Obesity

About obesity

The term ‘obese’ describes a person who’s very overweight, with a lot of body fat.

It’s a common problem in the UK that’s estimated to affect around one in every four adults and around one in every five children aged 10 to 11.

Defining obesity

There are many ways in which a person’s health in relation to their weight can be classified, but the most widely used method is body mass index (BMI).

BMI is a measure of whether you’re a healthy weight for your height. You can use the BMI healthy weight chart to work out your score.

For most adults, a BMI of:

• 18.5 to 24.9 means you’re a healthy weight
• 25 to 29.9 means you’re overweight
• 30 to 39.9 means you’re obese
• 40 or above means you’re severely obese

BMI isn’t used to definitively diagnose obesity, because people who are very muscular sometimes have a high BMI without excess fat. But for most people, BMI is a useful indication of whether they’re a healthy weight, overweight or obese.

A better measure of excess fat is waist circumference, which can be used as an additional measure in people who are overweight (with a BMI of 25 to 29.9) or moderately obese (with a BMI of 30 to 34.9).

Generally, men with a waist circumference of 94cm (37in) or more and women with a waist circumference of 80cm (about 31.5in) or more are more likely to develop obesity-related health problems.

Read more about diagnosing obesity

Risks of obesity

It’s very important to take steps to tackle obesity because, as well as causing obvious physical changes, it can lead to a number of serious and potentially life-threatening conditions, such as:

• type 2 diabetes 
• coronary heart disease 
• some types of cancer, such as breast cancer and bowel cancer
• stroke

Obesity can also affect your quality of life and lead to psychological problems, such as depression and low self-esteem (see below for more information about the health problems associated with obesity).

Causes of obesity

Obesity is generally caused by consuming more calories – particularly those in fatty and sugary foods – than you burn off through physical activity. The excess energy is stored by the body as fat.

Obesity is an increasingly common problem because for many people modern living involves eating excessive amounts of cheap, high-calorie food and spending a lot of time sitting down, at desks, on sofas or in cars.

There are also some underlying health conditions that can occasionally contribute to weight gain, such as an underactive thyroid gland (hypothyroidism), although these type of conditions don’t usually cause weight problems if they’re effectively controlled with medication.

Read more about the causes of obesity

Treating obesity

The best way to treat obesity is to eat a healthy, reduced-calorie diet and exercise regularly. To do this you should:

• eat a balanced, calorie-controlled diet as recommended by your GP or weight loss management health professional (such as a dietitian)
• join a local weight loss group
• take up activities such as fast walking, jogging, swimming or tennis for 150 to 300 minutes (two-and-a-half to five hours) a week
• eat slowly and avoid situations where you know you could be tempted to overeat

You may also benefit from receiving psychological support from a trained healthcare professional to help change the way you think about food and eating.

If lifestyle changes alone don’t help you lose weight, a medication called orlistat may be recommended. If taken correctly, this medication works by reducing the amount of fat you absorb during digestion. Your GP will know whether orlistat is suitable for you.

In rare cases, weight loss surgery may be recommended.

Read more about how obesity is treated

Other obesity-related problems

Obesity can cause a number of further problems, including difficulties with daily activities and serious health conditions.

Day-to-day problems related to obesity include:

• breathlessness
• increased sweating
• snoring
• difficulty doing physical activity
• often feeling very tired
• joint and back pain
• low confidence and self-esteem
• feeling isolated

The psychological problems associated with being obese can also affect your relationships with family and friends, and may lead to depression.

Serious health conditions

Being obese can also increase your risk of developing many potentially serious health conditions, including:

• type 2 diabetes – a condition that causes a person’s blood sugar level to become too high
• high blood pressure
• high cholesterol and atherosclerosis (where fatty deposits narrow your arteries), which can lead to coronary heart disease and stroke
• asthma
• metabolic syndrome – a combination of diabetes, high blood pressure and obesity
• several types of cancer, including bowel cancer, breast cancer and womb cancer
• gastro-oesophageal reflux disease (GORD) – where stomach acid leaks out of the stomach and into the oesophagus (gullet)
• gallstones – small stones, usually made of cholesterol, that form in the gallbladder
• reduced fertility
• osteoarthritis – a condition involving pain and stiffness in your joints
• sleep apnoea – a condition that causes interrupted breathing during sleep, which can lead to daytime sleepiness with an increased risk of road traffic accidents, as well as a greater risk of diabetes, high blood pressure and heart disease
• liver disease and kidney disease
• pregnancy complications, such as gestational diabetes or pre-eclampsia (when a woman experiences a potentially dangerous rise in blood pressure during pregnancy)

Obesity reduces life expectancy by an average of 3 to 10 years, depending on how severe it is. It’s estimated that obesity and being overweight contribute to at least 1 in every 13 deaths in Europe.

Outlook

There’s no “quick fix” for obesity. Weight loss programmes take time and commitment, and work best when fully completed. The healthcare professionals involved with your care should provide encouragement and advice about how to maintain the weight loss achieved.

Regularly monitoring your weight, setting realistic goals and involving your friends and family with your attempts to lose weight can also help.

Remember that even losing what seems like a small amount of weight, such as 3% or more of your original body weight, and maintaining this for life, can significantly reduce your risk of developing obesity-related complications like diabetes and heart disease.

Causes of obesity

Obesity is generally caused by eating too much and moving too little.

If you consume high amounts of energy, particularly fat and sugars, but don’t burn off the energy through exercise and physical activity, much of the surplus energy will be stored by the body as fat.

Calories

The energy value of food is measured in units called calories. The average physically active man needs about 2,500 calories a day to maintain a healthy weight, and the average physically active woman needs about 2,000 calories a day.

This amount of calories may sound high, but it can be easy to reach if you eat certain types of food. For example, eating a large takeaway hamburger, fries and a milkshake can total 1,500 calories – and that’s just one meal. 

Another problem is that many people aren’t physically active, so lots of the calories they consume end up being stored in their body as fat.

Poor diet

Obesity doesn’t happen overnight. It develops gradually over time, as a result of poor diet and lifestyle choices, such as:

• eating large amounts of processed or fast food – that’s high in fat and sugar
• drinking too much alcohol – alcohol contains a lot of calories, and people who drink heavily are often overweight
• eating out a lot – you may be tempted to also have a starter or dessert in a restaurant, and the food can be higher in fat and sugar
• eating larger portions than you need – you may be encouraged to eat too much if your friends or relatives are also eating large portions
• drinking too many sugary drinks – including soft drinks and fruit juice
• comfort eating – if you have low self-esteem or feel depressed, you may eat to make yourself feel better

Unhealthy eating habits tend to run in families. You may learn bad eating habits from your parents when you’re young and continue them into adulthood.

Read more about eating well

Lack of physical activity

Lack of physical activity is another important factor related to obesity. Many people have jobs that involve sitting at a desk for most of the day. They also rely on their cars, rather than walking or cycling.

For relaxation, many people tend to watch TV, browse the internet or play computer games, and rarely take regular exercise.

If you’re not active enough, you don’t use the energy provided by the food you eat, and the extra energy you consume is stored by the body as fat.

The Department of Health recommends that adults do at least 150 minutes (two-and-a-half hours) of moderate-intensity aerobic activity, such as cycling or fast walking, every week. This doesn’t need to be done all in one go, but can be broken down into smaller periods. For example, you could exercise for 30 minutes a day for five days a week.

If you’re obese and trying to lose weight, you may need to do more exercise than this. It may help to start off slowly and gradually increase the amount of exercise you do each week.

Read more about the physical activity guidelines for adults

Genetics

Some people claim there’s no point trying to lose weight because “it runs in my family” or “it’s in my genes”.

While there are some rare genetic conditions that can cause obesity, such as Prader-Willi syndrome, there’s no reason why most people can’t lose weight.

It may be true that certain genetic traits inherited from your parents – such as having a large appetite – may make losing weight more difficult, but it certainly doesn’t make it impossible.

In many cases, obesity is more to do with environmental factors, such as poor eating habits learned during childhood.

Medical reasons

In some cases, underlying medical conditions may contribute to weight gain. These include:

• an underactive thyroid gland (hypothyroidism) – where your thyroid gland doesn’t produce enough hormones
• Cushing’s syndrome – a rare disorder that causes the over-production of steroid hormones

However, if conditions such as these are properly diagnosed and treated, they should pose less of a barrier to weight loss.

Certain medicines, including some corticosteroids, medications for epilepsy and diabetes, and some medications used to treat mental illness – including antidepressants and medicines for schizophrenia – can contribute to weight gain.

Weight gain can sometimes be a side effect of stopping smoking

Diagnosing obesity

Body mass index (BMI) is widely used as a simple and reliable way of finding out whether a person is a healthy weight for their height.

For most adults, having a BMI of 18.5 to 24.9 means you’re considered to be a healthy weight. A person with a BMI of 25 to 29.9 is considered to be overweight, and someone with a BMI over 30 is considered to be obese.

While BMI is a useful measurement for most people, it’s not accurate for everyone.

For example, the normal BMI scores may not be accurate if you’re very muscular because muscle can add extra pounds, resulting in a high BMI when you’re not an unhealthy weight. In such cases, your waist circumference may be a better guide (see below).

What’s considered a healthy BMI is also influenced by your ethnic background. The scores mentioned above generally apply to people with a white Caucasian background. If you have an ethnic minority background, the threshold for being considered overweight or obese may be lower.

BMI shouldn’t be used to work out whether a child is a healthy weight, because their bodies are still developing. Speak to your GP if you want to find out whether your child is overweight.

Visiting your GP

If you’re overweight or obese, visit your GP for advice about losing weight safely and to find out whether you have an increased risk of health problems.

Your GP may ask about:

• your lifestyle – particularly your diet and how much physical activity you do; they’ll also ask you whether you smoke and how much alcohol you drink
• any possible underlying causes for your obesity – for example, if you’re taking medication or have a medical condition that may contribute to weight gain
• how you feel about being overweight – for example, if it makes you feel depressed
• how motivated you are to lose weight
• your family history – as obesity and other health conditions, such as diabetes, are often more common in families

As well as calculating your BMI, your GP may also carry out tests to determine whether you’re at increased risk of developing health complications because of your weight.

These could include measuring your:

• blood pressure
• glucose (sugar) and cholesterol levels in a blood sample
• waist circumference (the distance around your waist)

People with very large waists – generally, 94cm (37in) or more in men and 80cm (about 31.5in) or more in women – are more likely to develop obesity-related health problems.

Your GP may also take your ethnicity into account because it can affect your risk of developing certain conditions. For example, some people of Asian, African or Afro-Caribbean ethnicity may be at increased risk of high blood pressure (hypertension). Healthy waist measurements can also be different for people from different ethnic backgrounds.

After your assessment, you’ll be offered an appointment to discuss the results in more detail, ask any questions that you have, and fully explore the treatment options available to you.

Treating obesity

If you’re obese, speak to your GP for advice about losing weight safely.

Your GP can advise you about losing weight safely by eating a healthy, balanced diet and regular physical activity.

They can also let you know about other useful services, such as:

• local weight loss groups – these could be provided by your local authority, the NHS, or commercial services you may have to pay for
• exercise on prescription – where you’re referred to a local active health team for a number of sessions under the supervision of a qualified trainer

If you have underlying problems associated with obesity, such as polycystic ovary syndrome (PCOS), high blood pressure, diabetes or obstructive sleep apnoea, your GP may recommend further tests or specific treatment. In some cases, they may refer you to a specialist.

Read more about how your GP can help you lose weight

Diet

There’s no single rule that applies to everyone, but to lose weight at a safe and sustainable rate of 0.5 to 1kg (1lb to 2lbs) a week, most people are advised to reduce their energy intake by 600 calories a day.

For most men, this will mean consuming no more than 1,900 calories a day, and for most women, no more than 1,400 calories a day.

The best way to achieve this is to swap unhealthy and high-energy food choices – such as fast food, processed food and sugary drinks (including alcohol) – for healthier choices.

A healthy diet should consist of:

• plenty of fruit and vegetables
• plenty of potatoes, bread, rice, pasta and other starchy foods (ideally you should choose wholegrain varieties)
• some milk and dairy foods
• some meat, fish, aggs, beans and other non-dairy sources of protein
• just small amounts of food and drinks that are high in fat and suagr

Try to avoid foods containing high levels of salt because they can raise your blood pressure, which can be dangerous for people who are already obese.

You’ll also need to check calorie information for each type of food and drink you consume to make sure you don’t go over your daily limit.

Some restaurants, cafés and fast food outlets provide calorie information per portion, although providing this information isn’t compulsory. Be careful when eating out because some foods can quickly take you over the limit, such as burgers, fried chicken, and some curries or Chinese dishes.

Diet programmes and fad diets

Avoid fad diets that recommend unsafe practices, such as fasting (going without food for long periods of time) or cutting out entire food groups. These types of diets don’t work, can make you feel ill, and aren’t sustainable because they don’t teach you long-term healthy eating habits.

This isn’t to say that all commercial diet programmes are unsafe. Many are based on sound medical and scientific principles and can work well for some people.

A responsible diet programme should:

• educate you about issues such as portion size, making behavioural changes and healthy eating 
• not be overly restrictive in terms of the type of foods you can eat 
• be based on achieving gradual, sustainable weight loss rather than short-term rapid weight loss, which is unlikely to last

Very low calorie diets

A very low calorie diet (VLCD) is where you consume less than 800 calories a day.

These diets can lead to rapid weight loss, but they aren’t a suitable or safe method for everyone, and they aren’t routinely recommended for managing obesity.

VLCDs are usually only recommended if you have an obesity-related complication that would benefit from rapid weight loss.

VLCDs shouldn’t usually be followed for longer than 12 weeks at a time, and they should only be used under the supervision of a suitably qualified healthcare professional.

Speak to your GP first if you’re considering this type of diet.

Exercise

Reducing the amount of calories in your diet will help you lose weight, but maintaining a healthy weight requires physical activity to burn energy.

As well as helping you maintain a healthy weight, physical activity also has wider health benefits. For example, it can help prevent and manage more than 20 conditions, such as reducing the risk of type 2 diabetes by 40%.

The Chief Medical Officers recommend that adults should do at least 150 minutes (two-and-a-half hours) of at least moderate-intensity activity a week – for example, five 30-minute bouts a week. Something is better than nothing, and doing just 10 minutes of exercise at a time is beneficial.

Moderate-intensity activity is any activity that increases your heart and breathing rate, such as:

• brisk walking
• cycling
• recreational swimming
• dancing

Alternatively, you could do 75 minutes (one hour, fifteen minutes) of vigorous-intensity activity a week, or a combination of moderate and vigorous activity.

During vigorous activity, breathing is very hard, your heart beats rapidly and you may be unable to hold a conversation. Examples include:

• running
• most competitive sports
• circuit training

You should also do strength and balance training two days a week. This could be in the form of a gym workout, carrying shopping bags, or doing an activity such as tai chi. It’s also critical that you break up sitting (sedentary) time by getting up and moving around.

Read more about strength and balance exercises.

Your GP, weight loss adviser or staff at your local sports centre can help you create a plan suited to your own personal needs and circumstances, with achievable and motivating goals. Start small and build up gradually.

It’s also important to find activities you enjoy and want to keep doing. Activities with a social element or exercising with friends or family can help keep you motivated. Make a start today – it’s never too late.

Read more about the physical activity guidelines for adults and the physical activity guidelines for older adults.

Other useful strategies

Evidence has shown that weight loss can be more successful if it involves other strategies, alongside diet and lifestyle changes. This could include things like:

• setting realistic weight loss goals – if you’re obese, losing just 3% of your original body weight can significantly reduce your risk of developing obesity-related complications
• eating more slowly and being mindful of what and when you’re eating – for example, not being distracted by watching TV
• avoiding situations where you know you may be tempted to overeat
• involving your family and friends with your weight loss efforts –they can help to motivate you
• monitoring your progress – for example, weigh yourself regularly and make a note of your weight in a diary

Getting psychological support from a trained healthcare professional may also help you change the way you think about food and eating. Techniques such as cognitive behavioural therapy (CBT) can be useful.

Avoiding weight regain

It’s important to remember that as you lose weight your body needs less food (calories), so after a few months, weight loss slows and levels off, even if you continue to follow a diet.

If you go back to your previous calorie intake once you’ve lost weight, it’s very likely you’ll put the weight back on. Increasing physical activity to up to 60 minutes a day and continuing to watch what you eat may help you keep the weight off.

Medication

Many different types of anti-obesity medicines have been tested in clinical trials, but only one has proved to be safe and effective: orlistat.

You can only use orlistat if a doctor or pharmacist thinks it’s the right medicine for you. In most cases, orlistat is only available on prescription. Only one product (Alli) is available over the counter directly from pharmacies, under the supervision of a pharmacist.

Orlistat works by preventing around a third of the fat from the food you eat being absorbed. The undigested fat isn’t absorbed into your body and is passed out with your faeces (stools). This will help you avoid gaining weight, but won’t necessarily cause you to lose weight.

A balanced diet and exercise programme should be started before beginning treatment with orlistat, and you should continue this programme during treatment and after you stop taking orlistat.

When orlistat should be used

Orlistat will usually only be recommended if you’ve made a significant effort to lose weight through diet, exercise or changing your lifestyle.

Even then, orlistat is only prescribed if you have a:

• body mass index (BMI) of 28 or more, and other weight-related conditions, such as high blood pressure or type 2 diabetes
• BMI of 30 or more

Before prescribing orlistat, your doctor will discuss the benefits and potential limitations with you, including any potential side effects (see below). 

Treatment with orlistat must be combined with a balanced low-fat diet and other weight loss strategies, such as doing more exercise. It’s important that the diet is nutritionally balanced over three main meals.

If you’re prescribed orlistat, you’ll also be offered advice and support about diet, exercise and making lifestyle changes.

Orlistat isn’t usually recommended for pregnant or breastfeeding women.

Dosage and duration of treatment

One orlistat capsule is taken with water immediately before, during or up to one hour after, each main meal (up to a maximum of three capsules a day).

If you miss a meal, or the meal doesn’t contain any fat, you shouldn’t need to take the orlistat capsule. Your doctor should explain this to you, or you can check the patient information leaflet that comes with your medicine.

Treatment with orlistat should only continue beyond three months if you’ve lost 5% of your body weight. It usually starts to affect how you digest fat within one to two days.

If you haven’t lost weight after taking orlistat for three months, it’s unlikely to be an effective treatment for you. Consult your doctor or pharmacist, as it may be necessary to stop your treatment.

Taking orlistat with other health conditions

See your GP before starting treatment with orlistat if you have another serious health condition, such as type 2 diabetes, high blood pressure, or kidney disease, which you’re taking medication for. It may be necessary to change the dose of your medicine.

If you have type 2 diabetes, it may take you longer to lose weight using orlistat, so your target weight loss after three months may therefore be slightly lower.

If orlistat has helped you lose weight after three months, your prescription may be continued for up to a year. After that, your GP will carry out a review and decide whether you should continue taking it.

Side effects

Common side effects of orlistat include:

• fatty or oily stools
• needing the toilet urgently
• passing stools more frequently
• an oily discharge from your rectum (you may have oily spots on your underwear)
• flatulence (wind)
• stomach pain
• headaches
• upper respiratory tract infections, such as a cold

These side effects are much less likely to occur if you stick to a low-fat diet.

Women taking the oral contraceptive pill should use an additional method of contraception, such as a condom, if they experience severe diarrhoea while taking orlistat. This is because the contraceptive pill may not be absorbed by your body if you have diarrhoea, so it may not be effective.

Surgery

Weight loss surgery, also called bariatric surgery, is sometimes used to treat people who are severely obese.

Bariatric surgery is usually only available on the NHS to treat people with severe obesity who fulfil all of the following criteria:

• they have a BMI of 40 or more, or between 35 and 40 and another serious health condition that could be improved with weight loss, such as type 2 diabetes or high blood pressure
• all appropriate non-surgical measures have been tried, but the person hasn’t achieved or maintained adequate, clinically beneficial weight loss
• the person is fit enough to have anaesthesia and surgery
• the person has been receiving, or will receive, intensive management as part of their treatment
• the person commits to the need for long-term follow-up

Bariatric surgery may also be considered as a possible treatment option for people with a BMI of 30 to 35 who have recently (in the last 10 years) been diagnosed with type 2 diabetes.

In rare cases, surgery may be recommended as the first treatment (instead of lifestyle treatments and medication) if a person’s BMI is 50 or above.

Treating obesity in children

Treating obesity in children usually involves improvements to diet and increasing physical activity using behaviour change strategies.

The amount of calories your child should eat each day will depend on their age and height. Your GP should be able to advise you about a recommended daily limit, and they may also be able to refer you to your local family healthy lifestyle programme.

Children over the age of five should ideally get at least one hour (60 minutes) of vigorous-intensity exercise a day, such as running or playing football or netball. Sedentary activities, such as watching television and playing computer games, should be restricted.

Read more about the physical activity guidelines for children and young people

Referral to a specialist in treating childhood obesity may be recommended if your child develops an obesity-related complication, or there’s thought to be an underlying medical condition causing obesity.

The use of orlistat in children is only recommended in exceptional circumstances, such as if a child is severely obese and has an obesity-related complication.

Bariatric surgery isn’t generally recommended for children, but may be considered for young people in exceptional circumstances, and if they’ve achieved, or nearly achieved, physiological maturity.