Clinical Obesity: Understanding the Facts
Overview of obesity
Obesity is a condition that is epidemic in most countries, including the United States. Being obese means that you are more susceptible to developing a vast range of chronic diseases such as heart disease, type 2 diabetes, and cancer.
Statistics released by the Centers for Disease Control and Prevention shows that between 2015-2016, 39.8% of American adults (totaling 93.3 million), and 18.5% of American teenagers (totaling 13.7 million) are clinically obese.
Obesity can be defined as a Body Mass Index (BMI) of 30kg/m2 or more. BMI calculation is based on an individual’s weight and height but it is not very specific as it possesses some limitations. Studies have shown that factors such as age, race, sex, and muscle mass can influence the relationship between BMI and body fat.
The limitations of BMI include:
- It does not tell the difference between excess fat, muscle, or bone density
- It does not provide any indication of fat distribution in individuals
What causes obesity?
Obesity is caused by an imbalance between energy intake and output. Consuming more calories than you expend during daily activity or exercise (when prolonged) can cause obesity as these calories accumulate and lead to weight gain.
More definite causes of obesity include:
- Taking diets with more fat and caloric content
- Leading a sedentary lifestyle
- Genetics: has a role to play in energy production and fat storage
- Poor sleep: the more you stay awake, the hungrier you will get as certain high-calorie foods tend to be consumed then
- Aging: Changes resulting from aging such as a decrease in muscle mass and decreased metabolic rate leads to obesity
- Weight gained during pregnancy may be difficult to shed and eventually result in obesity
Some medical conditions have also been linked to the causation of obesity and they include:
- Polycystic ovarian syndrome (PCOS): Here, there is a hormonal imbalance. It occurs in females and the hormones involved are the reproductive hormones.
- Prader-Willi syndrome: Is a rare genetic disorder where an individual is born and is excessively hungry
- Cushing syndrome is a condition where one possesses increased levels of the stress hormone, cortisol.
- Hypothyroidism is a condition where the thyroid glands are under-producing hormones.
- Osteoarthritis: is bone pain and inflammation that occurs majorly in the elderly. It leads to immobilization/ inactivity that this increases the likelihood of being obese.
Risk factors for obesity
Obesity is caused by an interplay of genetic, environmental, and psychological factors.
Genetics: some individuals possess certain genetic factors that make it hard for them to lose weight. Babies that were born premature or with very low birth weight are more likely to be obese in adulthood than term and normal-weight babies.
The environment also plays a vital role in the development of obesity. It can influence what you eat and your level of activity. It could be that it is not conducive to physical activity or that unhealthy foods are being served. Also, the reward system of certain parents tends to be unhealthy foods.
Psychological factors as a cause of obesity
Being depressed can lead to weight gain as some people see food as a sort of emotional comfort. Some anti-depressants and antipsychotic drugs such as olanzapine can also lead to weight gain. Other drugs that can cause weight gain include steroids and contraceptives.
For a smoker, quitting after a while can lead to weight gain.
Diagnosis of obesity
The Body Mass Index (BMI) is used to get a rough estimate of a person’s weight in relation to the height. Obesity is said to occur when one has a BMI of 30kg/m2 or more but as earlier stated, it has certain limitations.
More precise ways of measuring body fat and its distribution include:
- Skin-fold thickness
- Waist-to-hip ratio
- Imaging tests such as ultrasound scan, computed tomography (CT) and magnetic resonance imaging (MRI)
As obesity can pose certain health risks, the doctor may order certain tests to rule out the possible health risks associated with obesity and also confirm a diagnosis. These tests include:
- Blood tests such as liver function test, diabetic screen, lipid profile, glucose level tests, thyroid tests
- Heart tests such as electrocardiogram
Measuring the fat level around the waist is a good predictor of risks for health risks associated with obesity.
What complications can arise from obesity?
Weight gain isn’t just the only feature or effect of obesity. The effect of obesity can be systemic as internal organs may be affected, the bones too may be affected. Obesity is known to speed up the inflammatory processes that take place in the body and this can eventually result in the development of cancer. Obesity is also a recognized risk factor for type 2 DM.
The following are health conditions that have obesity as a core risk factor, some may even be life-threatening:
- Type 2 diabetes mellitus
- Heart disease
- Stroke/cerebrovascular accident
- Cancers of the breast, colon or endometrium
- Fatty liver disease
- Gall bladder disease
- Sleep apnea
- Infertility or subfertility
Treatment of obesity
Medical modalities exist which help with weight loss. It begins with meeting a family physician who will, in turn, make the necessary referrals to a weight specialist.
Weight loss will likely involve different specialists which make up a team. This team consists of the dietician, therapist, and/or other health workers.
Lifestyle modifications are often proposed by the physician. When indicated, medications will be recommended as well as weight-loss surgeries.
The health team in charge will educate on better food choices and help you adopt an adequate food plan for healthy eating. Exercising for 60minutes for five days in a week will help to build muscles, strength, tolerance and metabolic rate.
Another way of dealing with anxiety problems, depression, or emotional eating is by identifying unhealthy triggers and this can be achieved by counseling or through support groups.
Medical weight loss
In addition to healthy eating and exercise plans, the physician may add certain medications but this is only done when there is a failure of achieving weight loss with other modalities or if the Body Mass Index is 27kg/m2 or more in the presence of obesity-related health disorders.
The medications work by either suppressing appetite or by preventing fat absorption. They are associated with adverse side effects such as frequent bowel movements; bowel urgency and gas as is typical for the drug Orlistat. Anyone taking such a drug is to be monitored closely by the physician.
Surgery for weight loss
This is also known as bariatric surgery. It works only if the patient is committed to changing their lifestyle.
It works by either reducing the quantity of food one can eat comfortably or by preventing the body from absorbing food. It could be via both modalities.
It is not an easy way out and as with other surgical procedures, it possesses some serious risks. After the surgery, the patient will have to adjust their food pattern or quantity or risk getting sick.
Suitable candidates for weight loss surgery include those with a BMI of 40 and above or a BMI of 35 to 39.9 with obesity-related health problems.
Some adjustments are made before surgery. The patient should be emotionally prepared for the surgery and also be ready to adopt the lifestyle changes proposed. Also, before surgery, patients will be expected to lose weight.
The following options exist for weight loss surgery:
- Gastric bypass surgery: here, there is a creation of a small pouch at the top of the stomach which is linked directly to the intestine. A greater part of the stomach is bypassed because food gets into the intestine through the pouch.
- Laparoscopic adjustable gastric banding: this divides the stomach into two parts with the aid of a band.
- Gastric sleeve: here, some part of the stomach is removed
- Biliopancreatic diversion with duodenal switch: here a greater part of the stomach is removed
There has been a worldwide surge of obesity and obesity-related diseases. This is the major reason for emphasizing healthy food choices and physical activities at the community, state, and federal levels.
However, healthy lifestyle changes are dependent on the individual.
Prevention of obesity
It is much easier to prevent than to treat obesity. Prevention is by adopting a healthy lifestyle such as exercising moderately (brisk walking, biking, swimming) for about 20 to 30 minutes daily. Eat healthily, take lots of fruits, vegetables, whole grains, and lean protein. Foods that have high-caloric, high-fat content should be eaten in moderation.