Obesity: Definition, Causes, and Pathophysiology

What is obesity?

Obesity is a complex disease that is defined by the world health organization (WHO) as abnormal or excessive fat accumulation that presents a risk to health. A person with a body mass index, calculated using the weight and height of the person, of 30 or above is defined as obesity too, and a person with a body mass index of 25 or above is classified as overweight.Obese Person

Apart from being a cosmetic concern, obesity is also a medical concern as it can result in multiple morbidities in an individual like heart disease, diabetes, and hypertension among others. These obesity-related diseases are amongst the leading causes of preventable, premature death in the US, according to the center for disease control and preventions (CDC). The good news, however, is that even the slightest weight loss can help improve the health of an obese person and potentially prevent the complications associated with obesity.

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Obesity Statistics and Facts

According to the CDC, obesity is a ‘common, serious, and costly’ disease affecting approximately 42.4 percent of the American population alone. The year 2020 is the first time the obesity rates have crossed the 40 percent mark in the US with a 26 percent increase in obesity rate since 2008.

Apart from the medical concerns and consequences of obesity, obesity also brings along a serious financial burden. According to the CDC report, the medical costs of an obese person are $1,429 higher than the medical costs of a normal weight person. Overall, the annual obesity medical cost in the United States alone for the year 2008 was 147 billion US dollars.

Obesity is not a problem in the US alone as it plagues the entire world. According to the European Association for the Study of Obesity (EASO), 44% of the diabetes burden, 23% of the ischaemic heart disease burden, and between 7% and 41% of certain cancer burdens can be credited to overweight and obesity.

Furthermore, EASO also states that the world obesity rate increased by 100 percent since the 1980s, which is concerning due to the high mortality associated with obese people than those of normal weight. Obesity claims 2.8 million adult lives usually, either directly or through the comorbidities.

What are the causes of obesity?

Medicine considers obesity as a serious disease. Moreover, since 1997, the WHO has announced that there is a global epidemic of obesity in the world. In developing countries, more than half of adults cannot boast of ideal weight and a third of the population is obese. The Ukrainians are not behind either. The overweight population is 58.4%, while the obesity rate is 24.1%.

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Medics call it the overweight syndrome, which is characterized by excessive accumulation of fat and increasing body weight. There are various reasons for this, among which the imbalance between calorie intake and physical activity levels must be highlighted. Simply put, if more calories are eaten than spent during the day more fat gets deposited. But the causes of obesity can also be different and widely ranging:

  • An inherited predisposition
  • Endocrine disorders
  • Psychological problems and stresses
  • An unhealthy lifestyle, which includes low physical activity, unhealthy diet (eating carbohydrate foods (especially flour products, potatoes), non-observance of the diet, etc.)

Most people with obesity can say about themselves: “I actually eat a little, less than others! They do not lie when they say this. Their mood is associated with an elementary desire to eat something and leads to involuntary, automatic absorption of food. They believe they have eaten a small amount of food and do not feel saturated when they eat it.
People suffering from obesity have serious dysfunction in all their organs and systems. Severe changes are observed in the joints of the lower limbs. Due to heavy loads, cartilage constricts, deforms and breaks down, and joint arthrosis develops. An “enhanced diet” consisting of meat, fats and boiled broth poisons the body with fatty acids, which also deprive bones and teeth of mineral salts. The course of pregnancy against the background of obesity is often accompanied by pathology. The incidence of toxicosis increases; the fetuses are usually born large, but with signs of prematurity. Obesity is a risk factor for diseases such as type 2 diabetes mellitus, arterial hypertension, coronary heart disease, liver, and biliary tract diseases.

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What types, forms, and degrees of obesity do exist?

We differ between two types of obesity – hypertrophic and hyperplastic.

In the first case, the number of fat cells in a person remains unchanged. But there is a constant accumulation of new amounts of fat in them. This type of obesity is usually characteristic of older people.

The second type is characterized by a constant increase in the number of fat cells. These cells secrete a substance that leads to an increase in appetite. Overeating too much causes new cells to appear. This type develops in patients who have the appropriate heredity and are prone to overeating. It develops in adolescents, pregnant women, and women in menopause.

Obesity forms

By the way that fat accumulates in the body, two types of obesity are distinguished – android (male) and gynoid (female).

In the female type of obesity, fat deposits are more localized on the hips, buttocks, and abdominal area. The shape becomes pear-shaped. The male type of obesity is called apple. Because of the accumulation of fat in the area of the chest, back, and abdomen, the figure becomes apple rounded. This type of fat often accumulates not under the skin, but around the internal organs. This type of obesity is called visceral.

Degrees of obesity

Body Mass Index (BMI) is used to assess obesity. This index is calculated by dividing the body weight expressed in kilograms by the growth square expressed in meters. Depending on the BMI, four stages of obesity are distinguished:

  1. Obesity: There are no expressed symptoms of obesity. BMI is in the range of 25-29.9. It is treated with the correction of nutrition and increased physical activity.
  2. First degree: Outwardly rather pronounced, but more often perceived as an aesthetic defect, although shortness of breath, increased sweating, swelling, etc. may already be observed. BMI within 30-34.9. Requires immediate weight correction.
  3. Second degree: Characterized by significant deposits of fat, which are difficult to miss. BMI in the range of 35-39.9. The symptoms characteristic of the first degree are combined with reduced performance, difficulty walking, and active exercise. Treatment is required because obesity is prone to progress.
  4. Third-degree: BMI above 40. The signs of obesity at this level are easily identifiable by their appearance. Headaches and cardiovascular dysfunction are added to this stage. Dyspnea is not only observed in movement but also at rest, with severe swelling of the legs. Such a patient needs not only the help of a dietician but also the advice of an endocrinologist.

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How do you diagnose obesity?

The diagnosis of obesity starts with an external examination. Anthropometric parameters are also used. In addition to BMI, the size of the waist circumference, hips, and their ratio are evaluated. The thickness of the fat fold on the abdomen is measured, which makes it possible to determine the type of obesity and the amount of fat in the body. A general therapeutic examination is performed, based on which instrumental and laboratory tests are prescribed. The laboratory diagnosis of obesity includes general and biochemical analysis. These tests determine diabetes propensity, cholesterol levels, and other indicators. Hormones are tested for – thyroid gland, pituitary gland, and sex hormones. A general urine analysis is carried out to identify kidney problems. The inclusion of a hormone panel in the tests helps to establish the role of heredity in the development of the disease.

Several of the instrumental studies should be highlighted. Computer tomography makes it possible to accurately determine the thickness of fat under the skin, as well as to diagnose visceral obesity and pathologies of internal organs. The second most important method is an ultrasound of the thyroid gland, adrenal glands, pancreas, and liver. This study shows structural changes in the organs. To clarify the diagnosis, an appointment is made: MRI, bioimpedance analysis (BIA), underwater (hydrostatic) weighing, bi-energy X-ray absorption (DRA).

Management Of Obesity

Obesity treatment tactics are chosen depending on the type, stage, and presence of related diseases. In the initial stages, a diet that includes foods with high fiber content. The diet should be prescribed by a dietitian, taking into account individual characteristics. The diet is supplemented by physical activity.

The basic principles of treatment include application: – low-calorie diet

  • Dosed physical loads
  • Lifestyle changes
  • Physiotherapy and acupuncture
  • Drug therapy
  • Surgical treatment
  • Pathogenetic and symptomatic therapy. – psychotherapeutic assistance.

Medical treatment of obesity is used in combination with diet. This is a long-term treatment. The doctor chooses the medicines individually, indicating the need for a healthy lifestyle. Surgical treatment of obesity is currently considered the most effective. But bariatric surgery is used in the final stages of the disease. There are two ways of performing such surgery. American and Canadian surgeons perform a 90% bypass on the stomach, which helps to get rid of 70 to 80% of the extra pounds. In Europe, regulated stomach bandages are used more often, which will get rid of 50-60% of the excess weight.

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The effects of obesity

Obesity is primarily associated with aesthetic unattractiveness and movement restrictions. But doctors warn of serious complications of obesity. These include:

Cardiovascular diseases
Each additional kilo of weight leads to 1.5 km of blood vessels. This is a huge additional burden on the heart which increases the likelihood of heart attacks and strokes.

Respiratory diseases
Obesity makes it difficult for the respiratory system to function. This leads to heart pain, sleep apnea, and increased fatigue.

Diabetes mellitus
In obese people, this disease is much more common. The risk of insulin-dependent diabetes increases by a factor of 40.

Arterial hypertension
The heart suffers, so pressure problems cannot be avoided.

Hormonal system failure
Insulin resistance occurs, which eventually leads to diabetes and slows down growth. Women have menstrual irregularities, and the amount of the hormone progesterone decreases which makes them look more manly. In contrast, men’s appearance becomes feminine due to a decrease in testosterone, and many are diagnosed with erectile dysfunction.

Gall bladder diseases
In people who are overweight, cholecystitis, and gallstone disease are much more frequently diagnosed.

Diseases of the liver
Obesity can cause cirrhosis of the liver. It also leads to higher levels of ‘bad’ cholesterol in the body and the formation of cholesterol plaques.

Cancer 
There is incontrovertible evidence that fat women are more likely to suffer from breast cancer and men from prostate cancer. Patients of both sexes risk getting cancer of the rectum, kidneys, and stomach.

Diseases of the musculoskeletal system, including gout and arthritis
The spine and joints are under increased strain. A kilogram of body weight puts an equal load on the joints. This leads to the destruction and deformation of both joints and spine. There are pains that make it difficult for the joints to move. The effects of obesity are compounded by mental problems and a decrease in self-esteem. Patients need help from a psychotherapist. The whole range of complications leads to the premature death of obese people.

What kind of prevention is needed?

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Obesity prevention involves, above all, a healthy lifestyle:

  • A moderate, varied, and regular diet is necessary
  • Eat only when you are hungry
  • Drink water. People often mistake the feeling of thirst for hunger
  • Limit the use of salt. Your body needs 5-7g of table salt every day. Excess salt traps water in the body, which contributes to unhealthy weight gain.
  • Chew your food carefully, eat it slowly, and enjoy the taste of the food.
  • Never go on a diet that you will never be able to follow throughout your life.
  • Arrange unloading days (apple, buttermilk, vegetable…)
  • Eat more raw fruits and vegetables. They contain more fiber and tartronic acid, which help the body get rid of toxins and excessive fat.
  • Avoid fatty meat, sausages, smoked meats, muffins, spicy sauces, and mayonnaises.
  • Prefer non-fat varieties of meat, fish, cheese, sour milk products, and bakery products made from coarse flour.
  • Avoid ‘snacks’
  • B active: walk more and exercise.

References

https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859313/

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