Issue link: https://www.massageandbodyworkdigital.com/i/992435
A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 41 The World Obesity Federation defines this condition as "a chronic, relapsing, progressive disease process." The American Association of Clinical Endocrinologists suggests a new label: adiposity-based chronic disease (ABCD). This is an attempt to steer attention toward the pathophysiology of this condition and away from associated value judgments. DIAGNOSIS AND STATISTICS The body-mass index (BMI) is a formula used to describe a person's weight/height ratio. Statistically, we can predict an increased risk for certain complications when people have high BMIs, but these numbers are notoriously imprecise, especially at the lower end of the overweight spectrum. Tall and proportionate people or large and very athletic people may have "high" BMIs and still be healthy and fit, for instance. Also, BMI-related risk profiles show some racial disparities. For whites, the lowest risk of weight-related complications is with a BMI under 30, but for blacks the risk starts sooner: their target is under 25. Asians' optimal weight is lower still, with variances for specific ethnic origins. "I hate that every time I visit the doctor, or even a massage therapist, I am automatically seen as a walking risk factor. Well, I bet my blood pressure, my cholesterol, and my A1C readings are better than yours." —Ann Blair Kennedy, DrPH, athlete, and clinical assistant professor at University of South Carolina School of Medicine, Greenville Tools other than the BMI to determine obesity or the percentage of body fat exist, but in the United States it is the main diagnostic criterion for obesity, following these guidelines: BMI 18.5–24.9 Optimal weight 25–29.9 Overweight 30–34.9 Class 1 obesity 35–39.9 Class 2 obesity 40 or higher Class 3 obesity Obesity is an important health problem in the United States and other industrialized countries. In 2017, it was estimated that 31.4 percent of the population over age 20 in the United States were obese (that's 78 million people), and that number continues to grow at an alarming pace. We spend almost $200 billion a year on this situation—and this does not include the $121 billion spent on weight-loss products. A person with this condition incurs almost $3,000 more in health costs each year than a person who is not obese. PATHOPHYSIOLOGY: WHAT DO WE UNDERSTAND ABOUT OBESITY? Obesity is clearly the result of taking in more energy in the form of calories than is expended in the work of daily activities, but the process and its repercussions are extremely complicated. Other factors, including the types of calories consumed, how well a person sleeps, levels of stress and distress, medications, and even what kind of neighborhood a person lives in, can all have influence on weight gain and barriers to weight loss. Fat cells, or adipocytes, are distributed all over the body. The two places we are most interested in are the abdomen (central fat) and the superficial fascia (peripheral fat). We used to think of fat cells as passive storage tanks, but we know now that they are metabolically active, and they secrete a vast array of hormones and other chemicals. For this reason, obesity is often discussed as an endocrine system issue. The secretions that fat cells produce, especially those in the abdomen, are pro-inflammatory, promote blood coagulation, and influence insulin sensitivity and appetite regulation. As we have learned more about adipocytokines (chemicals secreted by fat cells), we have come to understand that obesity becomes a self-sustaining condition. In other words, once a person's physiology and internal chemistry has changed, it becomes increasingly difficult to reverse that change. Eating less food makes metabolism slow down—no weight loss. In fact, dieting is a recognized contributor to obesity. Moderate exercise has less impact on calorie burning for this population. The sense of appetite changes: people who are obese are less sensitive to the hormones that signal satiety (having had enough to eat). Even the sense of smell (which triggers appetite) is often stronger in people who are overweight than it is in others. Experts who study obesity in the United States and around the world have compiled a long list of contributing factors, some of which overlap each other. These include: metabolic factors, endocrine factors, socioeconomic factors, psychological factors, genetic factors, race, sex, age, dietary habits, pregnancy and menopause, level of physical activity, ethnic and cultural factors, smoking cessation, or history of gestational diabetes.