely than non-obese women to die from cancer of the gallbladder, breast, uterus, cervix, or ovaries. Other diseases and health problems linked to obesity include: Gallbladder disease and gallstones. Liver disease. Osteoarthritis, a disease in which the joints deteriorate. This is possibly the result of excess weight on the joints. Gout, another disease affecting the joints. Pulmonary (breathing) problems, including sleep apnea in which a person can stop breathing for a short time during sleep. Reproductive problems in women, including menstrual irregularities and infertility. Health care providers generally agree that the more obese a person is, the more likely he or she is to develop health problems. Psychological and social effects Emotional suffering may be one of the most painful parts of obesity. American society emphasizes physical appearance and often equates attractiveness with slimness, especially for women. Such messages make overweight people feel unattractive. Many people think that obese individuals are gluttonous, lazy, or both, even though this is not true. As a result, obese people often face prejudice or discrimination in the job market, at school, and in social situations. Feelings of rejection, shame, or depression are common.

Who should lose weight? Health care providers generally agree that people who have a BMI of 30 or more can improve their health through weight loss. This is especially true for people who are severely obese. Preventing additional weight gain is recommended if you have a BMI between 25 and 29.9, unless you have other risk factors. Obesity experts recommend you try to lose weight if you have two or more of the following: Family history of certain chronic diseases. If you have close relatives who have had heart disease or diabetes, you are more likely to develop these problems if you are obese. Pre-existing medical conditions. High blood pressure, high cholesterol levels, or high blood sugar levels are all warning signs of some obesity-associated diseases. "Apple" shape. If your weight is concentrated around your waist, you may have a higher risk of heart disease, diabetes, or cancer than people of the same weight who have a "pear" shape. Fortunately, a weight loss of 5 to 10 percent can do much to improve health by lowering blood pressure and cholesterol levels. In addition, recent research has shown that a 5- to 7-percent weight loss can prevent type 2 diabetes in people at high risk for the disease.

How is obesity treated? The method of treatment depends on your level of obesity, overall health condition, and motivation to lose weight. Treatment may include a combination of diet, exercise, behavior modification, and sometimes weight-loss drugs. In some cases of severe obesity, gastrointestinal surgery may be recommended. Remember, weight control is a life-long effort. For more information on health risks, treatment options, and binge eating, click on these links to WIN publications: Binge Eating Disorder Do You Know the Health Risks of Being Overweight? Gastrointestinal Surgery Weight Loss for Life

Additional Reading Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. Journal of the American Medical Association; 1999;282(16):1530-1538. National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Department of Health and Human Services, National Institutes of Health; 1998. NIH Publication No. 98-4083. National Task Force on Prevention and Treatment of Obesity. Overweight, obesity, and health risk. Archives of Internal Medicine. 2000;160(7):898-904. Partnership for Healthy Weight Management. Weight Loss: Finding a Weight Loss Program that Works for You. 2000. Phone: 1-888-8-PUEBLO. Website: www.consumer.gov/weightloss/brochures.htm. Partnership for Healthy Weight Management. Setting Goals for Healthy Weight Loss. 1999. Phone: 1-888-8-PUEBLO. Website: www.consumer.gov/weightloss/brochures.htm. The President’s Council on Physical Fitness and Sports, Department of Health and Human Services. Exercise and Weight Control. Website: www.fitness.gov/Reading_Room/reading_room.html. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans. 2000. Phone: 1-888-878-3256. Website: www.usda.gov/cnpp or www.health.gov/dietaryguidelines.

Weight-control Information Network 1 WIN WAY BETHESDA, MD 20892-3665 Phone: (202) 828-1025 FAX: (202) 828-1028 E-mail: win@info.niddk.nih.gov Internet: www.niddk.nih.gov/health/nutrit/nutrit.htm Toll-free number: 1-877-946-4627 The Weight-control Information Network (WIN) is a national service of the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, which is the Federal Government's lead agency responsible for biomedical research on nutrition and obesity. Authorized by Congress (Public Law 103-43), WIN provides the general public, health professionals, the media, and Congress with up-to-date, science-based health information on weight control, obesity, physical activity, and related nutritional issues. WIN answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about weight control and related issues. Publications produced by WIN are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet was also reviewed by Thomas Wadden, Ph.D., Director, Weight and Eating Disorders Program, University of Pennsylvania, and Goulda Downer, Ph.D., President, Metroplex Health and Nutrition Services. This e-text is not copyrighted.WIN encourages unlimited duplication and distribution of this fact sheet.

10 Tips for Family Caregivers

1. Caregiving is a job and respite is your earned right. Reward yourself with respite breaks often.
2. Watch out for signs of depression, and don’t delay in getting professional help when you need it.
3. When people offer to help, accept the offer and suggest specific things that they can do.
4. Educate yourself about your loved one’s condition and how to communicate effectively with doctors.
5. There’s a difference between caring and doing. Be open to technologies and ideas that promote your loved one’s independence.
6. Trust your instincts. Most of the time they’ll lead you in the right direction.
7. Caregivers often do a lot of lifting, pushing, and pulling. Be good to your back.
8. Grieve for your losses, and then allow yourself to dream new dreams.
9. Seek support from other caregivers. There is great strength in knowing you are not alone.
10. Stand up for your rights as a caregiver and a citizen.

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Tips for Family Caregivers from Doctors

• Write questions down so you won’t forget them
• Be clear about what you want to say to the doctor. Try not to ramble.
• If you have lots of things to talk about, make a consultation appointment, so the doctor can allow enough time to meet with you in an unhurried way.
• Educate yourself about your loved one’s disease or disability. With all the information on the Internet it is easier than ever before.
• Learn the routine at your doctor’s office and/or the hospital so you can make the system work for you, not against you.
• Recognize that not all questions have answers—especially those beginning with “why.”
• Separate your anger and sense of impotence about not being able to help your loved one as much as you would like from your feeling about the doctor. Remember, you are both on the same side.
• Appreciate what the doctor is doing to help and say thank you from time to time.

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Care Management Techniques You Can Use

Did you ever wish you could just pick up the phone and call someone who would take stock of your situation, help you access the right services, counsel you and your family to help resolve some of your differences, then monitor your progress with an eye toward channeling your energy and abilities as effectively as possible? If your answer is “yes,” you’re not alone. Having the help of a care coordinator (often called a care manager) could make all of our lives easier and less lonesome, and help us be more capable family caregivers. While most of us may not have access to a care coordinator, we can all learn how to think and act like one, thereby reaping numerous benefits for our loved ones and ourselves.

What Is Care Coordination?

Although every case is different, the care coordination approach usually involves:

• Gathering information from healthcare providers;
• An assessment of your care recipient and the home environment;
• Research into available public and/or private services and resources to meet your loved one’s needs; and
• Ongoing communication between all parties to keep information up-to-date and services appropriate and effective.

Unfortunately, an assessment of your abilities and needs is not necessarily a standard part of the process, but it should be. A complete view of the situation cannot be gained without one. An objective analysis of your health, emotional state, other commitments, etc., are key elements in determining how much you can and cannot do yourself, and what type of outside support is needed to ensure your loved one’s health and safety.

Become Your Own Care Coordinator By learning and applying at least some of the care coordination techniques and ideas that follow, you’ll be in a much better position to develop an organized course of action that will, hopefully, make you feel more confident and in control — a goal well worth working toward.

Educate yourself on the nature of the disease or disability with which you’re dealing. Reliable information is available from the health agency that deals with your loved one’s condition and the National Institutes of Health. When using the Internet, stick with well-known medical sites. Understanding what is happening to your care recipient will provide you with the core knowledge you need to go forward. It will also make you a better advocate when talking with healthcare professionals.

Write down your observations of the present situation including:

• Your loved one’s ability to function independently, both physically and mentally.
• The availability of family and/or friends to form a support network to share the care.
• The physical environment: Is it accessible or can it be adapted at reasonable cost?
• Your other responsibilities — at work, at home, and in the community.
• Your own health and physical abilities.
• Your financial resources, available insurance, and existence of healthcare or end-of-life documents.

This assessment will help you come to a realistic view of the situation. It will let you know the questions to which you need answers. It can be a handy baseline for charting your caregiving journey and reminding you just how much you’ve learned along the way.

Hold a family conference. At least everyone in the immediate family should be told what’s going on. A meeting can set the stage for divvying up responsibilities so that there are fewer misunderstandings down the road when lots of help may be needed. A member of the clergy, a professional care coordinator, or even a trusted friend can serve as an impartial moderator. A family meeting is a good way to let everyone know they can play a role, even if they are a thousand miles away. It can help you, the primary family caregiver, from bearing the brunt of all the work all of the time.

Keep good records of emergency numbers, doctors, daily medications, special diets, back-up people, and other pertinent information relating to your loved one’s care. Update as necessary. This record will be invaluable if something happens to you, or if you need to make a trip to the ER. If you can maintain a computer-based record, that will make updating all that much easier and it might even allow you to provide the medical team with direct access to the information.

Join a support group, or find another caregiver with whom to converse. In addition to emotional support, you’ll likely pick up practical tips as well. Professionals network with each other all the time to get emotional support and find answers to problems or situations they face. Why shouldn’t family caregivers?

Start advance planning for difficult decisions that may lie ahead. It’s never too early to discuss wills, advance directives, and powers of attorney, but there comes a time when it is too late. It is also vital that you and your loved one think through what to do if you should be incapacitated, or, worse, die first. It can happen.

Develop a care team to help out during emergencies, or over time if your situation is very difficult. In an ideal world there will be lots of people who want to help. More likely you’ll be able to find one or two people to call on in an emergency or to help with small chores. The critical thing is to be willing to tell others what you need and to accept their help.

Establish a family regimen. When things are difficult to begin with, keeping a straightforward daily routine can be a stabilizer, especially for people who find change upsetting and confusing.

Approach some of your hardest caregiving duties like a professional. It’s extraordinarily difficult to separate your family role from your caregiving role, to lock your emotions up in a box while you focus on practical chores and decisions. But it is not impossible to gain some distance some of the time. It requires an almost single-minded approach to getting the job at hand done as efficiently and effectively as possible. It takes practice, but is definitely worth the effort.

©National Family Caregivers Association | www.nfcacares.org | Phone: 800/896-3650

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Seating & Mobility As a caregiver, you need to be very understanding to the individual's needs. This is a very hard time as they are being told they need to start living their life in a different manor than they had done so previously. It will be most beneficial to educate them, either with a professional, or through a support group. By becoming involved in different activities with others in the same condition, the individual will be able to make the transition much easier. As far as the actual device, you will want to make sure that the individual is fully capable of performing all the operations of the mobility device and can do so in a comfortable manner. Areas to pay close attention to include an adjustable backrest, a suspension system, a fore-and-aft track adjustment, an up-and-down seat adjustment, an armrest and/or footrest, and lumbar region support.

How do you care for your mobility device? The most important areas that you need to pay attention to are referred to as the 3 B’s…Bad batteries, bent wheel rims and failed bearings. If you notice something that doesn’t seem right, but it isn’t all too annoying, you should still get it looked at right away. This could prevent a more severe accident from happening. So as the saying goes “it’s better to be safe than sorry”.

When a wheelchair is purchased, you will want to make sure that all the correct adjustments and modifications are made. This needs to be done by a professional and should take up to a couple of hours if done correctly. As long as the proper measures are taken initially, the work of maintaining the device will be substantially easier.

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Additional Resources It's always wise to find out what your county and state have to offer in the way of services, even if you think you won't qualify for them. Check the blue pages of your phone book for the numbers, or go on line. Counties and states all have web sites. Type the name of your state or county and state into any major search engine i.e. Iowa, or Montgomery County, PA. Navigate from there to locate the Department of Health and Human Services and the specific office most relevant to your needs, such as office on disabilities, elder affairs, or maternal and child health.

Other good sources of information include your local hospital or clinic (social work department), area adult day centers, social service and faith-based agencies, and/or the local chapter of the health agency that focuses on your loved one's condition. It is by no means certain that any of these will offer caregiver support services, but they are good places to check, and they are good sources for information about services to directly support your loved one.

National Family Caregivers Association 10400 Connecticut Avenue, Suite 500 Kensington, MD 20895 800-896-3650 Web site: http://www.thefamilycaregiver.org :: e-mail: info@thefamilycaregiver.org

The National Family Caregivers Association (NFCA) is a grassroots organization created to educate, support, empower, and advocate for the millions of Americans who care for chronically ill, aged, or disabled loved ones. NFCA is the only constituency organization that reaches across the boundaries of different diagnoses, different relationships, and different life stages to address the common needs and concerns of all family caregivers. NFCA serves as a public voice for family caregivers to the press, to Congress and the general public. NFCA offers publications, information, referral services, caregiver support, and advocacy.

Caregiver-Specific Web Sites There are a variety of Web sites that offer information and support for family caregivers, in addition to those from specific organizations.

• http://www.caregiver.org
• http://www.caregiving.org
• http://www.caregiving.com
• http://www.caregiver.com

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