What to Expect From a Lap-Band® Seminar

Lap Band san Diego LAP-BAND Seminar

Are you interested in transforming your life through Lap-Band® and wondering about our free seminars? *The Lap-Band San Diego seminars are designed as an introduction to the procedure. This first step can be a beneficial one when considering surgical weight loss. Seminar attendance is not mandatory, but there are reasons to consider it, including:*

*Results may vary.

1. Information. At a seminar, our physicians, staff members, and former patients provide the details you need to make an informed decision about the procedure. You will learn benefits and risks. Before attending, you may want to browse our website to find out who is a candidate for weight loss surgery. If you think you are a candidate, a seminar will outline the advantages of this laparoscopic gastric banding procedure, as well as what to expect in terms of weight loss and long-term weight management.

2. Q&A. You have the chance to ask questions at our seminars and to hear questions or comments from other attendees. Since former patients are in attendance, they can also provide valuable insight within the seminar setting. Of course, there will be some inquiries you prefer to make in private. These can be addressed during an individualized consultation with one of our physicians.

3. Resources. We have educational materials for you to take home and review. These resources cover specifics about Lap-Band and its recognition as a minimally invasive and safe medical procedure. There will also be information available about payment options, potential insurance coverage, or financing plans.

4. Family involvement. We know your weight loss journey requires the support of friends and family. They will be more likely to provide this support if they understand the process. So we encourage you to invite a spouse, loved one, or close friend to attend a seminar with you.

5. Common goals. Most individuals who attend our seminars share the goal of freeing themselves from the health complications of obesity. If you have concerns about making a dramatic change, it often helps to attend a seminar and a support group meeting so you can interact with other individuals wishing to improve their quality of life.

Remember, seminar attendance is highly encouraged if you have an interest in Lap-Band. To attend the next seminar sponsored by The Gastric Banding Group, please contact us or sign up online for a reservation and location information.

Results may vary from person to person.

Body Contouring for Problem Areas

i-Lipo Body Sculpting

* Results not typical.

As you reach a healthier weight with the Lap-Band®, you may desire a more toned appearance to complement the new you. This is why patients sometimes turn to body contouring options.*

*Results may vary. All medical procedures have risks of complications.

Invasive vs. Noninvasive Contouring

Liposuction and tummy tucks are two well known plastic surgery procedures for body shaping, but these invasive techniques involve anesthesia, recovery, and interrupted activities. Fortunately, there are alternatives.*

We offer noninvasive laser contouring that features short treatments, generally immediate results, and usually no downtime. *Commonly treated areas include places prone to fat deposits, such as the waist, thighs, hips, and upper arms.* Before body contouring, you may want to be at or close to your post-surgical goal weight. Certain medical conditions may also prevent you from receiving the treatment. *To find out if you’re a candidate, simply check with your physician.*

*Results may vary. All medical procedures have risks of complications.  Consult your doctor.

Reducing Inches with i-Lipo

The i-Lipo laser contouring is an effective and affordable alternative to traditional liposuction. Clinical studies have verified the laser’s capabilities, and it has FDA approval. An i-Lipo body sculpting laser generally provides immediate results and is safe when administered by qualified staff. Since it is noninvasive, work and activity schedules are not usually affected. The time commitment is also manageable. As with any procedure, you’ll want to gain the information you need before scheduling treatment.*

During the technique, a low level laser stimulates the body to shrink its own fat cells. *This procedure has gained popularity because it generally triggers fat elimination without pain. The i-Lipo laser contours and creates a measurable loss of inches in targeted areas.*

*Results may vary. All medical procedures have risks of complications.  Consult your doctor.

Advanced Weight Loss Services

Fitness and nutrition are key components to losing and maintaining weight and a trim body. If you decide to integrate advanced body contouring, the i-Lipo laser technique can be a viable alternative to invasive procedures.*

At Lap-Band San Diego we take a multidisciplinary approach to weight loss, providing a range of resources. If you’re interested in i-Lipo, please contact the Gastric Banding Medical Group for a consultation.*

*Results may vary. All medical procedures have risks of complications.  Consult your doctor.

 

Weight Loss Success After LAP-BAND

* Results may vary from person to person.

The road to optimal weight loss and improved health can begin with the LAP-BAND® procedure, which may lead to gradual and safe weight reductions. * We believe the average patient may lose more than 20 pounds throughout the year after surgery, with approximately two-pound decreases each week. These losses generally continue over time, so patients at five years post-surgery generally lose an average of 60% of their excess weight! Lap-Band weight loss occurs because the device limits the amount of food the stomach can hold, creating a feeling of fullness with smaller portions.*

* Results may vary from person to person.

Weight Maintenance.
Once a target weight is reached, many Lap-Band patients maintain their results. During the longest study to date of the procedure, more than 3,000 patients were followed for 10 to 15 years. The study results, published in January, found that a significant number of participants maintained their losses beyond a decade, making the procedure a long-term method for substantial weight loss. *

* Results may vary from person to person.

Lifestyle and Lap-Band.
Though the surgery is integral to this success, behavioral and dietary changes also play a role in dramatic weight loss after Lap-Band. You must be open to following lap band dietary guidelines, such as eating high protein meals and avoiding snacks. Exercising regularly can also encourage the body to shed weight sooner. Your physician will let you know when to start exercising after surgery. You’ll be encouraged to get active at least four times a week, incorporating both cardio and strength training. Fortunately, most of the weight lost following Lap-Band is excess fat. You keep more of the lean muscle you need for a healthy metabolism and fitness.*

* Results may vary from person to person.

Aftercare and Support.
At Lap-Band San Diego, we offer excellent aftercare and programs for continued success. Life after Lap-Band does require smart choices. However, with education and support groups, you’ll have the tools for life changing reductions in weight and obesity-related health complications. * Please contact us for more information about the Lap-Band Procedure.

* Results may vary from person to person.

i-Lipo Body Sculpting Procedure Zaps Fat

i-Lipo Body Sculpting

* Results may vary from person to person.

Safe, non-surgical laser body sculpting is now available to break down fat and contour the body for generally effective results. The Gastric Banding Center staff is specially trained to provide this relaxing i-Lipo laser procedure. It’s a body sculpting laser that generally takes inches off problem areas, without impacting normal activities. Plus, the effectiveness of this laser treatment has been confirmed through scientific studies. Since laser body contouring is non-invasive, you don’t have to take an anesthetic and there is no down time to lose fat from the waist, hips, thighs and other areas. We all know reducing these areas is difficult even with healthy eating and exercise. Fortunately, the i-Lipo procedure offers an alternative to surgical liposuction. The headline-grabbing i-Lipo equipment is available at the Gastric Banding Center of San Diego, which is currently offering the groundbreaking, fat-zapping procedure at a special low rate for patients. *

* Results may vary from person to person.

Savings on Effective, Non-Invasive Body Contouring

The i-Lipo laser by Chromogenex Technologies LTD contours the body to smaller proportions. With the procedure, you usually experience the removal of excess fat without side effects. The i-Lipo laser technology generally reduces the size of the fat cells, as its beam emulsifies them. As fat cell contents are released and excreted through the lymphatic system, smaller waistlines, thighs, love-handles and hips can be seen after the treatment. With a total of 36 individual laser beams, you rest comfortably on a table while i-Lipo targets the application areas. One session takes 20 minutes. To save on the latest non-invasive body contouring procedure that decreases inches and increases self-confidence, contact us for more information.*

* Results may vary from person to person.

Do You Know the Health Risks of Being Overweight ?

Do You Know the Health Risks of Being Overweight ?

  • Type 2 diabetes
  • Heart disease and stroke
  • Body Mass Index Table
  • Cancer
  • Sleep apnea
  • Osteoarthritis
  • Gallbladder disease
  • Fatty liver disease
  • How can I lower my health risks?
  • Additional resources

Weighing too much may increase your risk for developing many health problems. If you are overweight or obese on a body mass index (BMI) chart, you may be at risk for:

  • Type 2 diabetes
  • Heart disease and stroke
  • Cancer
  • Sleep apnea
  • Osteoarthritis
  • Gallbladder disease
  • Fatty liver disease.

You can lower your health risks by losing as little as 10 to 20 pounds.

Type 2 diabetes

What is it?

Type 2 diabetes used to be called adult-onset diabetes or noninsulin-dependent diabetes. It is the most common type of diabetes in the U.S. Type 2 diabetes is a disease in which blood sugar levels are above normal. High blood sugar is a major cause of early death, heart disease, kidney disease, stroke, and blindness.

How is it linked to overweight?
More than 80 percent of people with type 2 diabetes are overweight. It is not known exactly why people who are overweight are more likely to suffer from this disease. It may be that being overweight causes cells to change, making them less effective at using sugar from the blood. This then puts stress on the cells that produce insulin (a hormone that carries sugar from the blood to cells) and makes them gradually fail.

What can weight loss do?
You can lower your risk for developing type 2 diabetes by losing weight and increasing the amount of physical activity you do. If you have type 2 diabetes, losing weight and becoming more physically active can help you control your blood sugar levels. Losing weight and exercising more may also allow you to reduce the amount of diabetes medication you take.

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Heart disease and stroke

What is it?

Heart disease means that the heart and circulation (blood flow) are not functioning normally. If you have heart disease, you may suffer from a heart attack, congestive heart failure, sudden cardiac death, angina (chest pain), or abnormal heart rhythm. During a stroke, blood and oxygen do not flow normally to the brain, possibly causing paralysis or death. Heart disease is the leading cause of death in the U.S., and stroke is the third leading cause.

How is it linked to overweight?
People who are overweight are more likely to suffer from high blood pressure, high levels of triglycerides (blood fats) and LDL cholesterol (a fat-like substance often called the “bad cholesterol”), and low levels of HDL cholesterol (the “good cholesterol”). These are all risk factors for heart disease and stroke. In addition, people with more body fat have higher blood levels of substances that cause inflammation. Inflammation in blood vessels and throughout the body may raise heart disease risk.

What can weight loss do?
Losing 5 to 15 percent of your weight can lower your chances for developing heart disease or having a stroke. If you weigh 200 pounds, this means losing as little as 10 pounds. Weight loss may improve your blood pressure, triglyceride, and cholesterol levels; improve how your heart works and your blood flows; and decrease inflammation throughout your body.

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Body Mass Index Table

To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight. The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.

 

 

 

 

 

 

 

 

 

 

 

 

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Cancer

What is it?

Cancer occurs when cells in one part of the body, such as the colon, grow abnormally or out of control and possibly spread to other parts of the body, such as the liver. Cancer is the second leading cause of death in the U.S.

How is it linked to overweight?
Being overweight may increase the risk of developing several types of cancer, including cancers of the colon, esophagus, and kidney. Overweight is also linked with uterine and postmenopausal breast cancer in women. Gaining weight during adult life increases the risk for several of these cancers. Being overweight also may increase the risk of dying from some cancers. It is not known exactly how being overweight increases cancer risk. It may be that fat cells make hormones that affect cell growth and lead to cancer. Also, eating or physical activity habits that may lead to being overweight may also contribute to cancer risk.

What can weight loss do?
Avoiding weight gain may prevent a rise in cancer risk. Weight loss, and healthy eating and physical activity habits, may lower cancer risk.

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Sleep apnea

What is it?

Sleep apnea is a condition in which a person stops breathing for short periods during the night. A person who has sleep apnea may suffer from daytime sleepiness, difficulty concentrating, and even heart failure.

How is it linked to overweight?
The risk for sleep apnea is higher for people who are overweight. A person who is overweight may have more fat stored around his or her neck. This may make the airway smaller. A smaller airway can make breathing difficult, loud (snoring), or stop altogether. In addition, fat stored in the neck and throughout the body can produce substances that cause inflammation. Inflammation in the neck may be a risk factor for sleep apnea.

What can weight loss do?
Weight loss usually improves sleep apnea. Weight loss may help to decrease neck size and lessen inflammation.

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Osteoarthritis

What is it?

Osteoarthritis is a common joint disorder. With osteoarthritis, the joint bone and cartilage (tissue that protects joints) wear away. Osteoarthritis most often affects the joints of the knees, hips, and lower back.

How is it linked to overweight?
Extra weight may place extra pressure on joints and cartilage, causing them to wear away. In addition, people with more body fat may have higher blood levels of substances that cause inflammation. Inflammation at the joints may raise the risk for osteoarthritis.

What can weight loss do?
Weight loss can decrease stress on your knees, hips, and lower back, and lessen inflammation in your body. If you have osteoarthritis, losing weight may help improve your symptoms.

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Gallbladder disease

What is it?

Gallstones are clusters of solid material that form in the gallbladder. They are made mostly of cholesterol and can sometimes cause abdominal or back pain.

How is it linked to overweight?
People who are overweight have a higher risk for developing gallbladder disease and gallstones. They may produce more cholesterol, a risk factor for gallstones. Also, people who are overweight may have an enlarged gallbladder, which may not work properly.

What can weight loss do?
Weight loss — especially fast weight loss (more than 3 pounds per week) or loss of a large amount of weight — can actually increase your chance of developing gallstones. Modest, slow weight loss of about 1/2 to 2 pounds a week is less likely to cause gallstones.

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Fatty liver disease

What is it?

Fatty liver disease occurs when fat builds up in the liver cells and causes injury and inflammation in the liver. It can sometimes lead to severe liver damage, cirrhosis (build-up of scar tissue that blocks proper blood flow in the liver), or even liver failure. Fatty liver disease is like alcoholic liver damage, but it is not caused by alcohol and can occur in people who drink little or no alcohol. The National Digestive Diseases Information Clearinghouse (NDDIC) has more information on fatty liver disease or nonalcoholic steatohepatitis (NASH).

How is it linked to overweight?
People who have diabetes or “pre-diabetes” (when blood sugar levels are higher than normal but not yet in the diabetic range) are more likely to have fatty liver disease than people without these conditions. And people who are overweight are more likely to have diabetes (see Type 2 diabetes above). It is not known why some people who are overweight or diabetic get fatty liver and others do not.

What can weight loss do?
Losing weight can help you control your blood sugar levels. It can also reduce the build-up of fat in your liver and prevent further injury. People with fatty liver disease should avoid drinking alcohol.

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How can I lower my health risks?

If you are overweight, losing as little as 5 percent of your body weight may lower your risk for several diseases, including heart disease and diabetes. If you weigh 200 pounds, this means losing 10 pounds. Slow and steady weight loss of 1/2 to 2 pounds per week, and not more than 3 pounds per week, is the safest way to lose weight.

To lose weight and keep it off over time, try to make long-term changes in your eating and physical activity habits. Choose healthy foods, such as vegetables, fruits, whole grains, and low-fat meat and dairy products, more often and eat just enough food to satisfy you. Try to do at least 30 minutes of moderate-intensity physical activity— walking— most days of the week, preferably every day. To lose weight, or to maintain weight loss, you may need to do more than 30 minutes of moderate physical activity daily.

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Additional resources

National Cancer Institute
NCI Public Inquiries Office
Suite 3036A
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322
Phone: 1-800-4-CANCER ( 1-800-422-6237 )
TTY: 1-800-332-8615
http://www.nci.nih.gov/

National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Phone: 1-800-860-8747 or (301) 654-3327
http://diabetes.niddk.nih.gov/

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
Phone: 1-800-891-5389 or (301) 654-3810
http://digestive.niddk.nih.gov/

National Heart, Lung, and Blood Institute
NHLBI Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
TTY: (240) 629-3255
http://www.nhlbi.nih.gov/

National Institute of Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
1 AMS Circle
Bethesda, Maryland 20892-3675
Phone: 1-877-22-NIAMS ( 1-877-226-4267 ) or (301) 495-4484
TTY: (301) 565-2966
http://www.niams.nih.gov/

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As Obesity Surgery Soars, Patients Weigh Which Method is Best

By MARILYNN MARCHIONE, AP Medical Writer. Associated Press. New York:
Jan 1, 2006. pg. 1

As more people abandon New Year’s resolutions to lose weight and turn to obesity surgery, doctors are debating which type is safest and best.

And researchers are uncovering some surprising trends.

The most common method in the United States – gastric bypass, or stomach-stapling surgery – may be riskier than once thought. Yet surgeons still favor it for people who need to lose weight fast because of heart damage or other serious problems.

A gentler approach favored in Europe and Australia – an adjustable stomach band – can give long-term results that are almost as good and with far fewer risks. It may be the best option for children or women contemplating pregnancy, and is reversible if problems develop.

A radical operation – cutting away part of the stomach and rerouting the intestines – is increasingly being recommended for severely obese people. It gives maximum weight loss but also is the riskiest solution.

A large U.S. government study just got under way to compare all three options.

But regardless of which method is used, studies show an inescapable reality: No surgery gives lasting results unless people also change eating and exercising habits.

“The body just has many ways of compensating, even after something as drastic as surgery,” said Dr. Louis Aronne, director of the weight loss program at Weill-Cornell Medical College.

He is president of the Obesity Society, the largest group of specialists in bariatrics, as this field is known. The group’s recent annual conference in Vancouver featured many studies on surgery’s long-term effects.

Obesity is a problem worldwide. About 31 percent of American adults – 61 million people – are considered obese, with a body-mass index of 30 or more. That’s based on height and weight. Someone 5- foot-4 is obese at 175 pounds; 222 does it for a 6-footer.

Federal guidelines say surgery shouldn’t be considered unless someone has tried conventional ways to shed pounds and is at least 100 pounds over ideal weight, or has a BMI over 40, or a BMI over 35 plus a weight-related medical problem like diabetes or high blood pressure.

More people are meeting those conditions. A decade ago, less than 10,000 such surgeries were done in the United States. That ballooned to 70,000 in 2002 and more than 170,000 in 2005, says the American Society for Bariatric Surgery.

Doctors disagree over which is better: the most popular method, Roux-en-Y gastric bypass, or the adjustable band, which is rapidly gaining fans. Either can be done through a big incision, or laparoscopically with tiny instruments passed through small cuts in the abdomen.

In gastric bypass, a small pouch is stapled off from the rest of the stomach and connected to the small intestine. People eat less because the pouch holds little food, and they absorb fewer calories because much of the intestine is bypassed. They must take protein and vitamin supplements to prevent deficiencies.

The adjustable band has been available in the U.S. only since 2001 but far longer in Europe and Australia where it is dominant. It accounted for 17 percent of U.S. obesity procedures in 2005.

A ring is placed over the top of the stomach and inflated with saline to tighten it and restrict how much food can enter and pass through the stomach.

Deaths from the procedure are only 0.1 percent compared to about 2 percent for gastric bypass. One recent study of Medicare patients found deaths a year after gastric bypass as high as 3 to 5 percent.

The band’s reversibility makes it a better choice for children, some doctors say.

“It’s becoming more well-known and more accepted. Patients like it because it’s less invasive. It’s an easier surgical procedure. It’s safer,” said Georgeann Mallory, executive director of the bariatric society.

“To me it is a very straightforward decision,” said Dr. Paul O’Brien, director of the Centre for Obesity Research and Education at Monash University in Melbourne, Australia. “I would strongly recommend that the consumer consider the safest effective procedure first,” which is the band, he said.

American doctors have preferred bypass operations because they produce faster, greater weight loss. But new research by O’Brien and others calls that into question.

Combining results on 23,638 patients in 43 published studies, they found that bypasses beat bands for the first three years but were comparable after seven years, with excess weight loss of 55 percent for bypass and 51 percent for bands.

That impressed Dr. Edward Livingston, chief of gastrointestinal surgery at the University of Texas Southwestern Medical Center and chief of bariatric surgery for the Department of Veteran’s Affairs national system.

“I really was not enthusiastic about bands until I came to Dallas from Los Angeles and saw the results from the group that I joined, which where quite good,” he confessed. “What you can accomplish in a year with a gastric bypass you can accomplish in five years with a laparoscopic band.”

Results would improve if Americans copied the Australians and included in the price of the band any future adjustments, Livingston said.

“A key to the success of banding procedures is the followup and working with a patient on their compliance,” he said. “When they come in and they’ve sort of fallen off the wagon, you adjust the band. It really has an amazing effect.”

Bands also appear safer for women attempting pregnancy. Several years ago in Massachusetts, a woman and her 8-month-old fetus died of complications 18 months after gastric bypass surgery. Other pregnancy-related deaths have been reported.

In contrast, another study O’Brien and colleagues presented at the obesity meeting found that pregnancy outcomes for women with stomach bands were comparable to normal-weight women, and better than for obese women without bands.

Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City, did a band operation in October for Long Islander Donna Dotzler, who weighed 279 pounds, but wants to do a more drastic surgery for her husband.

“I gave up on New Year’s resolutions maybe five years ago,” said Jim Dotzler, who weighs 479 pounds. “I’m a smart guy. If this were a matter of willpower, I’d have taken care of this a long time ago.”

The operation Roslin has advised for him is BPD, which stands for biliopancreatic diversion, with or without a second procedure called a duodenal switch. Studies show it can cause loss of up to 80 percent of excess body weight for at least as long as 10 years afterward.

Surgeons remove three-fourths of the stomach to leave a sleeve- or banana-shaped organ that is connected to the small intestine, bypassing more of it than a standard gastric bypass does. It can be done in two operations a year apart to reduce its severity and the chances of death, which can be as high as 5 percent.

The “switch” preserves a valve that controls release of food into the intestines from the stomach. These operations account for nearly 5 percent of U.S. obesity surgeries and are growing.

On the horizon are other approaches, like vagus nerve stimulation, to control impulses to eat, and new drugs like rimonabant, which blocks a pleasure center in the brain that makes people want to munch.

“I see the future as combined therapy,” with surgery, medication and other approaches used simultaneously, said Aronne, the obesity society president. “Time will tell what works out best.”

Copyright © Associated Press Jan 1, 2006. Reproduced with permission of the copyright owner. Further reproduction or distribution is prohibited without permission.

 

 

On a Scale of Life or Death

by Valerie Reitman, Times Staff Writer / Los Angeles Times
Jan 4, 2006

It started with a terrible dream: Cyrus Tehrani had died. At the funeral, his wife and six children wept over his outsized coffin.

That nightmare jolted Joe Guarderas awake. He knew that if his best friend Cyrus, 34, didn’t take drastic action, the dream would become reality.

Cyrus had grown gargantuan. His girth had destroyed his knees, spiked his blood pressure, sapped his breath and landed him in the hospital for several days with severe leg swelling.

Cyrus’ older sister, Sheila Tehrani, 37, was just as big, and just as imperiled. Only a pound separated the siblings: Cyrus weighed 578, Sheila 579.

Guarderas hatched a plan. “If you knew Cyrus was going to die,” Guarderas recalled asking the healthier Sheila, “would you give anything to get him back?”

“In a heartbeat,” Sheila replied.

“Would you give up the house?”

“Of course,” Sheila replied.

Well, said Guarderas, “that’s what you may have to do.”

——————————————————————————–

That conversation late in 2004 launched the Tehranis’ last-ditch attempt to shed the weight that was slowly smothering them. Surgery to slash their food intake would cost at least $25,000 each. With no health insurer willing to pay, the only recourse was to refinance the house they had inherited from their father. Sheila still lives in a studio apartment behind the house.

Sheila researched options on the Internet and made an appointment with one of Los Angeles’ most experienced bariatric surgeons, Dr. Carson Liu.

Liu wondered if it was too late. Had the siblings become so huge that the surgery was too risky?

Vast numbers of Americans face a similar predicament. They have outgrown the weightiest medical description: morbid obesity. About 725,000 to a million people fit in this “super-obese” category.

But even that term is no longer expansive enough for the Tehranis and a fast-rising number of others. Between 140,000 and 400,000 Americans are believed to weigh more than 400 pounds. Liu dubs them the “super-duper” obese.

With a few hundred extra pounds severely straining every bodily organ, they appear to have one last hope: bariatric surgery.

But that surgery poses such grave risks for huge patients that many surgeons refuse to operate on them.

“They are at the end of their lives,” Liu said. “They are being operated on much too late. These are the patients that have bad congestive heart failure — their hearts can’t keep up with their bodies, which are falling apart.”

——————————————————————————–

By the time the Tehranis consulted Liu in early April 2005, they could walk only a few yards before becoming winded. Their arms puffed out like basketballs. Their distended bellies draped to their knees like sandbags. Restaurants with booths, chairs with armrests, airline flights, even clothes from shops catering to big and tall people — all were out of the question. (Cyrus jokes that labels on his clothes couldn’t accommodate all the Xs: he wore 7X shirts over 78-inch-waist pants.)

Stares were as painful as stairs for Sheila.

A pudgy child, she had grown quite heavy by high school, despite the attempts of her father — an engineer who immigrated to the United States from Iran — to police what she ate.

When she was 11, her father sent her to the now-defunct Schick behavioral modification center in Pasadena, where she received tiny electrical shocks as she took bites of a Hostess apple pie. Like the diets before, it didn’t work.

By her late 20s, she no longer could fit behind the wheel of her Toyota pickup truck. She sold it and gave up driving.

She grew more sedentary, rarely leaving her studio apartment in the back of the family house. Instead, she earned money baby-sitting the children whom relatives would take to her home.

Grocery shopping required exercising only her index finger — to dial Vons for delivery.

Cyrus, who as a husky teenager had biked and lifted weights, wedged himself behind the wheel of his Ford Windstar minivan (“thank God for tilt steering,” he says) to commute to Santa Ana, where he still makes DVD masters used to mass-produce movies and music.

The Vietnamese immigrant owners and workers there affectionately rub his belly and call him their Buddha. He calls the men there — and everywhere else — Slim. Other potential employers snubbed him because of his size, he says.

Caring for six children — three of his own with Karen, his wife of seven years, and her three children from a previous marriage — kept him busy.

But his stamina had dwindled. By the time Joe Guarderas talked to Cyrus’ sister, he could barely get out of bed or bend over to tie his shoes. To ease his aches and lower his blood pressure, he downed prescription and over-the-counter pills by the handful.

When he was in the hospital last spring with his leg problems, a cardiologist told him he’d be lucky to live 10 years.

But until Sheila convinced him of the serious health risk after Guarderas’ dream, Cyrus preferred to look at the “funny” side of being fat. He reveled in his young son’s riposte to an unkind remark by his kindergarten friend: “Wow, Gavin, your dad is really fat.”

“My daddy’s not fat,” Gavin shot back. “My daddy’s full of love.”

——————————————————————————–

The Tehranis certainly overate. They loved heaping portions of calorie-rich Persian foods — breads, rice, cheeses and kebabs. Cyrus often ate super-size fast-food combos for lunch and had a weakness for Ben & Jerry’s Chunky Monkey and Chubby Hubby ice cream, at about 600 calories per cup.

“If I knew I’d buy as much Ben & Jerry’s as I have, I’d have bought stock,” said Cyrus, who really packed on the pounds after quitting smoking in his 20s.

The siblings also ate to soothe bouts of depression after the deaths of their parents and a half-sister.

But the siblings and friends insist that they weren’t eating near the Costco-size quantities one would think necessary to be 400 pounds overweight. “It’s not like we were pulling up to a food trough,” Cyrus says.

Sheila said she did none of the things she heard others report at Overeaters Anonymous meetings. “I thought these people were sick, because they were eating out of the trash and were closet eaters,” she said.

All it takes to gain a pound a week is a 500-calorie surplus every day. That’s two Mrs. Fields cookies or a large order of McDonald’s fries.

A pound per week totes up 52 pounds annually. In five years, that’s 260 pounds.

The bigger the Tehranis got, the less they restrained themselves. At their size, what did one extra Krispy Kreme doughnut matter?

Surgeon Liu attributes two-thirds of super-obesity to genetics (many members of the Tehrani family are heavy, though not super-obese) and one-third to eating habits and lack of exercise.

Yo-yo dieting can make it worse.

“There is something that happens when fat cells starve,” Liu said. “It makes people extremely hungry, and they fall off their diets and gain the weight back so fast — and then maybe add an additional 20 pounds.”

Above 300 pounds, the weight seems to accrue even faster, Liu says, without “the patient — or anybody — realizing exactly why.”

——————————————————————————–

Few doctors have a scale that goes beyond 350 pounds. So Cyrus was shocked in April when he stood on Liu’s and it registered 150 pounds more than his last weigh-in four years earlier.

“I knew I had gotten fatter, but I never thought I would break that 500-pound mark,” Cyrus said. “And when I saw 578, I got sick to my stomach.”

Standing 5 feet 11, Cyrus had a weight-to-height ratio, or body mass index, of 81, more than triple the maximum 25 considered healthy for most adults. At 5 feet 2, Sheila had a body mass index of 106.

Cyrus’ health insurer refused to cover weight-loss surgery. Insurance companies typically want documentation that patients have tried dieting. The insurers blanch at the procedure’s mortality rates, and also fear that too many of the 20 million obese patients nationwide will sign up for their plans if they offer the surgery too readily, Liu said.

Sheila has no insurance.

By the time they saw Liu, the Tehranis, inspired by the huge weight losses of NBC weather forecaster Al Roker and singer Carnie Wilson, were convinced they needed a gastric bypass procedure.

But Liu told the Tehranis gastric bypass was too risky for them. Super-obese patients are 10 times more likely to die from bariatric surgery than those who are morbidly obese. And he warned that a serious complication necessitating hospitalization for a month could easily cost $300,000, virtually all the equity in their childhood home.

The only procedure he would do for them was the LAP-BAND® System adjustable gastric banding system, in which a synthetic ring is attached to the upper end of the stomach. Liu has performed more than 1,700 gastric bypasses and 350 using LAP-BAND® Systems. He said he prefers the latter because it is far less drastic and, unlike the bypass, is adjustable and reversible, though weight loss is slower.

If they still wanted a bypass, Liu assured the Tehranis, he would do it — after they each lost 150 pounds with LAP-BAND® Systems.

He instructed the siblings to lose 28 pounds, about 5% of their weight, before the surgery to show their determination, shrink their fatty livers and make the surgery easier.

The Tehranis delayed the start of their diets for a week until after Sheila’s birthday party. After that, they stuck to two protein shakes and one healthful, low-carbohydrate meal a day. In six weeks, Sheila dropped 28 pounds and Cyrus lost 19.

——————————————————————————–

But Liu said he was worried that swelling in Cyrus’ legs might indicate the right side of his heart was failing. He was concerned that Sheila’s fast pulse might mean her heart was starting to give out.

Liu said he needed to conduct tests for congestive heart failure. The overnight stay in the intensive-care unit at Olympia Medical Center, near Beverly Hills, cost the siblings $5,000 each.

On the last day of solid food before the operation, the Tehranis pigged out one last time. Cyrus downed a Tommy’s triple cheeseburger topped off by Chubby Hubby.

Sheila had higher standards. “I’m not investing my last meal on Tommy’s,” she recalled telling Cyrus. She opted for rice and kebabs from Shiraz restaurant in Glendale.

Liu dubbed such binges “last meal syndrome.”

Sheila barely slept the night before she and her bother entered the hospital. Cyrus’ children clung to him as he prepared to leave.

“When you come home, will you be skinny?” 5-year-old Jillian piped up.

He reassured them it wouldn’t be long before he could ride the rides at Disneyland with them — something he’s been too big to do since age 21.

At the hospital, Cyrus and Sheila nervously poked fun at each other. The only children of parents who divorced when they were 3 and 7, they have always been close and see (and tease) each other constantly.

“I told [wife] Karen I have atrophy of the jaw because I’m not chewing nearly as much,” Cyrus told Sheila.

“But you’re still talking,” Sheila shot back.

A nurse asked Cyrus if he had any valuables with him. He looked at Karen.

“Just her,” he said.

“Do you have an advance directive?” the nurse asked.

“She knows what I want,” Cyrus said.

As they were wheeled separately into their intensive care unit rooms, the Tehranis realized they wouldn’t see each other for a while.

“Bye, Fat,” Cyrus said to his sister.

When Liu looked askance, Cyrus explained that “fatso” was a name they fondly split.

“Bye, So,” she said.

——————————————————————————–

Liu worried as he walked out of the hospital that night, not so much about Cyrus, whose health had improved with the weight loss, but about Sheila. Her liver hadn’t shrunk much. So much fat still swathed her overburdened lungs that he worried she might not wake from the anesthesia.

The morning of June 7, their hearts were beating at triple the normal rate. But test results revealed no permanent damage. Liu gave the go-ahead for both.

Sheila was first. As music from David Gray’s “White Ladder” album poured into the operating room, Liu inserted an instrument equipped with a tiny camera into her navel. An image of her insides flashed onto monitors above the operating table.

He inserted three more tong-like cutting and suturing devices into her abdomen.

The long hours that Liu, 40, spent playing video games while growing up chagrined his Chinese immigrant parents, but they paid off professionally. Eyes glued to the monitor, he maneuvered the tools.

It took more than an hour to work through the hardened fat, which looked like yellow gel on the screen. Finally, Liu saw the left lobe of Sheila’s liver, swollen to the size of a five-pound steak from what is normally the size of an orange. The surgeon assisting him pulled it aside to reveal the stomach.

Liu positioned the inflatable LAP-BAND® System so it cinched her stomach into an asymmetrical hourglass shape, with 98% of the stomach below the band.

At 11 a.m., Liu finished the 2 1/2 -hour procedure. It had taken five times longer than usual.

“I’m hungry,” the fit, 6-foot, 1-inch Liu declared. He repaired to the hospital’s cafeteria for a two-hour break.

Cyrus’ abdominal wall was softer and his liver much smaller. Liu finished his procedure in just 50 minutes. The Tehranis went home the next day.

The LAP-BAND® System, which narrowed the stomach opening from the size of a silver dollar to the size of a dime, made the siblings feel stuffed. At first, they could down just liquids, then soft foods, like tofu and yogurt.

For the first month, Sheila was depressed. “I don’t know what it was — whether it was that food was always my outlet and now it was taken away or if it was because, being healthy all my life, this was the most I’d ever seen a doctor,” she said.

But she dropped 22 pounds by the time they next saw Liu, two weeks after surgery.

At a family cookout soon after, Cyrus and Sheila could eat only about one-third of a chicken breast and some green beans each.

By mid-July, Cyrus began to pull ahead; he had dropped 48 pounds in five weeks, 83 pounds total. Sheila had dropped 28 pounds, for a total of 61.

Sheila mentioned to Liu that she had eaten pasta and bread, albeit in tiny portions.

He reacted with horror.

“You ate bread?”

He told her it was time to tighten the LAP-BAND® System.

“He’s punishing me for eating bread,” she joked as Liu filled a syringe and pumped saline into the barely visible port opening in her chest, which was attached to the LAP-BAND® System device.

Cyrus began walking more around the neighborhood with his children.

Two months after the surgery, both Tehranis had dropped below 500 pounds. Cyrus had lost 97 pounds and Sheila 85. The whole family rented an RV and went camping at Lake Perris, the siblings’ first camping trip since they were kids.

At their October appointment, Sheila told Liu she needed “a LAP-BAND® System for my mind,” something to choke off the emotional issues and the habits that drove her to eat.

Sheila considered it a victory that she got by with just one tiny box of Junior Mints for Halloween. Cyrus carried his children’s trick-or-treat bags but abstained.

On the eve of the family’s Thanksgiving potluck dinner, Sheila made chocolate chip and gingerbread cookies, without sampling any batter, and ate only a few the next day. Cyrus ate some turkey and splurged on a dollop of homemade cranberry sauce.

He has become downright militant about sweets and starches, much to Sheila’s chagrin. She believes that eating a little of something she loves will prevent her from feeling deprived, then binging.

Cyrus has become zealous about going to Bally’s gym in Pasadena several nights a week to lift weights and walk on the treadmill. His children are asleep when he returns home.

“Every day I wake up and look into the faces of my motivation,” Cyrus said of them.

——————————————————————————–

It has been six months since the surgery. At their most recent appointment, early in December, Cyrus registered the loss of 19 more pounds, while Sheila showed a gain of 1 1/2 pounds. All told, Cyrus had lost 146 pounds and Sheila, 101.

Sheila was disappointed but refused to let Liu tighten the LAP-BAND® System. She already had trouble eating meat and told him it was painful to down more than half a cup of food at a time.

“There’s only so much you can eat, even if you do eat crap,” she said.

Liu told her she must start exercising. She vowed to get a treadmill. Cyrus suggested an elliptical trainer.

“Are you kidding?” she replied. “I’d start a fire with my calves” rubbing together.

Cyrus, meanwhile, complained to Liu that he was losing muscle as well as fat, despite his workouts and increased protein intake.

” ‘Boohoo, I’m losing weight,’ ” Sheila mocked.

She later said she felt “like we’re having two completely different experiences. He stands up at support group meetings — and he happens to be wearing a T-shirt that says ‘I had an IQ test and it came out negative’ — and he’s saying, ‘It’s all mental.’ He’s like, ‘Don’t eat it, don’t do it.’ I don’t know if it’s because he’s a man and I’m a woman, but I’m much more emotional.”

Though everyone praises her accomplishment, Sheila said she still imagines them thinking, “Oh, my God; you’re still so fat.”

The one thing the siblings — who were down to 432.6 and 477.6 pounds as of Dec. 7 — do agree on is how much the weight loss has changed their lives. “It’s amazing how much more energy I have now,” Cyrus said. “I’ve lost a whole person.”

Their faces look healthier. Sheila walked up a steep hill at Eagle Rock Hillside Park on Thanksgiving with the rest of the clan. She played in the inaugural Tehrani kickball game — though her 3-year-old niece served as pinch runner. For the first time in years, she went Christmas shopping, spending a few hours walking around the Glendale Galleria with her best friend.

Cyrus has lost 20 inches from his waist. He no longer needs medications and his blood pressure is nearly normal.

A few weeks after the operation, Karen called Guarderas to thank him for saving Cyrus’ life.

On New Year’s Eve, she reflected on how much better life is now that Cyrus can join the rest of the family in so many activities.

She choked up as she recalled the cardiologist’s grim 2004 warning that Cyrus wasn’t likely be around much longer and how she tried to protect the children from that prediction.

They sensed the looming threat, she believes: Jillian hated to leave Cyrus’ side, not wanting to go to kindergarten, sometimes even trying to sneak home. Now, she loves school.

And so the Tehranis don’t mind paying $730 more each month for the next 30 years to pay off the $100,000 home-equity loan they took out to pay for their transformation and the surgery they may need in the future to cut off the folds of skin. Said Sheila: “Oh, my God, we are so lucky we had the option…. How do you put a price on your life?”

——————————————————————————–

The Times will follow the Tehranis’ progress with occasional articles in the paper and on latimes.com. The writer can be reached at Valerie.Reitman@latimes.com.

Copyright © 2006 Los Angeles Times. All right reserved. Republished with permission.

Health Risks of Being Overweight

Do You Know the Health Risks of Being Overweight ?

  • Type 2 diabetes
  • Heart disease and stroke
  • Body Mass Index Table
  • Cancer
  • Sleep apnea
  • Osteoarthritis
  • Gallbladder disease
  • Fatty liver disease
  • How can I lower my health risks?
  • Additional resources

Weighing too much may increase your risk for developing many health problems. If you are overweight or obese on a body mass index (BMI) chart, you may be at risk for:

  • Type 2 diabetes
  • Heart disease and stroke
  • Cancer
  • Sleep apnea
  • Osteoarthritis
  • Gallbladder disease
  • Fatty liver disease.

You can lower your health risks by losing as little as 10 to 20 pounds.

Type 2 diabetes

What is it?

Type 2 diabetes used to be called adult-onset diabetes or noninsulin-dependent diabetes. It is the most common type of diabetes in the U.S. Type 2 diabetes is a disease in which blood sugar levels are above normal. High blood sugar is a major cause of early death, heart disease, kidney disease, stroke, and blindness.

How is it linked to overweight?
More than 80 percent of people with type 2 diabetes are overweight. It is not known exactly why people who are overweight are more likely to suffer from this disease. It may be that being overweight causes cells to change, making them less effective at using sugar from the blood. This then puts stress on the cells that produce insulin (a hormone that carries sugar from the blood to cells) and makes them gradually fail.

What can weight loss do?
You can lower your risk for developing type 2 diabetes by losing weight and increasing the amount of physical activity you do. If you have type 2 diabetes, losing weight and becoming more physically active can help you control your blood sugar levels. Losing weight and exercising more may also allow you to reduce the amount of diabetes medication you take.

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Heart disease and stroke

What is it?

Heart disease means that the heart and circulation (blood flow) are not functioning normally. If you have heart disease, you may suffer from a heart attack, congestive heart failure, sudden cardiac death, angina (chest pain), or abnormal heart rhythm. During a stroke, blood and oxygen do not flow normally to the brain, possibly causing paralysis or death. Heart disease is the leading cause of death in the U.S., and stroke is the third leading cause.

How is it linked to overweight?
People who are overweight are more likely to suffer from high blood pressure, high levels of triglycerides (blood fats) and LDL cholesterol (a fat-like substance often called the “bad cholesterol”), and low levels of HDL cholesterol (the “good cholesterol”). These are all risk factors for heart disease and stroke. In addition, people with more body fat have higher blood levels of substances that cause inflammation. Inflammation in blood vessels and throughout the body may raise heart disease risk.

What can weight loss do?
Losing 5 to 15 percent of your weight can lower your chances for developing heart disease or having a stroke. If you weigh 200 pounds, this means losing as little as 10 pounds. Weight loss may improve your blood pressure, triglyceride, and cholesterol levels; improve how your heart works and your blood flows; and decrease inflammation throughout your body. Results may vary from person to person.

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Body Mass Index Table

To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight. The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.

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Cancer

What is it?

Cancer occurs when cells in one part of the body, such as the colon, grow abnormally or out of control and possibly spread to other parts of the body, such as the liver. Cancer is the second leading cause of death in the U.S.

How is it linked to overweight?
Being overweight may increase the risk of developing several types of cancer, including cancers of the colon, esophagus, and kidney. Overweight is also linked with uterine and postmenopausal breast cancer in women. Gaining weight during adult life increases the risk for several of these cancers. Being overweight also may increase the risk of dying from some cancers. It is not known exactly how being overweight increases cancer risk. It may be that fat cells make hormones that affect cell growth and lead to cancer. Also, eating or physical activity habits that may lead to being overweight may also contribute to cancer risk.

What can weight loss do?
Avoiding weight gain may prevent a rise in cancer risk. Weight loss, and healthy eating and physical activity habits, may lower cancer risk.

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Sleep apnea

What is it?

Sleep apnea is a condition in which a person stops breathing for short periods during the night. A person who has sleep apnea may suffer from daytime sleepiness, difficulty concentrating, and even heart failure.

How is it linked to overweight?
The risk for sleep apnea is higher for people who are overweight. A person who is overweight may have more fat stored around his or her neck. This may make the airway smaller. A smaller airway can make breathing difficult, loud (snoring), or stop altogether. In addition, fat stored in the neck and throughout the body can produce substances that cause inflammation. Inflammation in the neck may be a risk factor for sleep apnea.

What can weight loss do?
Weight loss usually improves sleep apnea. Weight loss may help to decrease neck size and lessen inflammation.

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Osteoarthritis

What is it?

Osteoarthritis is a common joint disorder. With osteoarthritis, the joint bone and cartilage (tissue that protects joints) wear away. Osteoarthritis most often affects the joints of the knees, hips, and lower back.

How is it linked to overweight?
Extra weight may place extra pressure on joints and cartilage, causing them to wear away. In addition, people with more body fat may have higher blood levels of substances that cause inflammation. Inflammation at the joints may raise the risk for osteoarthritis.

What can weight loss do?
Weight loss can decrease stress on your knees, hips, and lower back, and lessen inflammation in your body. If you have osteoarthritis, losing weight may help improve your symptoms.

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Gallbladder disease

What is it?

Gallstones are clusters of solid material that form in the gallbladder. They are made mostly of cholesterol and can sometimes cause abdominal or back pain.

How is it linked to overweight?
People who are overweight have a higher risk for developing gallbladder disease and gallstones. They may produce more cholesterol, a risk factor for gallstones. Also, people who are overweight may have an enlarged gallbladder, which may not work properly.

What can weight loss do?
Weight loss — especially fast weight loss (more than 3 pounds per week) or loss of a large amount of weight — can actually increase your chance of developing gallstones. Modest, slow weight loss of about 1/2 to 2 pounds a week is less likely to cause gallstones.

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Fatty liver disease

What is it?

Fatty liver disease occurs when fat builds up in the liver cells and causes injury and inflammation in the liver. It can sometimes lead to severe liver damage, cirrhosis (build-up of scar tissue that blocks proper blood flow in the liver), or even liver failure. Fatty liver disease is like alcoholic liver damage, but it is not caused by alcohol and can occur in people who drink little or no alcohol. The National Digestive Diseases Information Clearinghouse (NDDIC) has more information on fatty liver disease or nonalcoholic steatohepatitis (NASH).

How is it linked to overweight?
People who have diabetes or “pre-diabetes” (when blood sugar levels are higher than normal but not yet in the diabetic range) are more likely to have fatty liver disease than people without these conditions. And people who are overweight are more likely to have diabetes (see Type 2 diabetes above). It is not known why some people who are overweight or diabetic get fatty liver and others do not.

What can weight loss do?
Losing weight can help you control your blood sugar levels. It can also reduce the build-up of fat in your liver and prevent further injury. People with fatty liver disease should avoid drinking alcohol.

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How can I lower my health risks?

If you are overweight, losing as little as 5 percent of your body weight may lower your risk for several diseases, including heart disease and diabetes. If you weigh 200 pounds, this means losing 10 pounds. Slow and steady weight loss of 1/2 to 2 pounds per week, and not more than 3 pounds per week, is the safest way to lose weight.

To lose weight and keep it off over time, try to make long-term changes in your eating and physical activity habits. Choose healthy foods, such as vegetables, fruits, whole grains, and low-fat meat and dairy products, more often and eat just enough food to satisfy you. Try to do at least 30 minutes of moderate-intensity physical activity— walking— most days of the week, preferably every day. To lose weight, or to maintain weight loss, you may need to do more than 30 minutes of moderate physical activity daily.

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Additional resources

National Cancer Institute
NCI Public Inquiries Office
Suite 3036A
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322
Phone: 1-800-4-CANCER (1-800-422-6237)
TTY: 1-800-332-8615
http://www.nci.nih.gov/

National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Phone: 1-800-860-8747 or (301) 654-3327
http://diabetes.niddk.nih.gov/

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
Phone: 1-800-891-5389 or (301) 654-3810
http://digestive.niddk.nih.gov/

National Heart, Lung, and Blood Institute
NHLBI Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
TTY: (240) 629-3255
http://www.nhlbi.nih.gov/

National Institute of Arthritis and Musculoskeletal and Skin Diseases
Information Clearinghouse
1 AMS Circle
Bethesda, Maryland 20892-3675
Phone: 1-877-22-NIAMS (1-877-226-4267) or (301) 495-4484
TTY: (301) 565-2966
http://www.niams.nih.gov/

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Statistics Related to Obesity

Statistics Related to Overweight and Obesity

  • What are overweight and obesity?
  • How are weight-related health risks determined?
  • Body Mass Index Table
  • Why do statistics about overweight and obesity differ?
  • Prevalence Statistics Related to Overweight and Obesity
  • Economic Costs Related to Overweight and Obesity
  • Other Statistics Related to Overweight and Obesity

About two-thirds of adults in the United States are overweight, and almost one-third are obese, according to data from the National Health and Nutrition Examination Survey (NHANES) 2001 to 2004. This fact sheet presents statistics on the prevalence of overweight and obesity in the United States, as well as the health risks, mortality rates, and economic costs associated with these conditions. To understand these statistics, it is necessary to know how overweight and obesity are defined and measured, something this publication addresses. This fact sheet also explains why statistics from different sources may not match.

Overweight and obesity are known risk factors for:

  • diabetes
  • coronary heart disease
  • high blood cholesterol
  • stroke
  • hypertension
  • gallbladder disease
  • osteoarthritis (degeneration of cartilage and bone of joints)
  • sleep apnea and other breathing problems
  • some forms of cancer (breast, colorectal, endometrial, and kidney)

Obesity is also associated with:

  • complications of pregnancy
  • menstrual irregularities
  • hirsutism (presence of excess body and facial hair)
  • stress incontinence (urine leakage caused by weak pelvic floor muscles)
  • psychological disorders, such as depression
  • increased surgical risk
  • increased mortality

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What are overweight and obesity?

Overweight refers to an excess of body weight compared to set standards. The excess weight may come from muscle, bone, fat, and/or body water. Obesity refers specifically to having an abnormally high proportion of body fat.[1] A person can be overweight without being obese, as in the example of a bodybuilder or other athlete who has a lot of muscle. However, many people who are overweight are also obese.

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How are weight-related health risks determined?

Various methods are used to determine if someone’s weight has increased his or her health risks. Some are based on the relationship between height and weight; others are based on measurements of body fat. The most commonly used method today is the body mass index (BMI). BMI is an index of weight adjusted for the height of an individual.

BMI can be used to screen for both overweight and obesity in adults. It is the measurement of choice for many obesity researchers and other health professionals, as well as the definition used in most published information on overweight and obesity. BMI is a calculation based on height and weight, and it is not gender-specific in adults. BMI does not directly measure percentage of body fat, but it is a more accurate indicator of overweight and obesity than relying on weight alone.

BMI is calculated by dividing a person’s weight in kilograms by height in meters squared. The mathematical formula is “weight (kg)/height (m²).”

To determine BMI using pounds and inches, multiply weight in pounds by 704.5,* divide the result by height in inches, and then divide that result by height in inches a second time. (You can also use the BMI calculator at www.nhlbisupport.com/bmi or check the chart below.)

* The multiplier 704.5 is used by the National Institutes of Health (NIH). Other organizations may use a slightly different multiplier; for example, the American Dietetic Association suggests multiplying by 700. The variation in outcome (a few tenths) is insignificant.

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Body Mass Index Table

To use the table, find the appropriate height in the left-hand column and then move across to a given weight. The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.

Source: Clinical Guidelines on Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, NHLBI, September 1998

An expert panel convened by the National Heart, Lung, and Blood Institute (NHLBI) in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), both part of NIH, identified overweight as a BMI of 25 to 29.9 kg/m², and obesity as a BMI of 30 kg/m² or greater. However, overweight and obesity are not mutually exclusive, since people who are obese are also overweight.[1] Defining overweight as a BMI of 25 or greater is consistent with the recommendations of the World Health Organization (WHO)[2] and most other countries.

Calculating BMI is simple, quick, and inexpensive—but it does have limitations. One problem with using BMI as a measurement tool is that very muscular people may fall into the “overweight” category when they are actually healthy and fit. Another problem with using BMI is that people who have lost muscle mass, such as the elderly, may be in the “healthy weight” BMI category (BMI 18.5 to 24.9) when they actually have reduced nutritional reserves. BMI, therefore, is useful as a screening tool for individuals and as a general guideline to monitor trends in the population, but by itself is not diagnostic of an individual patient’s health status. Further assessment of patients should be performed to evaluate their weight status and associated health risks.

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Why do statistics about overweight and obesity differ?

The definitions or measurement characteristics for overweight and obesity have varied over time, from study to study, and from one part of the world to another. The varied definitions affect prevalence statistics and make it difficult to compare data from different studies. Prevalence refers to the total number of existing cases of a disease or condition in a given population at a given time. Some overweight- and obesity-related prevalence rates are presented as crude or unadjusted estimates, while others are age-adjusted estimates. Unadjusted prevalence estimates are used to present cross-sectional data for population groups at a given point or time period, without accounting for the effect of different age variations among groups. For age-adjusted rates, statistical procedures are used to remove the effect of age differences when comparing two or more populations at one point in time, or one population at two or more points in time. Unadjusted estimates and age-adjusted estimates will yield slightly different values.

Previous studies in the United States have used the 1959 or the 1983 Metropolitan Life Insurance tables of desirable weight-for-height as the reference for overweight.[3] More recently, many Government agencies and scientific health organizations have estimated overweight using data from a series of cross-sectional surveys called the National Health Examination Surveys (NHES) and NHANES. The National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC) conducted these surveys. Each had three cycles: NHES I, II, and III spanned the period from 1960 to 1970, and NHANES I, II, and III were conducted in the 1970s, 1980s, and early 1990s. Since 1999, NHANES has become a continuous survey.

Many earlier reports use a statistically derived definition of overweight from NHANES II (1976 to 1980). This definition (based on the gender-specific 85th percentile values of BMI for 20- to 29-year-olds) is a BMI greater than or equal to (>) 27.3 for women and 27.8 for men. NHANES II further defines “severe overweight” (based on 95th percentile values) as a BMI > 31.1 for men and a BMI > 32.2 for women.[4] Some studies round these numbers to a whole number, which affects the statistical prevalence. In 1995, WHO recommended a classification for three “grades” of overweight using BMI cutoff points of 25, 30, and 40.[5] WHO suggested an additional cutoff point of 35 and slightly different terminology in 1998.[2]

The expert panel convened by NHLBI and NIDDK released a report in September 1998 that provided definitions for overweight and obesity similar to those used by WHO. The panel identified overweight as a BMI > 25 to less than (30. These definitions, widely used by the Federal Government and more frequently by the broader medical and scientific communities, are based on evidence that health risks increase in individuals with a BMI > 25.

BMI cutoff points are a guide for definitions of overweight and obesity and are useful for comparative purposes across populations and over time; however, the health risks associated with overweight and obesity are on a continuum and do not necessarily correspond to rigid cutoff points. For example, an overweight individual with a BMI of 29 does not acquire additional health consequences associated with obesity simply by crossing the BMI threshold of > 30. However, health risks generally increase with increasing BMI.

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Prevalence Statistics Related to Overweight and Obesity*

Overweight and obesity are found worldwide, and the prevalence of these conditions in the United States ranks high along with other developed nations.

Below are some frequently asked questions and answers about overweight and obesity statistics. Data are based on NHANES 2001 to 2004. Unless otherwise specified, the figures given represent age-adjusted estimates. Age-adjusted estimates are used in order to account for the age variations among the groups being compared. Population numbers are based on estimates from the U.S. Census Bureau’s Current Population Survey.

Q: How many adults age 20 and older are overweight or obese (BMI > 25)?

A: About two-thirds of U.S. adults are overweight or obese.[6]

All adults: 133.6 million (66 percent)
Women: 65 million (61.6 percent)
Men: 68.3 million (70.5 percent)

* The statistics presented here are based on the following definitions unless otherwise specified: healthy weight = BMI > 18.5 to < 25; overweight = BMI > 25 to < 30; obesity = BMI > 30; and extreme obesity = BMI > 40.

Q: How many adults age 20 and older are obese (BMI > 30)?

A: Nearly one-third of U.S. adults are obese.[6]

All adults: 63.6 million (31.4 percent)
Women: 35 million (33.2 percent)
Men: 28.6 million (29.5 percent)

Q: How many adults age 20 and older are at a healthy weight (BMI > 18.5 through 24.9)?

A: Less than one-third of U.S. adults are at a healthy weight.[6]

All adults: 65.4 million (32.3 percent)
Women: 38.1 million (36.1 percent)
Men: 27.4 million (28.3 percent)

Q: How has the prevalence of overweight and obesity in adults changed over the years?

A: The prevalence has steadily increased over the years among both genders, all ages, all racial and ethnic groups, all educational levels, and all smoking levels.[7] From 1960 to 2004, the prevalence of overweight increased from 44.8 to 66 percent in U.S. adults age 20 to 74.[6] The prevalence of obesity during this same time period more than doubled among adults age 20 to 74 from 13.3 to 32.1 percent, with most of this rise occurring since 1980.[6]

Q: What is the prevalence of overweight or obesity in minorities?

A: Among women, the age-adjusted prevalence of overweight or obesity (BMI > 25) in racial and ethnic minorities is higher among non-Hispanic Black and Mexican-American women than among non-Hispanic White women. Among men, there is little difference in prevalence among these three groups [6]. Sufficient data for other racial and ethnic minorities has not yet been collected.

Non-Hispanic Black Women: 79.6 percent
Mexican-American Women: 73 percent
Non-Hispanic White Women: 57.6 percent

Non-Hispanic Black Men: 67 percent
Mexican-American Men: 74.6 percent
Non-Hispanic White Men: 71 percent
(Statistics are for populations age 20 and older.)

Studies using this definition of overweight and obesity provide ethnicity-specific data only for these three racial and ethnic groups. Studies using different BMI cutoff points derived from NHANES II data to define overweight and obesity have reported a high prevalence of overweight and obesity among Hispanics and American Indians. The prevalence of overweight and obesity in Asian Americans is lower than in the population as a whole.[1]

Q: What is the prevalence of overweight and obesity in children and adolescents?

A: While there is no generally accepted definition for obesity as distinct from overweight in children and adolescents, the prevalence of overweight* is increasing for children and adolescents in the United States. Approximately 17.5 percent of children (age 6 to 11) and 17 percent of adolescents (age 12 to 19) were overweight in 2001 to 2004.[6]

* Overweight is defined by the sex- and age-specific 95th percentile cutoff points of the 2000 CDC growth charts. These revised growth charts incorporate smoothed BMI percentiles and are based on data from NHES II (1963 to 1965) and III (1966 to 1970), and NHANES I (1971 to 1974), II (1976 to 1980), and III (1988 to 1994). The CDC BMI growth charts specifically excluded NHANES III data for children older than 6 years.[8]

Figure 1. Overweight and Obesity, by Age: United States, 1960-2004

Source: CDC/NCHS, Health, United States, 2006

Q: What is the mortality rate associated with obesity?

A: Most studies show an increase in mortality rates associated with obesity. Individuals who are obese have a 10- to 50-percent increased risk of death from all causes, compared with healthy weight individuals (BMI 18.5 to 24.9). Most of the increased risk is due to cardiovascular causes.[1] Obesity is associated with about 112,000 excess deaths per year in the U.S. population relative to healthy weight individuals.[9]

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Economic Costs Related to Overweight and Obesity

As the prevalence of overweight and obesity has increased in the United States, so have related health care costs—both direct and indirect. Direct health care costs refer to preventive, diagnostic, and treatment services such as physician visits, medications, and hospital and nursing home care. Indirect costs are the value of wages lost by people unable to work because of illness or disability, as well as the value of future earnings lost by premature death.

Most of the statistics presented here represent the economic cost of overweight and obesity in the United States in 1995, updated to 2001 dollars.[10] Unless otherwise noted, these statistics are adapted from Wolf and Colditz,[11] who based their data on existing epidemiological studies that defined overweight and obesity as a BMI > 29. Because the prevalence of overweight and obesity has increased since 1995, the costs today are higher than the figures given here.

Q: What is the cost of overweight and obesity?

A: Total Cost: $117 billion
Direct Cost: $61 billion*
Indirect Cost: $56 billion

*A recent study estimated annual medical spending due to overweight and obesity (BMI >25) to be as much as $92.6 billion in 2002 dollars—9.1 percent of U.S. health expenditures.[12]

Q: What is the cost of lost productivity related to overweight and obesity?

A: The cost of lost productivity related to obesity among Americans age 17 to 64 is $3.9 billion. This value considers the following annual numbers (for 1994):

Workdays lost: $39.3 million
Physician office visits: $62.7 million
Restricted-activity days: $239 million
Bed-days: $89.5 million

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Other Statistics Related to Overweight and Obesity

Q: How physically active is the U.S. population?

A: Only 26 percent of U.S. adults engage in vigorous leisure-time physical activity three or more times per week (defined as periods of vigorous physical activity lasting 10 minutes or more). About 59 percent of adults do no vigorous physical activity at all in their leisure time.[13]

About 25 percent of young people (age 12 to 21) participate in light-to-moderate activity (e.g., walking, bicycling) nearly every day. About 50 percent regularly engage in vigorous physical activity. Approximately 25 percent report no vigorous physical activity, and 14 percent report no recent vigorous or light-to-moderate physical activity.[14]

Q: What is the cost of physical inactivity?

A: The direct cost of physical inactivity may be as high as $24.3 billion.[15]

Q: What are the benefits of physical activity?

A: In addition to helping control weight, physical activity decreases the risk of dying from coronary heart disease and reduces the risk of developing diabetes, hypertension, and colon cancer.[14]

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Obesity Complications

A person is considered overweight if they have a BMI of 25-30 and if the BMI is >30 they are considered extremely overweight or obese (see BMI index table). There are many medical complications of obesity which cause serious health problems. These medical complications of obesity are a leading cause of preventable death.

The most serious of these medical conditions include:

  • Stroke
  • Heart Disease (Coronary Artery Disease)
  • High Blood pressure
  • Cancer
  • Diabetes
  • Respiratory Disease and Asthma
  • Elevated Cholesterol & Triglycerides
  • Sleep Apnea

Obesity is also related to other conditions such as:

  • Joint problems & Back Pain (osteoarthritis)
  • Infertility & Menstrual Irregularities
  • Reflux Esophagitis (Heart Burn)
  • Gallbladder Disease
  • Emotional problems (Depression, poor self-esteem & anxiety)
  • Inactive & Anti-Social lifestyle
  • Poor Hygiene
  • Osteoporosis
  • Skin Infections and Ulcers
  • Urinary Incontinence
  • Poor Venous Circulation
  • Low Energy

In addition, most overweight patients typically suffer the consequences and effects of lost time at work.

The good news is that many of these medical conditions can be reversed & controlled as a direct result of weight loss so patients can live a better quality life.

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