What thoughts come to mind when you think about overweight and obesity? Too much weight, or perhaps unhealthy food choices? Insufficient physical activity? Magazine articles and TV shows about dieting? Do you already feel you have enough information, but your own thoughts and feelings are hindering change?
Perhaps you feel guilt about your situation, and a sense of inadequacy as your goals have drifted further away? Or perhaps you have noticed that the reasons for your overeating are more related to stress or loneliness than to genuine hunger or lack of information.
Obesity is Particularly Related to the Body’s Metabolism
Overweight is connected to many different factors, and rarely can a single cause be identified. In fact, the scientific mechanisms behind obesity are often misunderstood, both at the individual level and by policymakers or healthcare professionals.
Metabolically speaking, overweight and obesity arise when we consume more calories than we expend. Over time, unused energy is stored as excess fat in our body’s adipose tissue, and a person’s weight increases.
Does Eating less Resolve Overweight?
Losing this excess weight and keeping it off truly requires more than just eating less and exercising more. We often read in opinion columns or perhaps hear from our slender friends a very simplified version of how to control weight: “if you eat less than you expend, you will lose weight.” Metabolically and mathematically, this is true – but it is surprisingly simplistic advice for someone who has been trying to lose weight diligently for a long time.
If you have discussed your overweight with healthcare professionals, you may have received advice such as “try to eat less” or “exercise more” or even the often hurtful comment “just pull yourself together.” All these seemingly sensible pieces of advice can be incorrect depending on the situation, and in the following chapters of this book, I will explain why.
Obesity and Overweight are Individual to each Body
The fact is that many different factors influence our calorie or energy balance, such as our own physiology, i.e., our body’s individual operating mechanism, our genetic inheritance from our parents, our living environment, our social and economic situation – and especially psychological factors. These psychological factors greatly affect us, especially our ability to maintain weight management in the long term.
The Body’s Homeostatic System Affects Appetite and Even Energy Expenditure
And that’s not all: our body weight is influenced by our body’s homeostatic system, which affects our appetite, the amount of food and drink we consume, and our energy expenditure. Many parts of the body are involved in this complex process, including the hypothalamus in the brain (which processes hormonal and neural transmitters from other brain structures), the digestive tract, including the intestines, and also the adipose tissue itself.
The role of adipose tissue is precisely changing with scientific research: just a few decades ago, fat cells were considered simple energy stores and protective tissue. In light of increasing current knowledge, the fat cell is, in fact, a functionally complex and metabolically active cell.
Weight Loss Changes the Body’s Balance
Weight loss, or dieting, changes this balance, for example, by increasing hunger and slowing down metabolism. The body thus strives in many ways to resist our desired weight loss! More of the hormone ghrelin is secreted from the stomach, which increases feelings of hunger and our appetite.
At the same time, the digestive tract, including the intestines, pancreas, and adipose tissue, secrete fewer satiety signals, so the brain does not recognize feelings of fullness as before. Such mechanisms are the reason why many who have lost weight regain it, despite strenuous efforts.
Obesity is not Resolved by a Short-Term Project, but by Sustained Effort
If weight loss is perceived as a short-term project or the methods are incorrect, it very often fails. Sometimes the reasons for weight loss failure are too many or too strict lifestyle changes implemented too quickly.
Weight loss is too often a project-based endeavor or a performance-oriented task, where success is typically evaluated by how quickly weight is lost in the short term. In permanent weight management, however, lifestyle changes are seen as a learning process, and changes and their implementation are tailored to suit the individual, so that the outcome, in addition to weight loss, includes, for example, improved well-being and functional capacity, as well as fewer health risks and eating-related anxiety.
Therefore, for many reasons, the ‘calories in – calories out’ calculation simply does not work for successful weight management. As a weight management physician, I constantly encounter these situations, and that is why this book comprehensively presents the important areas for change that you yourself can influence.
How Do I Know if I Am Overweight – and how is it Measured?
Overweight and obesity are discussed when the adipose tissue accumulated in the body exceeds a certain limit. As I explained in my book Painotohtori, the medical definition of overweight and obesity is clear. To determine overweight, the Body Mass Index (BMI) is often used, which comes from the English words
Body Mass Index formula: BMI = Your Weight (kg) / (Your Height (m) * Your Height (m)).
The Body Mass Index can easily be calculated, for example, with a pocket calculator. You can compare the result to the table below, which is suitable for adults, but not for adolescents, children, or, for example, pregnant individuals or the elderly.
Body Mass Index Definitions (According to the World Health Organization):
| Body Mass Index (BMI) | Weight Classification |
| 18.5 – 24.9 | normal weight |
| 25.0 – 29.9 | overweight |
| 30.0 – 34.9 | obesity |
| 35.0 – 39.9 | severe obesity |
| 40.0 or more | morbid obesity |
What Does the Body Mass Index Tell Us – or Does it Tell Us Anything?
For most people, BMI is well-suited for assessing the degree of overweight or obesity, but it is not perfect. For example, if you are very muscular, the Body Mass Index is not suitable for you, because BMI does not differentiate between weight from muscle or adipose tissue. In such cases, BMI would indicate that you are overweight, even though you are muscular rather than overweight.
Waist Circumference Can be a Better Indicator of Obesity
For an overall assessment of your health and weight, there is another equally good indicator: waist circumference. Waist circumference is an important indicator, especially when you want information about your need for weight loss, even if your weight is not yet very high. Weight loss may be necessary and beneficial for you, even if your Body Mass Index is not elevated!
Measuring waist circumference is particularly good for determining the location of adipose tissue. Fat accumulated in the abdominal cavity (also called “apple-shaped obesity” due to body shape) has been shown to have a clear link to an increased risk of cardiovascular diseases and type 2 diabetes.
How to Measure Waist Circumference
Waist circumference is most easily measured by yourself 1-2 cm above the navel on bare skin, or halfway between the lowest rib and the top of the iliac crest. The tape measure must not be crooked; it should be horizontal, meaning at the same height at the front, back, and sides. Remember to stand straight, with both feet. First, inhale and then exhale, and the tape measure reading is taken at the end of the exhalation. The tape measure should not be too tight or too loose.
Waist Circumference and its Interpretation for Men and Women
The diagram from the Heart Association below helps in interpreting your own waist circumference measurement. Please remember that this interpretation is also only suitable for adults, and not, for example, for children, adolescents, or pregnant individuals.
| Waist Circumference (cm) | Target Value | Slight Health Risk | Significant Health Risk |
| Men | < 94 | 94-101 | > 102 |
| Women | < 80 | 80-87 | > 88 |
| Recommendation | No obesity-related health risk | Avoid weight gain or lose weight | Weight should be lost. Seek help from a healthcare professional for weight reduction. |
Another commonly used guideline in Finland is as follows: a waist circumference over 90 cm for women and over 100 cm for men indicates abdominal obesity, whereas a waist circumference over 80 cm for women and over 90 cm for men is called abdominal overweight.
The scale is often a rather “blunt” instrument for measuring weight loss progress, whereas waist circumference often tells a better truth about fat reduction. Waist circumference can be monitored, for example, by trouser size or the number of belt holes: if you notice yourself loosening your belt or that your trousers are too small, it’s a good time to address the situation and try to stop your waist circumference from increasing.
Body Composition Measurement Helps in Assessing Obesity
In terms of weight management, the body consists of fat and fat-free tissue, which includes muscle mass and, for example, body water. Monitoring changes in adipose tissue and muscle mass can be helpful for both the dieter and the healthcare professional, such as a doctor, who may be treating them.
Simpler body composition monitors intended for consumers, i.e., bioimpedance devices, are constantly evolving but are still quite inaccurate. Of course, they are still useful as indicators, especially if you always use the same device and take measurements at the same time of day. A more reliable way to determine body composition is a DEXA device, based on X-ray radiation, which is mostly used for measuring bone density. DEXA devices are the most reliable measures for whole-body composition.
Painoklinikka Can Help You with Weight Management.
Overweight and obesity can affect many things, and it is by no means just an issue related to appearance. Weight management is important for human health and well-being, as it is the root cause of many diseases. For example, type 2 diabetes is already a disease of children and adolescents, and type 2 diabetes can be triggered at a young age due to morbid obesity.
If you have struggled with weight management and feel that something should be done – contact Painoklinikka. With the help of our expert weight management physicians, we can together find a solution to your situation.
André Heikius
Medical Director, CEO
