Obesity

Overview

The World health organisation has defined obesity and overweight as an abnormal or excessive fat accumulation that can impair health. According to WHO, worldwide obesity has almost tripled since 1975. It is set to become a leading cause for a wide range of non-communicable chronic conditions. Obesity is preventable.

Types of Obesity

Body mass index (BMI) is a simple calculation involving a person’s height and weight. It recommends a healthy range of weight based on the individual’s height. Based on BMI, obesity can be classified as:

Class 1: Class 1 obesity is defined as having a BMI ranging between 30.0-34.9
Class 2: Class 2 obesity is defined as having a BMI ranging between 35.0-39.9
Class 3: Class 3 obesity is defined as having a BMI greater than or equal to 40.0

Along with height and weight, waist circumference is also taken into consideration to determine the risk factor for several chronic diseases related to overweight and obesity.

About The Condition

Obesity is a condition which results from a complex combination of environmental and genetic factors. It is linked to a wide range of chronic conditions such as diabetes, cardiovascular diseases, and cancer. Obesity and overweight can also have a significant psychological impact on the individual. In 1997, the World Health Organisation formally recognized obesity as a global epidemic due to its increasing prevalence amongst both adults and children around the world.

Risks of Obesity

There are several risk factors associated with overweight and obesity. These include:

Lifestyle and diet: Leading an extremely sedentary lifestyle with a lack of physical exercise along with eating a high calorie diet (high in saturated and trans-fat, high sugar) is the most significant risk factor for obesity around the globe. It is also easily preventable. Studies show that not getting enough sleep and increase in stress can also result in unhealthy weight gain.
Age: The risk of gaining weight increases with age due to hormonal and lifestyle changes associated with ageing. However, today, childhood obesity has become an increasingly troubling issue.
Medical conditions: Certain conditions such as Prader-Willi syndrome, Cushing syndrome and other medical conditions can result in unhealthy weight gain.
Medications: Certain medications such as some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta-blockers can result in weight gain unless the treatment course is complemented with physical exercise and diet.
Pregnancy: Weight gain is common (and normal) during pregnancy. Some women however find it difficult to shed the added weight after delivery.
Previous weight loss attempts: Previous weight loss attempts by following certain diets or fasting followed by rapid weight gain due to binging can contribute to further weight gain by slowing down the metabolism.

Symptoms

There are no specific symptoms of obesity apart from a high body mass index (BMI) and an unhealthy fat distribution (defined by the waist circumference). People suffering from obesity may also experience related complications such as:

Cardiovascular disorders
Sleep apnoea
Type 2 diabetes
High blood cholesterol
Respiratory problems
Osteoarthritis (joint pain)
Urinary incontinence
Gallbladder disease
Cancers of the esophagus, pancreas, colon, rectum, kidney, endometrium, ovaries, gallbladder, breast or liver
Infection in the folds of the skin

Diagnosis of Obesity

Your doctor will diagnose obesity based on your medical history, physical exam and your body mass index. You might also have to undergo additional tests to rule out underlying conditions if any.

Obesity Treatment

Based on the severity of the condition, your doctor might recommend a combination of any of the following treatments:

Diet: Your doctor or dietician would recommend a low-calorie diet with healthier foods like fruits, vegetables and whole-grain carbohydrates. Limit salt and processed sugar consumption. Ass more lean meats such as fish and chicken to your diet.
You should also be wary of crash diets of fad diets that promise rapid weight loss. These can eventually lead to long term weight gain by slowing down metabolism.
Lifestyle: Incorporate routine physical activity and exercise into your daily routine. People with obesity require at least 150 minutes of moderate-intensity exercise in a week to prevent further weight gain. Try to walk wherever possible instead of driving.
Medication: Weight loss medication might be prescribed to augment diet and exercise for individuals with a BMI higher than 30 or suffering from obesity-related complications such as diabetes, sleep apnoea, etc.
Weight loss surgery: Weight loss surgery also called bariatric surgery and can help people lose as much as 35% of their body weight. It has a few risks associated with it and you would have to make permanent lifestyle and dietary changes to ensure its long-term effectiveness. Common weight loss surgeries are:
1. - Gastric bypass surgery: In this procedure, the surgeon will create a small pouch on the top of your stomach. The small intestine is cut below the stomach and attached to the new pouch. After the surgery, food and liquid flows directly from the pouch to the small intestine, bypassing most of the stomach.
  - Adjustable gastric banding: The surgeon will separate your stomach into two pouches with the help of an inflatable band. The band is designed to stay permanently.
  - Biliopancreatic diversion with duodenal switch: In this procedure, a large part of your stomach is removed. The surgeon will leave the valve that releases food into the small intestine and the first part of the small intestine (duodenum). The middle section of the small intestine is closed and the last part of the small intestine is attached directly to the duodenum.
  - Gastric sleeve: For this procedure, your surgeon will remove a part of your stomach, creating a smaller reservoir for food. This is the most common type of weight loss surgery performed.
Endoscopic procedures: In these types of procedures, endoscopes and tools are inserted into your stomach through your mouth. The surgeon can then either place stitches in your stomach to reduce its size and limit intake or place a small balloon filled with water to achieve the same. You can achieve 5-20% of total body weight loss after this procedure.

Prevention

The most effective way to deal with obesity is to prevent it. Obesity is no longer limited to any specific age group or demographic. The best ways to prevent obesity include:

Healthy balanced diet: Follow a healthy balanced diet including fibre, whole grains and lean meat. Avoid highly processed food and sugars. Ensure that you consume only the required number of calories based on your lifestyle. Try reducing portion sizes. Maintain a food diary to record and measure your intake.
Exercise: Incorporate moderate to intense exercise for at least 60-90 minutes, 3 to 4 times a week. Try walking whenever possible.

FAQs

1. Can obesity cause infertility?

Obesity can affect your ability to conceive. It can affect your hormone levels and your menstrual cycle. It can also result in a condition called anovulation where the body doesn’t produce eggs properly. Obesity can make IVF more challenging.
It is also important to note that achieving a healthy body weight before pregnancy can also reduce the risk of several pregnancy conditions such as gestational diabetes and hypertension.

2. Can obesity cause shortness of breath?

Obesity can result in a syndrome called obesity hypoventilation syndrome. This is when poor breathing causes lower oxygen levels and higher concentration of carbon dioxide in the blood.

3. Can obesity be cured?

Obesity is usually curable with simple lifestyle and dietary changes. In the case of extreme conditions, surgical treatments such as bariatric surgery is also recommended.

4. Is obesity genetic?

Obesity is caused due to a complex interplay of genetic and environmental factors. Having a family history of obesity does increase the propensity of an individual developing the condition as well.