Understanding Obesity, It’s Consequences and Treatment

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health. It is defined by body mass index (BMI) and further evaluated in terms of fat distribution via the waist–hip ratio and total cardiovascular risk factors.

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health. It is defined by body mass index (BMI) and further evaluated in terms of fat distribution via the waist–hip ratio and total cardiovascular risk factors. 

People are generally considered obese when their body mass index (BMI), a measurement obtained by dividing a person’s weight by the square of the person’s height, is over 30 kg/m2, the range 25–30 kg/m2 is defined as overweight.

Some East Asian countries use lower values. Obesity increases the likelihood of various diseases and conditions, particularly&nbsp cardiovascular diseases, obstructive sleep apnea, certain types of cancer, osteoarthritis, depression.

Obesity is most commonly caused by a combination of excessive food intake, lack of physical activity, genetic susceptibility. A few cases are caused primarily by genes, endocrine disorders, medications, mental disorder. The view that obese people eat little yet gain weight due to a slow metabolism is not medically supported.  On average, obese people have a greater energy expenditure than their normal counterparts due to the energy required to maintain an increased body mass.

Obesity is mostly preventable through a combination of social changes and personal choices. Changes to diet and exercising are the main treatments.

Diet quality can be improved by reducing the consumption of energy-dense foods, such as those high in fat or sugars, and by increasing the intake of dietary fiber.

 Medications can be used, along with a suitable diet, to reduce appetite or decrease fat absorption. 

If diet, exercise, and medication are not effective, a gastric balloon or surgery may be performed to reduce stomach volume or length of the intestines, leading to feeling full earlier or a reduced ability to absorb nutrients from food.        

BMI (kg/m2) Classification[19]
from up to
18.5 underweight
18.5 25.0 normal weight
25.0 30.0 overweight
30.0 35.0 class I obesity
35.0 40.0 class II obesity
40.0 class III obesity  

 A “super obese” male with a BMI of 53;kg/m2: Weight 182kg (400 lbs.), height 185cm (6ft. 1in). He presents with stretch marks and enlarged breasts.

BMI= m /h2                                               

   Where m and h are the subject’s weight and height respectively.

   BMI is usually expressed in kilograms of weight per meter squared of height.

   To convert from pounds per inch squared multiply by 703(kg/m2) /(lbs. /sq. inch).

      WORLD HEALTH ORGANISATION CLASSIFICATION OF OBESITY

  • Any BMI 35 or 40 kg/m2 is severe obesity.
  • A BMI of ≥ 35 kg/m2 and experiencing obesity-related health conditions or ≥40–44.9  kg/m2 is  morbid obesity.
  • A BMI of ≥ 45 or 50 kg/m2 is  super obesity.

Relative risk of death over 10 years in white people who have never smoked in the United States by BMI. The BMI range 22.5 to 24.9 is set as the reference.

  COMPLICATIONS OF OBESITY:-

Excessive body is associated with various diseases and conditions, particularly cardiovascular diseases, diabetes mellitus type 2obstructive sleep apnea, certain types of cancerosteoarthritis, and asthma. As a result, obesity has been found to reduce life expectancy.

Health consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as osteoarthritis, obstructive sleep apnea, social stigmatization) and those due to the increased number of cardiovascular diseaseو non-alcoholic fatty liver disease). Increases in body fat alter the body’s response to insulin, potentially leading to insulin resistance. Increased fat also creates a pro-inflammatory state and aro- thrombotic state.

Medical field Condition Medical field Condition
Cardiology Coronary heart diseaseangina and Myocardial infarction
Congestive heart failure
High blood pressure
Abnormal cholesterol levels
Deep vein thrombosis and
Pulmonary embolism
Dermatology Stretch marks
Acanthosis nigricans
Lymphedema
Cellulitis
Hirsutism
Intertrigo
Endocrinology 
and Reproductive
medicine
Diabetes mellitus
polycystic ovarian syndrome
menstrual disorders
infertility complications during pregnancy
birth defects
intrauterine fetal death
Gastro-Enterology Gastroesophageal reflux disease[14]
Fatty liver disease
Cholelithiasis 
(gallstones)
Neurology stroke
meralgia paresthetica
migraines
carpal tunnel syndrome
dementia
idiopathic intracranial hypertension
multiple sclerosis
Oncology Esophageal colorectal
Pancreatic
Gallbladder
Endometrial
Kidney
Leukemia
Hepatocellular carcinoma
Malignant Melanoma
Psychiatry Depression in women Social 
stigmatization
Respirology Obstructive sleep apnea
Obesity hypoventilation syndrome
Asthma
Increased complications during general anaesthesia
Rheumatology 
and 
Orthopedics
Gout poor
mobility
osteoarthritis
low back pain
Urology 
and 
Nephrology
Erectile Dysfunction
Urinary Incontinence
Chronic renal failure
Hypogonadism
Buried penis

TREATMENT:-

  1. DIET

The main treatment for obesity consists of weight loss, dieting and physical exercise. Dieting, as part of a lifestyle change, produces sustained weight loss, despite slow weight regain over time. Intensive behavioural interventions combining both dietary changes and exercise are recommended.

Several diets are effective. In the short-term low carbohydrate diets appear better than low fat diets for weight loss. In the long term, however, all types of low-carbohydrate and low-fat diets appear equally beneficial.

  • MEDICATIONS

Five medications have evidence for long-term use:-

  1. Orlistat, b) Lorcaserin  c) Liraglutide  d) Phentermine–Topiramate and

e) Naltrexone–Bupropion.

3. ROLE OF BARIATRIC SURGERY

Bariatric surgical procedures provide consistent, long-term weight-lossو severely obese patients. In addition, such procedures especially bypass operations, provide a high rate of cure from type 2 diabetes and prevent the progression to diabetes in high-risk population

     

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