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What Are Overweight and Obesity?

Wed, 14 May 2008 11:21:53 GMT

What Are Overweight and Obesity?

The terms “overweight” and “obesity” refer to a person’s overall body weight and where the extra weight comes from. Overweight is having extra body weight from muscle, bone, fat, and/or water. Obesity is having a high amount of extra body fat. The most useful measure of overweight and obesity is the body mass index (BMI). BMI is based on height and weight and is used for adults, children, and teens. For more information about BMI, see “How Are Overweight and Obesity Diagnosed?”

Millions of Americans and people worldwide are overweight or obese. Being overweight or obese puts you at risk for many diseases and conditions. The more body fat that you carry around and the more you weigh, the more likely you are to develop heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems, and certain cancers.

A person’s weight is a result of many factors. These factors include environment, family history and genetics, metabolism (the way your body changes food and oxygen into energy), behavior or habits, and other factors.

Certain things, like family history, can’t be changed. However, other things—like a person’s lifestyle habits—can be changed. You can help prevent or treat overweight and obesity if you:

Follow a healthful diet, while keeping your calorie needs in mind
Are physically active
Limit the time you spend being physically inactive

Weight loss medicines and surgery also are options for some people who need to lose weight if lifestyle changes don’t work.

Outlook

Reaching and staying at a healthy weight is a long-term challenge for people who are overweight or obese. But it also can be a chance to lower your risk of other serious health problems. With the right treatment and motivation, it’s possible to lose weight and lower your long-term disease risk.

What Causes Overweight and Obesity?

Energy Balance

For most people, overweight and obesity are caused by not having energy balance. Weight is balanced by the amount of energy or calories you get from food and drinks (this is called energy IN) equaling the energy your body uses for things like breathing, digesting, and being physically active (this is called energy OUT).

Energy balance means that your energy IN equals your energy OUT. To maintain a healthy weight, your energy IN and OUT don’t have to balance exactly every day. It’s the balance over time that helps you maintain a healthy weight.

The same amount of energy IN and energy OUT over time = weight stays the same
More IN than OUT over time = weight gain
More OUT than IN over time = weight loss

Overweight and obesity happen over time when you take in more calories than you use.

Other Causes

Physical Inactivity

Many Americans aren’t very physically active. There are many reasons for this. One reason is that many people spend hours in front of TVs and computers doing work, schoolwork, and leisure activities. In fact, more than 2 hours a day of regular TV viewing time has been linked to overweight and obesity.

Other reasons for not being active include: relying on cars instead of walking to places, fewer physical demands at work or at home because modern technology and conveniences reduce the need to burn calories, and lack of physical education classes in schools for children.

People who are inactive are more likely to gain weight because they don’t burn up the calories that they take in from food and drinks. An inactive lifestyle also raises your risk for heart disease, high blood pressure, diabetes, colon cancer, and other health problems.

Environment

Our environment doesn’t always help with healthy lifestyle habits; in fact, it encourages obesity. Some reasons include:

Lack of neighborhood sidewalks and safe places for recreation. Not having area parks, trails, sidewalks, and affordable gyms makes it hard for people to be physically active.
Work schedules. People often say that they don’t have time to be physically active given the long hours at work and the time spent commuting back and forth to work.
Oversized food portions. Americans are surrounded by huge food portions in restaurants, fast food places, gas stations, movie theaters, supermarkets, and even home. Some of these meals and snacks can feed two or more people. Eating large portions means too much energy IN. Over time, this will cause weight gain if it isn’t balanced with physical activity.
Lack of access to healthy foods. Some people don’t live in neighborhoods that have supermarkets that sell healthy foods such as fresh fruits and vegetables. Or if they do, these items are often too costly.
Food advertising. Americans are surrounded by ads from food companies. Often children are the targets of advertising for high-calorie, high-fat snacks and sugary drinks. The goal of these ads is to sway people to buy these high-calorie foods, and often they do.

Genes and Family History

Studies of identical twins who have been raised apart show that genes have a strong influence on one’s weight. Overweight and obesity tend to run in families. Your chances of being overweight are greater if one or both of your parents are overweight or obese. Your genes also may affect the amount of fat you store in your body and where on your body you carry the extra fat.

Because families also share food and physical activity habits, there is a link between genes and the environment. Children adopt the habits of their parents. So, a child with overweight parents who eat high-calorie foods and are inactive will likely become overweight like the parents. On the other hand, if a family adopts healthful food and physical activity habits, the child’s chance of being overweight or obese is reduced.

Health Conditions

Sometimes hormone problems cause overweight and obesity. These problems include:

Underactive thyroid (also called hypothyroidism). This is a condition in which the thyroid gland doesn’t make enough thyroid hormone. Lack of thyroid hormone will slow down your metabolism and cause weight gain. You’ll also feel tired and weak.
Cushing’s syndrome. This is a condition in which the body’s adrenal glands make too much of the hormone cortisol. Cushing’s syndrome also can happen when people take high levels of medicines such as prednisone for long periods of time. People with Cushing’s syndrome gain weight, have upper-body obesity, a rounded face, fat around the neck, and thin arms and legs.
Polycystic ovarian syndrome (PCOS). This is a condition that affects about 5 to 10 percent of women of childbearing age. Women with PCOS often are obese, have excess hair growth, and have reproductive and other health problems due to high levels of hormones called androgens.

Medicines

Certain medicines such as corticosteroids (for example, prednisone), antidepressants (for example, Elavil^®), and medicines for seizures (for example, Neurontin^®) may cause you to gain weight. These medicines can slow the rate at which your body burns calories, increase your appetite, or cause your body to hold on to extra water—all of which can lead to weight gain.

Emotional Factors

Some people eat more than usual when they are bored, angry, or stressed. Over time, overeating will lead to weight gain and may cause overweight or obesity.

Smoking

Some people gain weight when they stop smoking. One reason is that food often tastes and smells better. Another reason is because nicotine raises the rate at which your body burns calories, so you burn fewer calories when you stop smoking. However, smoking is a serious health risk, and quitting is more important than possible weight gain.

Age

As you get older, you tend to lose muscle, especially if you’re less active. Muscle loss can slow down the rate at which your body burns calories. If you don’t reduce your calorie intake as you get older, you may gain weight. Midlife weight gain in women is mainly due to aging and lifestyle, but menopause also plays a role. Many women gain around 5 pounds during menopause and have more fat around the waist than they did before.

Pregnancy

During pregnancy, women gain weight so that the baby gets proper nourishment and develops normally. After giving birth, some women find it hard to lose the weight. This may lead to overweight or obesity, especially after a few pregnancies.

Lack of Sleep

Studies find that the less people sleep, the more likely they are to be overweight or obese. People who report sleeping 5 hours a night, for example, are much more likely to become obese compared to people who sleep 7–8 hours a night.

People who sleep fewer hours also seem to prefer eating foods that are higher in calories and carbohydrates, which can lead to overeating, weight gain, and obesity over time. Hormones that are released during sleep control appetite and the body’s use of energy. For example, insulin controls the rise and fall of blood sugar levels during sleep. People who don’t get enough sleep have insulin and blood sugar levels that are similar to those in people who are likely to have diabetes.

Also, people who don’t get enough sleep on a regular basis seem to have high levels of a hormone called ghrelin (which causes hunger) and low levels of a hormone called leptin (which normally helps to curb hunger).

What Are the Health Risks of Overweight and Obesity?

Being overweight or obese isn’t a cosmetic problem. It greatly raises the risk in adults for many diseases and conditions.

Overweight and Obesity-Related Health Problems in Adults

Heart Disease

This condition occurs when a fatty material called plaque (plak) builds up on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Plaque narrows the coronary arteries, which reduces blood flow to your heart. Your chances for having heart disease and a heart attack get higher as your body mass index (BMI) increases. Obesity also can lead to congestive heart failure, a serious condition in which the heart can’t pump enough blood to meet your body’s needs.

High Blood Pressure (Hypertension)

This condition occurs when the force of the blood pushing against the walls of the arteries is too high. Your chances for having high blood pressure are greater if you’re overweight or obese.

Stroke

Being overweight or obese can lead to a buildup of fatty deposits in your arteries that form a blood clot. If the clot is close to your brain, it can block the flow of blood and oxygen and cause a stroke. The risk of having a stroke rises as BMI increases.

Type 2 Diabetes

This is a disease in which blood sugar (glucose) levels are too high. Normally, the body makes insulin to move the blood sugar into cells where it’s used. In type 2 diabetes, the cells don’t respond enough to the insulin that’s made. Diabetes is a leading cause of early death, heart disease, stroke, kidney disease, and blindness. More than 80 percent of people with type 2 diabetes are overweight.

Abnormal Blood Fats

If you’re overweight or obese, you have a greater chance of having abnormal levels of blood fats. These include high amounts of triglycerides and low-density lipoprotein (LDL) cholesterol (a fat-like substance often called “bad” cholesterol), and low high-density lipoprotein (HDL) cholesterol (often called “good” cholesterol). Abnormal levels of these blood fats are a risk for heart disease.

Metabolic Syndrome

This is the name for a group of risk factors linked to overweight and obesity that raise your chance for heart disease and other health problems such as diabetes and stroke. A person can develop any one of these risk factors by itself, but they tend to occur together. Metabolic syndrome occurs when a person has at least three of these heart disease risk factors:

A large waistline. This is also called abdominal obesity or “having an apple shape.” Having extra fat in the waist area is a greater risk factor for heart disease than having extra fat in other parts of the body, such as on the hips.
Abnormal blood fat levels, including high triglycerides and low HDL cholesterol.
Higher than normal blood pressure.
Higher than normal fasting blood sugar levels.

Cancer

Being overweight or obese raises the risk for colon, breast, endometrial, and gallbladder cancers.

Osteoarthritis

This is a common joint problem of the knees, hips, and lower back. It occurs when the tissue that protects the joints wears away. Extra weight can put more pressure and wear on joints, causing pain.

Sleep Apnea

This condition causes a person to stop breathing for short periods during sleep. A person with sleep apnea may have more fat stored around the neck. This can make the breathing airway smaller so that it’s hard to breathe.

Reproductive Problems

Obesity can cause menstrual irregularity and infertility in women.

Gallstones

These are hard pieces of stone-like material that form in the gallbladder. They’re mostly made of cholesterol and can cause abdominal or back pain. People who are overweight or obese have a greater chance of having gallstones. Also, being overweight may result in an enlarged gallbladder that may not work properly.

Overweight and Obesity-Related Health Problems in Children and Teens

Overweight and obesity also increase the health risks for children and teens. Type 2 diabetes was once rare in American children. Now it accounts for 8 to 45 percent of newly diagnosed diabetes cases. Also, overweight children are more likely to become overweight or obese as adults, with the same risks for disease.

Who Is At Risk for Overweight and Obesity?

Populations Affected

Overweight and obesity affect Americans of all ages, sexes, racial/ethnic groups, and educational levels. This serious health problem has been growing over the years. In fact, overweight and obesity in adults have doubled since 1980, and overweight in children and teens has tripled.

Adults

According to the National Health and Nutrition Examination Survey (NHANES) 2003–2004, about one-third of adults in the United States are overweight and slightly more than one-third are obese. The survey also shows differences in overweight and obesity according to racial/ethnic groups.

In women, overweight and obesity are highest for non-Hispanic Black women (about 82 percent), compared to about 75 percent for Mexican American women and 58 percent for non-Hispanic White women.
In men, overweight and obesity also are higher for minority groups. They’re highest for Mexican American men (about 76 percent), compared to about 71 percent for non-Hispanic White men and about 69 percent for non-Hispanic Black men.

Children and Teens

According to NHANES 2003–2004, overweight and the risk for overweight is rising in children and teens. The survey shows that:

About 19 percent of school-aged children and about 17 percent of teens are overweight.
About 18 percent of school-aged children and about 17 percent of teens are at risk for overweight.

There are also some differences in overweight according to racial/ethnic groups.

In male children and teens, overweight is highest for Mexican Americans (about 22 percent), compared to 17 percent for non-Hispanic Whites and about 16 percent for non-Hispanic Blacks.
In female children and teens, overweight is highest for non-Hispanic Blacks (23 percent), compared to 16 percent for Mexican Americans and about 14 percent for non-Hispanic Whites.

Income

Overweight and obesity are also common in groups with low incomes. Women with low incomes are about 50 percent more likely to be obese than women with higher incomes. Among children and teens, overweight in non-Hispanic White teens is related to a lower family income.

Low-income families also buy more high-calorie, high-fat foods, which may add to the problem. This is because they tend to cost less than more healthful foods such as fruits and vegetables.

What Are the Signs and Symptoms of Overweight and Obesity?

Weight gain usually happens over time. Most people know when they’ve gained weight. Some of the signs of overweight or obesity include:

Clothes feeling tight and needing a larger size.
The scale showing that you’ve gained weight.
Having extra fat around the waist.
A higher than normal body mass index and waist circumference. (See “How Are Overweight and Obesity Diagnosed?”)

National Heart Lung and Blood Institute

Male menopause: Myth or reality?

Fri, 16 Nov 2007 07:47:48 GMT

Male menopause: Myth or reality?

Sometimes called male menopause, aging-related hormone changes are very different in men than in women. Learn about symptoms and treatment.

Less interested in sex lately? Tired? Grumpier than usual? Is this a midlife crisis brewing? Or are you feeling the normal hormone changes associated with aging? Hormone changes are a natural part of aging for men. But male menopause is not an accurate description. Unlike the more dramatic hormone plunge that occurs in women during menopause, hormone changes in men occur gradually, over a period of many years, the effects of which are often subtle and not noticed until much later in life. Some men are never affected by lower hormone levels at all — while some have physical and psychological symptoms that can include changes in sexual function, energy levels or mood.

While the term "male menopause" is sometimes used to describe decreasing testosterone levels related to aging, Todd Nippoldt, M.D., an endocrinologist at Mayo Clinic, Rochester, Minn., prefers the term "andropause." "There needs to be a distinction because we're dealing with two different situations," he says. "In women, ovulation ceases and female hormone production plummets over a relatively short time frame. In men, there's a gradual decline in the production of male hormones." Age-related decline in testosterone levels are also called testosterone deficiency, androgen decline in the aging male (ADAM) or late onset hypogonadism (LOH).

Male hormones over time

In general, older men have lower testosterone levels than do younger men. After age 40, testosterone levels in the blood begin to decline gradually — at a rate of about 1 percent a year. While there's a steep drop between the ages of 45 and 50, reduction in testosterone levels are rarely significant enough to be noticeable in men younger than 60. By the time men reach their 80s, about half have low testosterone. But testosterone levels vary greatly among men — and some men maintain normal testosterone levels into old age. Other men who have low testosterone levels don't have bothersome signs or symptoms.

What are the symptoms of andropause?

Lower than normal testosterone levels do not cause symptoms in all men — and signs and symptoms of low testosterone vary from person to person. Some of these signs and symptoms are a normal part of aging. The only sure way to know whether you have low testosterone levels is through blood tests.

Signs and symptoms of low testosterone can include:

Reduced sexual desire
Infertility
A decrease in spontaneous erections (such as during sleep)
Swollen or tender breasts (gynecomastia)
Loss of body and pubic hair
Small or shrinking testes
Height loss and thinning bones
Reduced muscle bulk and strength
Hot flushes and sweats

Other signs and symptoms can include:

Decreased energy, motivation and self-confidence
Feeling sad or depressed
Poor concentration and memory
Sleep apnea or other sleep problems
A low red blood cell count (mild anemia)
Increased body fat
Diminished physical or work performance

Testosterone replacement therapy

Treatment of low testosterone due to aging with testosterone replacement therapy (TRT) is controversial. The benefits of TRT are not clear, and it may increase the risk of prostate cancer. While certain men who have symptoms related to abnormally low testosterone may benefit from testosterone replacement therapy, it isn't appropriate treatment for most aging men. While it has been shown to help some men with low testosterone, TRT has risks, especially for men with certain health conditions such as prostate cancer and heart disease — and it may not improve your symptoms. More studies need to be done to determine the effectiveness and safety of TRT in aging men, and who can benefit most from this type of treatment. As it turned out with hormone replacement for women, TRT may have possible long-term risks that are not yet known.

Herbal supplements: Do they work?

Although many herbal supplements are widely marketed with the claim that they can relieve symptoms, none has been proved safe and effective for aging-related low testosterone. One of the most common supplements marketed to treat this condition, DHEA, may increase the risk of prostate cancer. More studies are needed to evaluate possible health benefits — and dangers — of taking DHEA or other supplements. Talk with your doctor before taking any herbal supplements, as some can cause side effects or cause problems with medications.

Is it low testosterone — or is it something else?

Symptoms caused by testosterone deficiency are similar to symptoms caused by other things. Signs and symptoms can include:

A number of other health problems such as liver disease, kidney failure, or an overactive or underactive thyroid
Side effects of medications
Lifestyle choices such as excessive alcohol use or use of illegal drugs
Psychological conditions, such as depression or emotional distress related to life changes that come with middle age (the so-called midlife crisis)

Steps that may help

While there's no way to avoid lower testosterone levels caused by aging, there are a few things you can do to help prevent or improve symptoms caused by the condition:

Eat right and stay active. Regular exercise and a healthy diet can help you maintain your strength, energy and lean muscle mass. It can also improve your mood and help you stay sharp as you get older.
Talk to your doctor about sexual problems. Erectile dysfunction and other sexual issues are common as men get older. Your doctor can help you find the best way to cope. Medical treatment, lifestyle changes or changes to the dose or types of medications you take may help.
Seek help if you feel down. Many older men suffer from depression. It often goes undiagnosed — but treatment can make a big difference in how you feel. Depression in men doesn't always mean having the blues. You may have depression if you feel irritable, isolated and withdrawn. Other signs of depression common in men include working all the time, drinking too much alcohol, using street drugs or seeking thrills from risky activities.

If you are an older man and you have bothersome symptoms you think might be caused by low testosterone, see your doctor to get a firm diagnosis and find out your treatment options. While low testosterone does cause signs and symptoms in some men, your symptoms may be caused by normal aging or something else. Identifying and treating other health issues that can cause or worsen symptoms, making lifestyle changes, or changing the type or dose of medications you take may be enough.

Mayo Clinic

Severe Urinary Problems Boost Death Risk in Older Men

Fri, 16 Nov 2007 07:39:31 GMT

Severe Urinary Problems Boost Death Risk in Older Men

HealthDay

By Robert Preidt

Friday, November 9, 2007

FRIDAY, Nov. 9 (HealthDay News) -- As many as 25 percent of men over age 45 admitted to hospital with acute urinary retention (AUR) die within a year, a death risk comparable to that of patients with a broken hip, a new study says.

AUR, the sudden inability to pass urine, is a medical emergency. The condition is often a progression of benign prostatic hyperplasia, an enlargement of the prostate that can interfere with normal urine flow. AUR may also be linked to the presence of other disorders such as diabetes and high blood pressure, according to background information in the study, which was published Nov. 9 by BMJ Online First.

The study authors, from the University College London and London School of Hygiene and Tropical Medicine, analyzed data on more than 176,000 English men over the age of 45 who were hospitalized for treatment of a first episode of AUR between 1998 and 2005.

The researchers found that one in seven of the men with spontaneous AUR (no evidence of precipitating factors other than benign prostatic hyperplasia), and one in four with precipitated AUR, died within one year.

The risk of death increased with age and the presence of other health problems (comorbidity). About half the AUR patients over age 85 with comorbid conditions died within a year after being hospitalized.

The researchers calculated that the overall one-year death risk for men admitted to hospital with AUR was two to three times higher than for the general male population. Among AUR patients ages 45 to 54, the death risk was nearly 24 times higher.

AUR patients may benefit from urgent multidisciplinary care to identify and treat comorbid conditions early, the researchers concluded.

HealthDay

Obesity Linked to Prostate Cancer Death Rates

Fri, 16 Nov 2007 07:36:39 GMT

Obesity Linked to Prostate Cancer Death Rates

Researchers aren't sure why mortality may be tied to weight

HealthDay

Monday, November 12, 2007

MONDAY, Nov. 12 (HealthDay News) -- In another sign that too much weight spells health problems, new research suggests that fat men are twice as likely to die after being diagnosed with prostate cancer than men of normal weight.

The research doesn't confirm a cause-and-effect link between obesity and a higher risk of death from prostate cancer, and it's not clear if losing weight would help patients after they're diagnosed with the disease.

Still, "if you look down the list of factors that are most predictive of a bad outcome, this [excess weight] ranks up there pretty high," said study co-author Dr. Matthew R. Smith, an oncologist at Massachusetts General Hospital in Boston.

According to the Prostate Cancer Foundation, the disease strikes one in six American men and is the most prevalent form of non-skin cancer in the United States. Risk rises with age, with more than 65 percent of all cases diagnosed in men over the age of 65.

However, prostate cancer can successfully be treated in many cases, particularly if it's caught early.

In the new study, Smith and his colleagues examined the results of men with advanced prostate cancer who were enrolled in a drug study between 1987 and 1992. The researchers looked at 788 men whose weights were recorded at the time of diagnosis to see if their body mass index -- BMI, a ratio of weight to height -- affected their risk of dying.

The researchers found that 6.5 percent of men with normal or low weight -- a BMI of less than 25 -- died from prostate cancer within five years. But the death rate for overweight men (a BMI of 25 to 30) was 13.1 percent, and it was 12.2 percent for obese men (a BMI of 30 or higher).

The higher rate of death remained constant even when the researchers adjusted their findings for other possible factors.

The study results are published in the Nov. 12 online issue of the journal Cancer.

It remains unclear why there might be a link between obesity and death rates from prostate cancer. It's possible that metabolism rates in heavy men might make the cancer more aggressive, Smith said, or obesity could render treatments less effective.

Dr. Martha K. Terris, a professor of urology at the Medical College of Georgia, who's familiar with the study findings, said hormone balance could be another factor. "Obesity changes the proportion of estrogen and testosterone in the blood, and this change may impact on the cancer behavior," she said.

Terris added that "obese individuals generally eat more high-fat diets with less fruits and vegetables that could contain key vitamins that help control cancer growth."

For now, Smith said, "the part we can't know is whether improvements in lifestyle intervention after prostate cancer diagnosis would improve outcomes."

Still, it would be wise for doctors to tell their patients about the apparent link between weight and prostate cancer death rates, Smith said. "This may be a teachable moment that prompts a discussion about general health considerations," he said.

In a related study published in Cancer, University of Michigan researchers found that families coping with prostate cancer reported improved quality of life from a structured support program integrated into the patients cancer management. The study, led by Dr. Laurel Northouse, found that patients and their spouses who participated in a five-session home counseling program reported significant improvement in such areas as symptom management, hope, uncertainty and the couples' communication.

HealthDay

Cialis effective for men with spinal cord injury

Fri, 16 Nov 2007 07:33:02 GMT

Cialis effective for men with spinal cord injury

Reuters Health

Tuesday, November 13, 2007

NEW YORK (Reuters Health) - A long-acting drug for erectile dysfunction is safe and effective for men with spinal cord injuries who have difficulty achieving erections, a new study shows.

A total of 186 men were randomly assigned to receive treatment with Cialis or placebo for 12 weeks. The study was completed by 129 in the treatment group and by 34 in the placebo group. The subjects, who were an average of 38 years old, had experienced erectile dysfunction for six months or longer. They were instructed to take the drug when they planned to have sex.

Nearly 85 percent of men given Cialis (know generically as tadalafil) said the drug improved their erections compared with19.5 percent of men given placebo. Another 78.5 percent said it improved their ability to engage in sexual activity versus just 14.6 percent of those on placebo. Specifically, the men on the active drug reported significantly more successful penetration and intercourse attempts. The most common side effects were headache and urinary tract infection.

"On-demand treatment with tadalafil...may help improve the sex lives of patients with erectile dysfunction and spinal cord injury and their partners," Dr. Francois Giuliano of Raymond Poincare Hospital, Garches, France and colleagues conclude in the study, published in the Archives of Neurology.

Just one in four men with a spinal cord injury can achieve erections adequate for intercourse on their own, the researchers point out. Cialis, which like Levitra and Viagra belongs to the class of drugs known as oral phosphodiesterase 5 inhibitors that are the first-line treatment for erectile dysfunction, has shown promise in treating the condition in men with spinal cord injury.

Tadalafil is effective for a longer period of time than Viagra and Levitra, and unlike the shorter-acting drugs, it does not interact with fatty foods, Giuliano and colleagues note.

This may offer men with spinal cord injury and their partners a "more natural sexual experience," they add. "Hence, tadalafil may be the agent of choice for spinal cord injury patients who do not want to plan their sexual activity around medication dosing," the researchers conclude.

SOURCE: Archives of Neurology, November 2007.

High Blood Pressure Hypertension

Thu, 08 Nov 2007 13:58:30 GMT

High Blood Pressure and Hypertension

What is blood pressure?

Blood pressure, measured with a blood pressure cuff and stethoscope by a nurse or other healthcare provider, is the force of the blood pushing against the artery walls. Each time the heart beats, it pumps blood into the arteries, resulting in the highest blood pressure as the heart contracts. One cannot take his own blood pressure unless an electronic blood pressure monitoring device is used. Electronic blood pressure monitors may also measure the heart rate, or pulse.

Two numbers are recorded when measuring blood pressure. The higher number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body. The lower number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and is filling with blood. Both the systolic and diastolic pressures are recorded as "mm Hg" (millimeters of mercury). This recording represents how high the mercury column is raised by the pressure of the blood.

High blood pressure, or hypertension, directly increases the risk of coronary heart disease (heart attack) and stroke (brain attack). With high blood pressure, the arteries may have an increased resistance against the flow of blood, causing the heart to pump harder to circulate the blood.

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) has determined two levels of high blood pressure for adults:

Stage 1
- 140 mm Hg to 159 mm Hg systolic pressure-top number
  and
- 90 mm Hg to 99 mm Hg diastolic pressure-bottom number
Stage 2
- 160 mm Hg or higher systolic pressure
  and
- 100 mm Hg or higher diastolic pressure

The NHLBI defines prehypertension as:

120 mm Hg - 139 mm Hg systolic pressure
and
80 mm Hg - 89 mm Hg diastolic pressure

The NHLBI guidelines define normal blood pressure as follows:

Less than 120 mm Hg systolic pressure
and
Less than 80 mm Hg diastolic pressure

These numbers should be used as a guide only. A single elevated blood pressure measurement is not necessarily an indication of a problem. Your physician will want to see multiple blood pressure measurements over several days or weeks before making a diagnosis of hypertension (high blood pressure) and initiating treatment. A person who normally runs a lower-than-usual blood pressure may be considered hypertensive with lower blood pressure measurements than 140/90.

What is a risk factor?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.

Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others who do develop the disease may have no known risk factors.

But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

What are the risk factors for high blood pressure?

Nearly one-third of all Americans have high blood pressure, but it is particularly prevalent in:

persons with diabetes mellitus, gout, or kidney disease.
African-Americans (particularly those who live in the southeastern United States).
persons in their early to middle adult years; men in this age group have higher blood pressure more often than women in this age group.
persons in their middle to later adult years; women in this age group have higher blood pressure more often than men in this age group (more women have high blood pressure after menopause than men of the same age).
middle-aged and elderly people - more than half of all Americans age 60 and older have high blood pressure.
persons whose parents or grandparents have/had high blood pressure.
obese people.
heavy drinkers of alcohol.
women who are taking oral contraceptives.

How does blood pressure increase?

The following may contribute to an increase in blood pressure:

being overweight
excessive sodium intake
a lack of exercise and physical activity

How is high blood pressure controlled?

Many people can control high blood pressure by:

choosing foods that are low in sodium (salt).
choosing foods low in calories and fat.
choosing foods high in starch and fiber.
maintaining a healthy weight, or losing weight if overweight.
limiting serving sizes.
increasing physical activity.
practicing moderation if consuming alcoholic beverages.

However, other people must take daily medication to control hypertension. People with hypertension should routinely have their blood pressure checked and be under the care of a physician.

Always consult your physician for more information.

University of Virginia

Nicotine Plus Alcohol May Be Tough to Beat

Thu, 08 Nov 2007 13:49:10 GMT

Nicotine Plus Alcohol May Be Tough to Beat

HealthDay

Tuesday, November 6, 2007

TUESDAY, Nov. 6 (HealthDay News) -- As many bar patrons know all too well, drinking and smoking tend to go together. Now, research in mice suggests why that might be so.

It's well known that, "The success rate for stopping drinking is much lower if someone continues smoking," noted lead researcher Thomas J. Gould, a neuroscientist and associate professor of psychology at Temple University in Philadelphia. The concurrent use of "ethanol [alcohol] and nicotine can lead to very serious problems," he added.

His team found that mice suffer deficits in their ability to learn and remember as they are withdrawing from nicotine. Furthermore, alcohol use appears to have negative effects on nicotine withdrawal. Interactions between the two addictions may generate a "negative spiral" of tolerance and dependence on both substances, Gould said.

That could explain why a smoker who walks into his favorite smoke-filled bar may feel like drinking. In the same situation, a social drinker who normally doesn't smoke may start craving a cigarette if they're having a drink, Gould said.

He was slated to present the findings Tuesday at the annual meeting of the Society for Neuroscience, in San Diego.

The mouse model's demonstration of the effects of withdrawal from chronic smoking also suggest an explanation of why light smokers may initially feel stimulated by nicotine but lose that stimulation as the habit continues, Gould said. When smoking becomes chronic, the initial stimulation is blocked and, instead, cognitive deficits begin to show up.

"So, it takes any of the positive effects and shifts the dose-response to the negative end quicker," Gould explained.

Similarly, someone addicted to alcohol has "pretty strong memories of the first time they drank," Gould said. But because of the cognitive deficits created by alcohol abuse and their impact on new learning, alcoholics have a harder time remembering the adverse effects alcohol has now. These later memories aren't as "driving" as the fonder and stronger memory of that first drink, he believes.

The genetic make-up of mice and humans is 96 percent alike, so the results of these animal studies "gives you clues of where to look and allows you to analyze things at different levels than you might be able to do in the human population -- it provides a stepping stone," Gould said.

The next step in his research will be to identify where in the brain tobacco and alcohol interact, he explained.

"If we can understand what changed and how it changed, then you can perhaps devise better interventions" for people, Gould said.

"There is a lot of clinical sense" behind Gould's findings, said Dr. Rob Vorel, a psychiatric fellow at Columbia University Medical Center's division of substance abuse in New York City.

Vorel said there is a lot of interest in how cigarette smoking affects cognitive function and thinking. For example, when smokers stop smoking, they often find that they can't get any work done -- and then start smoking again, so they can be more productive.

Without having seen the study's data, Vorel said, "it sounds like they actually found a correlation between alcohol and nicotine at the mouse level. Nicotine and alcohol dependence are so common, and it [the study] may reveal some mechanisms that reveal why so many alcoholics smoke."

The limits of this type of animal study, Vorel added, are that the findings are "not more than predictions of ideas to test. From an intellectual level, it's an important step forward."

Barbara Flannery, a research psychologist for RTI International, a scientific institute in Baltimore, agreed.

"Certainly, this can translate to humans. It's harder to learn when you're addicted to alcohol," she said. "I think that multiple abuse dependence on various substances like nicotine and alcohol definitely has an additive effect in that's it's more damaging than either alone."

HealthDay

Heart attack death risk higher in men

Thu, 08 Nov 2007 13:45:59 GMT

Heart attack death risk higher in men

Reuters Health

Tuesday, November 6, 2007

NEW YORK (Reuters Health) - Men who've experienced a "non-ST-elevation" heart attack, one of the two main types, or "unstable angina" are less likely to be alive 1 year later than are their female counterparts, according to a report in the journal Heart.

A non-ST-elevation heart attack differs from an ST-elevation heart attack in that the electrocardiogram does not show changes suggestive of typical heart damage. The condition is usually treated with various blood thinners and angioplasty if needed. Unstable angina involves chest pain that occurs unpredictably, not with exertion like stable angina.

Dr. Joakim Alfredsson, of Linkoping University Hospital, Sweden, and colleagues examined gender differences in the treatment and outcome of 53,781 patients with a diagnosis of either unstable angina or non-ST-elevation heart attack. All the patients were admitted to intensive care units in Sweden between 1998 and 2002.

Women, who comprised 37 percent of the group, were older than men (73 versus 69 years) and more likely to have a history of high blood pressure and diabetes. Women were less likely than men to have a history of heart attack.

Men were often treated more aggressively than women, yet they still had a higher death rate at 1 year. No differences in death rates were noted between men and women during the initial hospital stay or in the 30 days following hospital discharge.

The authors conclude that further studies are needed to determine the optimal treatment strategies for both genders.

SOURCE: Heart, November 2007.

Arm or Leg Swelling

Mon, 05 Nov 2007 19:32:03 GMT

Arm or Leg Swelling

Related Terms:

Edema, Oedema, Fluid Retention, Water Retention, Swollen Leg, Swollen Arm, Lymphedema, Lymphoedema

Swelling

Swelling is simply defined as the enlargement of an effected body part, generally arm or leg as a result of fluid rentention. It may also effect the skin, organs, hand, fingers, foot and even toes. The fluid collects because the body is not able to eliminate the excess liquids.

It is not uncommon and has been experienced by many many people. Usually, this swelling is temporary and goes away after the underlying condition is healed.

If it effects a specific area i.e. arm or leg it is referred to a localized edema, if it effects the entire over all body it is referred to as generalized edema.

Temporary Swelling

This temporary swelling may be caused by an infection, burn or sunburn, insect bites, an injury to the leg such as a sprain, surgery, or even medications such a hormone drugs, steroids, blood pressure drugs, or may be an allergic reaction in which is it referred to as angioedema. This may also be an part of the inflammatory response your body goes through it trying to protect and heal the leg or arm from the cause of the trauma.

Long Term Swelling.

Long term swelling is referred to as edema. This is usually related to specific medical conditions. These conditions may include diabetes, congestive heart failure, blood clot, varicose veins, kidney failure, liver failure or a number of cardio-vascular problems.

Treatment for this long term swelling is in conjunction with the treatment for the condition that caused it. Usually diuretics are also used to relieve the swelling or water-retention.

Permanent Leg or Arm Swelling

****In the situation of any permanent leg or arm swelling whether the cause is known or unknown, the diagnoses of lymphedema must be considered****

There are several groups of people who experience leg or arm swelling from known causes, but it doesn't go away or unknown causes where the swelling can actually get worse as time goes by.

Group One

This group includes those who have had the injuries, infections, insect bites, trauma to the leg, surgeries or reaction to a medication. When this swelling does not go away, and becomes permanent it is called secondary lymphedema.

Group Two

Another extremely large group that experiences permanent leg or arm swelling are cancer patients, people who are morbidly obese, or those with the condition called lepedema. What causes the swelling to remain permanent is that the lymph system has been so damaged that it can no longer operate normally in removing the body's waste fluid.

In cancer patients this is the result of either removal of the lymph nodes for cancer biopsy, radiation damage to the lymph system, or damage from tumor/cancer surgeries.

This is also referred to as secondary lymphedema.

Group Three

Group three consists of people who have leg or arm swelling from seemingly unknown reasons. There may be no injury, no cancer, no trauma, but for some reason the leg simply is swollen all the time.

The swelling may start at birth, it may begin at puberty, or may begin in the 3rd, 4th or even 5th decade of life or sometimes later.

This type of leg or arm swelling is called primary lymphedema. It can be caused by a genetic defect, malformation or damage to the lymph system while in the womb or at birth or be part of another birth condition that also effects the lymph system.

This is an extremely serious medical condition that must be diagnosed early, and treated quickly so as to avoid painful, debilitating and even life threatening complications. Treatment should NOT include the use of diuretics.

What is Lymphedema?

Lymphedema is defined simply as an accumulation of excessive protein rich fluid in the tissues of the leg. The accumulation of fluid causes the permanent swelling caused by a defective lymph system.

A conservative estimate is that there may be 1-2 million people in the United States with some form of primary lymphedema and two to three million with secondary lymphedema.

What are the symptoms of Lymphedema?

If you are an at risk person for lymphedema there are early warning signs you should be aware of. If you experience any or several of these symptoms, you should immediately make your physician aware of them.

1.) Unexplained aching, hurting or pain in the arm or leg.

2.) Experiencing "fleeting lymphedema." This is where the limb may swell, even slightly, then return to normal. This may be a precursor to full blown arm lymphedema.

3.) Localized swelling of any area. Sometimes lymphedema may start as swelling in one area, for example the hand, or between the elbow and hand. This is an indication of early lymphatic malfunction.

4.) Any inflammation, redness or infection.

5.) You may experience a feeling of tightness, heaviness or weakness of the arm or leg.

How is Lymphedema Treated?

The preferred treatment today is decongestive therapy. The forms of therapy are complete decongestive therapy (CDT) or manual decongestive therapy (MDT), there are variances, but most involve these two type of treatment.

It is a form of massage therapy where the leg is very gently massaged to actually move the fluid out of the leg and into an area where the lymph system still functions normally.

With these massage treatments, swelling is reduced and then the patient is fitted with a pre-measured custom pressure garment to keep the swelling down and/or is taught to use compression wraps to maintain the leg size.

What are some of the complications of lymphedema?

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immuno-deficient.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.

4. Loss of Function due to the swelling and limb changes.

5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections.

7. Sepsis, Gangrene are possibilities as a result of the infections.

8. Possible amputation of the limb.

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.

10. Skin complications such as splitting, plaques, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations.

Can lymphedema be cured?

No, at the present time there is no cure for lymphedema. But it can be treated and managed and most of the complications can be avoided. Life with lymphedema can still be active and full, with proper treatment, patient education, and patient life style adaptation.

For extensive information on lymphedema, please visit our home page:

Lymphedema People

http://www.lymphedemapeople.com

(c) Copyright 2005 by Pat O'Connor and Lymphedema People. Use of this information for educational purpose is encouraged and permitted. It must be available free and without charge and not used for financial renumeration or gain. Please include an acknowledgement to the author and a link to Lymphedema People.

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