Overweight

What is obesity?

Being overweight or obese (severely overweight) occurs when the amount of energy a person consumes through eating and drinking is higher than the body burns for a longer period of time. Overweight and obesity involve the storage of excess fat in the body, which can ultimately lead to health problems.

How does obesity arise

There are several factors that can contribute to the development of obesity and the difficulty in losing weight. These are the obesogenic environment, individual causes and genetic influences.

When energy-rich food is available everywhere and all day long, the temptation to eat and drink too much and too often is therefore great. In addition, the need to exercise is less, as public transport is available.

Causes of obesity

Everyone gains weight for different reasons, such as eating and drinking too much (unhealthy):

• Eating too large portions.
• Eating too many foods and/or meals with a high energy density.
• Too much snacking.
• Drinking too many sugary drinks such as soft drinks and juice.
• Drinking too much alcohol. Alcoholic drinks contain many calories. Too much alcohol can therefore lead to obesity.
• Eating while distracted (e.g. watching television while eating) can cause you to eat more than your body needs.
• Less exercise and sport, for example due to illness, injury or lack of time.
• Lifestyle changes due to living together, having children, unemployment or retirement.
• Quitting smoking. However, stopping smoking is very important for your health, so it is advisable to start losing weight after you have stopped smoking, if necessary. A general practitioner can refer you to a stop smoking course.
• After pregnancy, it can be difficult to get back to the weight you were at before pregnancy, especially if you gain more weight than you should.
• There are certain types of medicines that can cause weight gain
• Mental problems, such as unprocessed experiences and mental traumas, can cause eating binges. In addition, there seems to be a link between depression/depressive symptoms and obesity.

Genetic influence on obesity

Weight is partly determined by a predisposition in the family. People with a predisposition to obesity gain weight more easily if they eat a lot and take little exercise. It may also be more difficult for them to lose the weight.

The role of sleep and stress in obesity

Lack of sleep may be linked to obesity, among other things because little or no sleep can affect energy intake and therefore body weight. Long-term stress (chronic stress) may also be associated with obesity through increased fat storage in the abdomen, changed food preferences and because stress leads to less physical activity. Conversely, overweight and obesity also cause physical and psychological stress.

When are you overweight?

The BMI is a measure of weight in relation to height. The BMI is calculated by dividing the weight in kilograms by the square of the height in metres. Suppose you weigh 80 kilos and your height is 1.70 metres. Then your BMI is 80/(1.70×1.70) = 27.7.

Different limits apply for overweight:

• Children, 2-18: Different limits for overweight and obesity apply to children than to adults. Children are growing and therefore height, weight and BMI are dependent on age. National cut-off values for boys and girls have been established for the age categories 2 to 18 years.
• Adults, 19 to 70 years: overweight is defined as a BMI of 25-29.9 and obese as a BMI of 30 or higher. There are some exceptions:
  • • People from Asian origin (South Asia, Indonesia, China and Japan) have a higher fat mass with a similar BMI. This also applies to people from Suriname and the Antilles with an Asian background. That is why a BMI of 25 applies to them for overweight and 27.5 for obese.
    • The BMI seems less reliable if you are small or tall.
    • The BMI is not a reliable measure when you are pregnant or breastfeeding.
• Elderly people aged 70 and above: a BMI of more than 28 means overweight.

Waist circumference important in determining health risks

The disadvantage of BMI is that it does not take into account the fat distribution over the body. Therefore, waist circumference is an important additional measure to assess health risk.

In addition to the BMI, waist circumference is also used as a measure of fat distribution. Fat in and around the abdomen is detrimental to health. Are you overweight but have a healthy waist circumference? Then we recommend making an appointment with the doctor to check the risk of disease, just to be sure.

Children, adults aged 70 and over and ethnicity

In children, waist circumference is only used to assess the effect of any treatment. For adults aged 70 years and older, there is evidence that the standard cut-off points for waist circumference are too low and should be interpreted with caution. There is insufficient consensus on specific cut-off points in the elderly. As with BMI, there is evidence of lower cut-off points for people of South Asian, Chinese and Japanese origin. For these people a waist circumference of more than 90 cm for men is considered too high, for women it is above 80 cm.

What are the health risks of being overweight?

Being overweight increases the risk of conditions such as:

• Type 2 diabetes
• high blood pressure and cardiovascular diseases
• metabolic syndrome.
• different types of cancer
• gallstones
• Joint inflammation and wear
• breathing problems
• menstrual disorders
• fertility problems
• psychological problems
• in the elderly: more likely to lead to reduced mobility and limitations in daily functioning

People who are overweight have more health risks than people of a healthy weight. The more serious the obesity, the more and more serious the health problems. People with a lot of abdominal fat have an extra high health risk. There are also indications that the longer you are overweight, the higher your risk of, for instance, cardiovascular disease and type 2 diabetes.

Treatment of obesity

How do you prevent obesity?

Healthy eating and sufficient exercise play an important role in preventing overweight and maintaining a healthy weight. For people who have lost weight and want to maintain their weight, it is recommended that they take at least 60 minutes of moderate or vigorous exercise per day. A person who has lost weight should find a new balance that keeps the weight stable and take extra exercise. And that for the rest of your life.

Overweight (BMI 25-29.9) without additional health problems

Adults aged 19-69 who are moderately overweight without additional health problems (such as high blood pressure, high cholesterol or (pre)diabetes) can try to lose weight themselves and maintain the lower weight achieved. The health risks of being overweight can be reduced by losing 5 to 10% of weight.

The basis for healthy weight loss is to eat less in a healthy manner combined with more exercise. If this does not work, or in the event of a relapse, we recommend that you consult with your GP about the best approach.

Overweight (BMI 25-29.9) with additional health problems and obesity (BMI ≥30)

Adults between the ages of 19 and 69 who are overweight in combination with an increased waist circumference, high cholesterol, high blood pressure, (pre-) diabetes, cardiovascular disease, sleep apnoea and/or osteoarthritis are advised not to lose weight themselves but to consult their GP. The same applies to people with obesity (BMI ≥30), regardless of whether or not there are additional health problems. In consultation with the GP, possible causes are examined and follow-up steps are agreed upon.

Medication and surgery

The use of medication is always in consultation with the doctor involved in the treatment and is intended to support the treatment. Surgery is the last step in the treatment of obesity. Before surgery takes place, a detailed screening of the patient’s eligibility for surgery is carried out.

Overweight in children 2-18 years

When a child is overweight or obese, it is important not to start losing weight yourself. After all, children are growing and developing, which requires sufficient energy and nutrients. The treatment of overweight children should therefore always be carried out by the family doctor, the child health care centre or the school doctor who can refer the child to the right help.

Obesity in the elderly of 70 years and over

Elderly people of 70 years and older are only advised to lose weight if they have a BMI of 30 or more and if weight loss can help to reduce health problems. After all, weight loss goes hand in hand with loss of muscle mass. With the loss of muscle mass, muscle strength is also lost. This can make movement more difficult and increases the risk of falling. It is important that people of 70 years and older seek the right guidance from their GP to lose weight. The GP can assess whether weight loss is sensible and refer them to the right care provider.