Classification
We quantify the level of obesity according to Body Mass Index (BMI), with a mathematical calculation:


or


Example: Weight - 130Kg
Height - 1.72m
BMI = 43.94 Kg/m2

Following, obesity classification:

BMI up to 24.9 Kg/m2 = normal
BMI between 25 and 29.9 = overweight
BMI between 30 and 34.9 = obese class 1
BMI between 35 and 39.9 = obese class 2
BMI between 40 and 49.9 = morbidly obese
BMI between 50 and 59.9 = super morbidly obese
BMI over 60 = super super morbidly obese

Actually this index is oversimplified because it does not take into account the water, fat and muscle mass percentage. Since weight is the only source of information, BMI can wrongly equates an obese person to a bodybuilder. That is why we work with other parameters which are obtained through a technique called Bioimpedanciometry. This technique accurately calculates water, fat and muscle mass percentage. We also make use of Computed Tomography (CT) to distinguish visceral from subcutaneous fat.


There are two patterns of obesity:

• Visceral Obesity
It is mostly located inside the abdominal cavity. This kind of fat is dangerous because it releases hormones that cause arterial hypertension and diabetes; therefore it diminishes the quantity of life. People exhibiting this pattern carry most of their excess body fat in the abdominal area, giving them an "apple" shape. This is the male obesity pattern, that is, android.

• Subcutaneous Obesity
It is located underneath the skin, mostly hips and buttocks. This kind of fat does not produce dangerous hormones. However, due to physical alterations in the hips and thighs, it is difficult for the obese to move around, therefore it diminishes the quality of life. People exhibiting this pattern have the superior part of the body much thinner than the lower part, giving them a "pear" shape. This is the female obesity pattern, that is, gynecoid.

Comorbidities
Any kind of obesity pattern or level decreases quantity and quality of life, since obesity causes many diseases. Such diseases coming from obesity are called comorbidities.

The most frequent comorbid conditions are: hypertension, diabetes type 2, hypercholesterolemia, sleep apnea, cardiac insufficiency, hip and knee arthrosis, carotid and coronary artery obstruction and many others.

Comorbidities cause great waste of time and money, because patient must attend to several consultations, undergo many tests and sometimes hospitalization, and buy many medications. They cause early mortality to overweight people.

Another aspect to take into consideration is the psychological stress caused by obesity. Some patients have hard time to walk, to seat in a movie theater or plain chair, to buy clothes or even to toilet themselves after going to the bathroom. There is also the social discrimination against obesity, which makes harder to engage in social or emotional relationships, and sometimes even the professional life is compromised.

Treatment
Obesity treatment is a multiple task job that:
• Promotes fat loss, and not water or muscle mass loss;
• Promotes weight loss without side effect;
• Brings the patient back to a normal BMI (around 25 Kg/m2);
• Promotes weight loss and keep it off for life.
Obesity treatment is always clinical and must be kept for life, so that patient needs to change habits and daily routine.

Patient needs to learn again how to eat correctly, by choosing less calorie-dense food and food that causes satiety. This process is called alimentary reeducation.

Patient needs to exercise on a daily basis to keep the body from storing the exceeding calories in the form of fat.

Patient needs to be psychologically well balanced to avoid "the compulsive eating", that is, eating without a physiological need.

In brief, it is necessary that patient has a triple (alimentary, physical and psychological) reeducation to achieve a healthy weight loss. And it is mostly important to keep in mind that no medication substitutes the reeducation. Medication alone without a concomitant support can be harmful in many aspects. The use of medication should only be prescribed by a specialist as a complementary therapy.

It is vital for the treatment success to understand that the triple reeducation is something to be carried on for life. No obesity treatment with deadline has chance of being permanently well succeeded. Once a former overweight/obese person stops being vigilant and return to old habits, he/she for sure regains weight right away. For example, a person is admitted into a spa for 15 days to exercise, eat healthily and consequently lose weight, however, if he/she gets back from the spa and return to sedentarism and eats sweets, this person regains the lost weight in a matter of short time.

It is completely understandable that no one is capable of doing things for a very long period of time without having pleasure by doing it. So it is important for the obese to find physical activities that he/she really enjoys, and also the same applies to alimentary routine. The nutritionist helps the patient to elaborate a menu that really attends his/her needs and taste.