Is obesity a chronic disease?

Obesity is more than merely a high-risk state of health: It is a chronic disease. That's the assertion of James M. Rippe, MD, associate professor of medicine at Tufts University School of Medicine in Boston and Director of the Center for Clinical and Lifestyle Research, in Shrewsbury, MA.

"The medical profession shares a lot of the prejudices of society at large," says Rippe. "Obesity is the last remaining acceptable island of prejudice in medicine. Someone who is obese is obese not because of a lack of discipline, or through willful neglect; he is a person who has a chronic disease." In other words, says Rippe, obese individuals should be treated just as we treat diabetics - not with scorn, but with appropriate long-term treatment.

Body mass index defines obesity

If obesity is, in fact, a disease, how is it diagnosed? "Obesity is excess body fat," says Rippe. "And the best estimate of body fat is the body mass index (BMI)." BMI is your weight in kilograms divided by your height in meters squared, Rippe explains. If your BMI is between 25 and 30, he says, you are overweight. If it is over 30, you are obese.

(Editor's note: Shape Up America will calculate your BMI for you. Just visit their BMI center on the Internet at www.shapeup.org/sua/bmi/index.html.)

Many people are surprised at how high their BMI actually is, but don't kid yourself about "muscle weighing more than fat," warns Rippe. "For every one body builder there are 1,000 fat people," he says.

There is also an independent diagnosis for abdominal obesity - your waist circumference. "For women with a waist of greater than 35 inches, and men with waists greater than 40 inches, there is a significantly added risk for heart disease," Rippe notes.

To treat the chronic disease of obesity, Rippe recommends a multifaceted approach. "You can apply the same principles that have proved so valuable in the treatment of other chronic diseases," he advises. "First, try lifestyle therapy. Have the individual become more physically active, and pay attention to what they eat. If this doesn't work, try it in conjunction with medication. The final resort is surgery."

How should wellness professionals and/or medical departments intervene with those employees "diagnosed" with obesity? The first thing they need to do, says Rippe, is approach obesity guided by these principles:

1. Obesity is a health risk

Every employee should be assessed for the "vital signs" of obesity. "Every employee should know their BMI, their weight, and their waist circumference," he says.

Give employees the "good news" message that if they are overweight, a loss of only 5%-10% in body weight will result in significant health improvement.

2. Recognize that obesity is not a vanity issue, but a health issue.

This final principle is one wellness professionals should take (pardon the pun) to heart. In fact, Rippe applauds the American Heart Association's recent recognition of obesity as a major risk factor (see the cover story). We have known for a long long time that obesity contributes to other factors for heart disease," says Rippe. "By the time a person is obese [20% over their ideal weight] they have a 70% chance of having another risk factor - such as hypertension, dyslipidemia, or diabetes. Obesity is responsible for half of all hypertension, virtually all of adult onset diabetes, and at least half of all elevated blood cholesterol. The AHA has gone a step further based on a wealth of literature [see list, p. 89] and said that in and of itself, whether or not you have other risk factors, obesity is a significant risk factor."

Rippe concludes with these chilling statistics. "If you are obese, you have a greater than 50% chance having at least two risk factors for heart disease, and 70% of all heart disease is found in people with at least two risk factors," he notes. "The heart disease epidemic is driven by the obesity epidemic."

[For more information, contact James M. Rippe, MD, The Center for Clinical and Lifestyle Research, 21 North Quinsigamond Ave., Shrewsbury, MA 01545. Telephone: (508) 756-1228. Fax: (508) 754-5098. E-mail: jrippe@jamesrippe.com.]