Obesity and Metabolic Syndrome
Overweight and obesity are chronic conditions with many causes, not a lack of willpower. This page explains what makes weight loss hard, when the glands should be checked, what metabolic syndrome means, what options treatment generally has, and why we do not promise results from any method.
What is obesity, and why is it not a “lack of willpower”?
The NHS writes that obesity means the body has more fat than it needs, and this raises the risk of serious conditions. WHO calls it a chronic disease in which the environment, psychology and the body’s biology, including genetic predisposition, play a role. WHO writes that environments that make healthy, affordable food hard to get and limit safe activity also play a role in this disease. So the person alone is not at fault.
There is no place for blame here. Having obesity is not the same as laziness or a lack of willpower. People’s bodies differ, and some medical causes can be checked and treated.
Measures
The NHS and WHO use body mass index (BMI): weight in kilograms divided by the square of height in meters. For adults, 25 to 29.9 is overweight and 30 or more is obesity. The NHS writes that people of South Asian, Chinese, other Asian, Middle Eastern and African background are at risk at a lower BMI too: 23 to 27.4 is overweight and 27.5 or more is obesity. BMI cannot tell muscle from fat.
For people with a BMI under 35, the NHS also suggests the waist-to-height ratio: the waist should be less than half the height.
What makes weight loss hard?
The NHS gives a list: an eating disorder, depression, an illness or disability that limits movement, an underactive thyroid, Cushing’s syndrome, polycystic ovary syndrome, some medicines (some cortisones, antidepressants and beta blockers), genetics, age over 55 and menopause. If you have any of these or feel its symptoms, raise it with the doctor.
Complications and risks
The NHS writes that obesity raises the risk of type 2 diabetes, heart disease, stroke, high blood pressure, fatty liver and osteoarthritis. Some cancers are also on the list. Shortness of breath, tiredness, joint and back pain, snoring and depression are also possible. This is not meant to frighten. The main goal of treatment is to reduce these very risks.
Who should be seen?
The NHS says that if your BMI is in the overweight or obese range and:
- you want help to lose weight,
- your waist is more than half your height,
- you have prediabetes, diabetes, high blood pressure, high cholesterol, sleep apnea, joint pain or heart disease,
- obesity runs in the family,
- you suspect an eating disorder such as binge eating,
make an appointment. If another condition has made weight control hard, that is also a reason.
What does treatment generally look like?
NIDDK writes that treatment usually starts with healthy food and more activity, and the goal is gradual loss. The options, in order:
- Lifestyle: structured programs, according to NIDDK, at least 14 counseling sessions in six months, an eating plan matched to your needs, at least 150 minutes of moderate aerobic activity a week, and a daily record of food and activity. The NHS writes a goal of 0.5 to 1 kilogram a week and cutting back on fat, sugar and alcohol. The NHS says that losing 5 to 10 percent of weight can also improve health.
- Medicine: when lifestyle is not enough. The NHS names groups such as GLP-1 and GIP agonists and orlistat. These reduce appetite or reduce fat absorption and are used together with a low-calorie diet and activity. Prescribing and monitoring are up to the doctor.
- Metabolic and obesity surgery: NIDDK writes that it is usually considered for a BMI of 35 or higher and sometimes at a lower BMI with a serious accompanying condition. The NHS says the threshold is lower for some ethnic groups.
- Support programs: The NHS also names weight management programs with a coach, cognitive behavioral therapy and groups.
NIDDK states plainly that losing weight is hard and keeping it off is too, and that the benefits are possible, not certain. We also do not promise results. The plan is different for each person.
Metabolic syndrome
NHLBI writes that metabolic syndrome is a cluster of conditions that together raise the risk of heart disease, diabetes and stroke. It is present if you have three or more of these five: a large waist, high blood pressure, high blood sugar, high triglycerides, low HDL. NHLBI says it can usually be prevented with lifestyle change. Monitor each of these five separately, with the doctor.
When to get urgent help
Excess weight is not an emergency by itself. But if you have diabetes and high blood sugar comes with severe thirst, vomiting, fast breathing or confusion, call 115 (Iran’s emergency number; not valid abroad). See the full list in the guide “When should I call right away?”
Frequently asked questions
Why don't I lose weight even though I eat little?
The NHS writes that weight is not only a matter of calories and activity. Depression, conditions that limit movement, an underactive thyroid, Cushing's syndrome, polycystic ovary syndrome, some medicines (such as some cortisones, antidepressants and beta blockers), genetics, age over 55 and menopause also make it harder. If you are concerned, talk to the doctor to see whether there is a medical cause.
Are my glands causing my obesity?
They may play a part, but not always. WHO describes obesity as a chronic disease in which environmental, psychological and biological factors, including genetic predisposition, play a role. If you have excess weight along with tiredness, irregular periods, excess hair or easy bruising, targeted tests are needed.
Do I need medicine or surgery?
NIDDK writes that treatment usually starts with food and activity. Medicine is for when these are not enough, and surgery is mostly for a body mass index of 35 or higher, or lower than that with an accompanying condition such as type 2 diabetes or sleep apnea. The NHS writes that the thresholds are lower for ethnic groups that include the Middle East. The decision is up to the doctor and you.
How much weight should I lose, and how fast?
The NHS writes of gradual loss, about half a kilogram to one kilogram a week, and NIDDK gives an initial goal such as 5 percent of weight in about six months as an example. Both say that even this amount can improve blood pressure and blood sugar. Sudden or self-directed loss, especially with medicine or a very strict diet, is not safe without guidance.
What does metabolic syndrome mean?
NHLBI writes that it is when you have at least three of these five: a large waist, high blood pressure, high blood sugar, high triglycerides and low HDL. Together these raise the risk of heart disease, stroke and diabetes. It can usually be prevented or improved with lifestyle change.
Can I get weight-loss medicines from a pharmacy and start them myself?
The NHS describes them as medicines used together with a low-calorie diet and activity, and they need support even after stopping. The choice of medicine, the type, the schedule and the monitoring of side effects are up to the doctor. Do not start without the doctor's opinion.