Khaliah Ali, the daughter of boxing legend Muhammad Ali, struggled with obesity as a young girl but recently dropped much of her weight and found a measure of happiness, she told NBC’s Today.

“I’ve found peace and happiness and health,” Ali says. “And for the first time, I’m really feeling good in my skin.”

Ali, 49, is one of Muhammad Ali’s nine children and lives near Philadelphia. She is a designer and author and works with philanthropic organizations.

Ali lost more than 100 pounds by altering her diet, working out and undergoing bariatric surgery.

“It definitely was difficult,” Ali told Today host Al Roker. “Oftentimes in my life when I realized my weight exceeded his fighting weight, or you’re at gym, and you’re still picked last because you’re the child that’s out of shape and no one wanted you on their team, was often very difficult. But you know what, Al? It was also made very easy by the fact that my father always instilled in me a sense of pride and beauty and always reaffirmed to me how beautiful I was in his eyes.”

Ali advocates for people who struggle with obesity, especially Black women, nearly two-thirds of whom deal with weight issues, she says. “It’s not a sprint,” she says. “It’s a marathon. … This is a lifelong marathon in battle. I’m doing great today. I can’t tell you where I’ll be 10 years from now, but I’ll always keep fighting.”

Obesity and overweight is a common problem among Americans and can lead to dire health outcomes, officials say. Here are the signs and symptoms of obesity and what you need to know.

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“Obesity is a complex disease involving an excessive amount of body fat,” the Mayo Clinic says. “Obesity isn’t just a cosmetic concern. It’s a medical problem that increases the risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.”

Nearly 42 percent of Americans were obese in 2020 as measured by body mass index, or BMI, according to the Centers for Disease Control and Prevention. That’s up from 30.5 percent in 2017.

“Obesity is a major risk factor for infertility, but for the seriously obese wanting to have a baby, losing weight is often a losing battle,” adds Dr. Yijun Chen, a bariatric surgeon with the Center for Obesity and Metabolic Health at the University of California, Los Angeles.

Americans spent nearly $173 billion in 2019 in estimated annual medical costs related to obesity, the CDC says. Adults who had obesity spent $1,861 more in medical costs that year than did people with healthy weight.

“When there’s more of you, your heart has to pump harder to get the blood everywhere it needs to go,” says Dr. Elizabeth Klodas, a cardiologist and founder of Step One Foods. “So blood pressure goes up.”

“Hormonal changes associated with obesity can also lead to higher blood pressure readings,” Klodas adds. Obesity also makes your body insulin resistant, “meaning you need more and more insulin to store sugar,” she says. “Eventually you exhaust that compensatory capacity, and blood sugar levels start to rise.” That could lead to diabetes.

Obesity is defined by having a high BMI, a number that expresses the ratio between your height and body mass. It is a shortcut method of assessing whether a person is overweight or obese but is one of only several factors that determines whether an individual person has a weight problem.

“For most adults, having a BMI of 18.5 to 24.9 means you’re considered to be a healthy weight,” says the National Health Service, the government-funded medical and health care service of the United Kingdom. “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,” the NHS adds. “For example, the normal BMI scores may not be accurate if you’re very muscular because muscle can add extra kilos, resulting in a high BMI when you’re not an unhealthy weight.”

Another way to assess obesity is to measure waist circumference.

A person’s race or ethnicity can be a factor: For nonwhite people, the threshold for being considered overweight or obese may be lower, the NHS says.

Weight and BMI can be indicators of overweight or obesity. But there are other warning signs that indicate you may have a weight problem.

These include difficulty sleeping (sleep apnea), daytime drowsiness, fatigue, back or joint pain, excessive sweating, heat intolerance, infections in skin folds, depression or 

shortness of breath, according to the Hospital Clínic de Barcelona in Spain.

You may be obese if you have some specific medical problems, the clinic adds. They include certain skin disorders, stretch marks, or swelling or varicose veins in the lower limbs. 

High blood pressure and high cholesterol are also signs of obesity. “Insulin is a storage hormone and puts your body in storage mode. Storage form of cholesterol — LDL — goes up. Elimination form of cholesterol – HDL – goes down. Concentrated storage form of sugar — TGs — go up,” Koldas says.

“Common treatments for overweight and obesity include losing weight through healthy eating, being more physically active, and making other changes to your usual habits,” according to the  U.S. National Institute of Diabetes and Digestive and Kidney Diseases. “Weight-management programs may help some people lose weight or keep from regaining lost weight.”6254a4d1642c605c54bf1cab17d50f1e

But dealing with obesity may involve more than simply altering lifestyle. “It is much harder when we think about the symptoms of the disease,” says Carel Le Roux, professor of experimental pathology in the School of Medicine, University College Dublin. “These are the things that people experience that have the disease. And what we now understand is that the two most important symptoms are excess hunger or reduction in fullness.”

“Now what we hear patients say to us is that very often that when they are on a diet, they are thinking about food all the time,” Le Roux adds. “This is the excess hunger. It’s not dramatic, but patients are just a little bit more hungry than people who do not have the disease.”

Some people with obesity are not able to lose enough weight to improve their health or are unable to keep from regaining weight, the institute says. “In such cases, a doctor may consider adding other treatments, including weight-loss medicines, weight-loss devices, or bariatric surgery.”