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What is Obesity?

Obesity is characterized by an excessive accumulation of body fat. It is defined clinically by measures that "estimate" adiposity from body weight, body structure, and height. (1)

It is no longer considered a cosmetic problem caused by overeating and a lack of self-control. The World Health Organization (WHO.), Together with national and international medical and scientific societies, now recognize obesity as a chronic progressive disease resulting from multiple environmental and genetic factors.

It is a number one risk factor, which can be controlled, and is directly related to many diseases (called co-morbidities) such as hypertension, diabetes, arteriosclerosis, strokes, infertility, heart attacks and certain types of cancers.

The management of obesity has become the fundamental factor for the prevention of many diseases and the treatment of many patients who already suffer from them.

Obesity is a risk factor for type 2 diabetes mellitus (DM2). Therefore, there has been a parallel increase in the prevalence of T2DM, currently at 9% worldwide and projected to reach 12% by 2025. Given the growing population, the global burden is likely of diabetes increase by more than 50% in the next decade. The metabolic abnormalities associated with obesity increase the risk of cardiovascular disease, including coronary artery disease and heart failure. (3)

Causes of Obesity

Although there are genetic, behavioral, metabolic, and hormonal influences on body weight, obesity occurs when more calories are ingested than are burned with exercise and normal daily activities. The body stores these excess calories in the form of fat.

Obesity is usually the result of a combination of causes and contributing factors such as the following:

The genes you inherit from your parents can affect how much body fat you store and where that fat is distributed. Genetics can also play a role in how efficiently your body converts food into energy, in the way your body regulates your appetite, and in the way your body burns calories during exercise.

Obesity tends to run in the whole family. Not only because of the genes they share, but family members also tend to share similar eating and activity habits.

Unhealthy diet
A high calorie diet, high calorie drinks, and oversized portions contribute to weight gain.

Inactivity
If you have a sedentary lifestyle, it is very easy for you to eat more calories every day than you burn when you exercise and do normal daily activities. Looking at the screens of computers, tablets and phones is a sedentary activity. The number of hours you spend in front of a screen is highly associated with weight gain.

In some people, obesity can have a medical cause, such as Prader-Willi syndrome, Cushing syndrome, or other disorders. Medical problems, such as arthritis, can also decrease physical activity, which can lead to weight gain.

Some medications can cause weight gain if you don't compensate for it with diet or physical activity. These medications include some antidepressants, anticonvulsant medications, diabetes medications, antipsychotic medications, steroids, and beta-blockers.

There are social and economic factors related to obesity. Similarly, you may not have been taught healthy ways to cook or you may not have access to healthier foods. Also, the people you spend time with can influence your weight; you are more likely to develop obesity if you have obese friends or relatives.

Obesity can occur at any age, even in young children. However, as you age, hormonal changes and a less active lifestyle increase your risk of obesity. Also, the amount of muscle in the body tends to decrease with age.

Generally, the decrease in muscle mass leads to a decrease in metabolism. These changes also lower the calories you need, which can make it harder to avoid excess weight. If you do not consciously control what you eat and do not get more physical activity as you age, you are likely to gain weight.

  • Pregnancy. Weight gain is common during pregnancy. For some women, after the baby is born, it is difficult to lose that weight that they gained. This weight gain can contribute to the development of obesity in women. Breastfeeding may be the best option for losing the weight gained during pregnancy.
  • Give up smoking. Quitting smoking is often associated with weight gain. And for some people, it can lead to enough weight gain to qualify as obesity. Often this happens when people use food to cope with abstinence from smoking. However, in the long term, quitting smoking is still a greater health benefit than continuing to smoke. Your doctor can help you prevent weight gain after you quit smoking.
  • Lack of sleep. Not getting enough sleep or getting too much sleep can cause hormonal changes that increase your appetite. You may also feel like eating foods that are high in calories and carbohydrates, which can contribute to weight gain.
  • Stress. Many external factors that affect mood and well-being can contribute to obesity. People often reach for more high-calorie foods when experiencing stressful situations.
  • Microbial. Gut bacteria are affected by what you eat and can contribute to weight gain or difficulty losing weight.
  • Previous attempts to lose weight. Previous attempts at weight loss followed by rapid weight regain can contribute to further weight gain. This phenomenon, sometimes called a yo-yo diet, can slow down your metabolism.

Consequences of Obesity

Some of the diseases and complications related to Obesity are the following:

  • Arterial hypertension: Obesity is a major risk factor for high blood pressure. About 3 in 4 cases of hypertension are related to obesity (5). Hypertension increases the risk of other diseases. These include coronary heart disease, congestive heart failure, stroke, and kidney disease.
  • Varicose veins and phlebitis: A phlebitis is an inflammation in a vein. When this inflammation is produced by a blood clot that partially or totally clogs a vein, we speak of thrombophlebitis. It can occur superficially, in capillaries in the skin, or deep under the dermis tissues. Varicose veins are venous dilations that are characterized by preventing blood from returning efficiently to the heart (venous insufficiency). They are produced by an alteration of the venous valves, which by not closing properly, cause blood to accumulate in the veins, causing them to dilate.
  • Venostasis in the lower extremitiesVenous stasis, or venostasis, is a condition that involves slow blood flow in the veins, usually in the legs. Venous stasis is a risk factor for the formation of thrombi in the veins (venous thrombosis), as in the case of deep veins in the legs, called deep vein thrombosis (TVP)
  • Cardiac decompensation: Heart disease kills about 600,000 people each year in the United States. The American Heart Association considers obesity to be a major risk factor for heart disease. Large studies show that the risk of heart disease increases with obesity (6). People with severe obesity are at increased risk for coronary heart disease. This means that they are at higher risk of having a heart attack. Obesity increases your risk of heart failure. Severe obesity is associated with irregular heartbeats (arrhythmias). These arrhythmias can triple the risk of cardiac arrest. However, a little excess weight can protect against death from heart failure after diagnosis is made. (7).
  • Arterial sclerosis: Atherosclerosis occurs when the blood vessels that carry oxygen and nutrients from the heart to the rest of the body (arteries) become thick and stiff, sometimes restricting the flow of blood to organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls of the arteries can harden, a condition commonly called arterial hardening.

Your fat overload increases your need for oxygen while decreasing your ability to breathe. This is the reason why you can feel suffocated when you exert yourself. People with obesity have a reduced lung capacity. These people are at an increased risk for respiratory infections. They are more likely to have asthma and other breathing disorders. Asthma has been shown to be three to four times more common in people with obesity (8).

  • Pick-wick syndrome (respiratory failure) or Hypoventilation and obesity syndrome (OHSS): It is a respiratory disease of obese people that causes low oxygen levels and too much carbon dioxide in the blood. The oxygen level is low and the carbon dioxide level is high because of a condition called hypoventilation during the day (daytime hypoventilation). The three main characteristics of OHSS are: 1) obesity; 2) diurnal hypoventilation (difficulty in eliminating carbon dioxide); and 3) a sleep breathing disorder (such as obstructive sleep apnea syndrome). OHSS is also known as Pickwick syndrome, because people with OHSS can have symptoms like those described by Charles Dickens in his essay "The Posthumous Papers of the Pickwick Club."
  • Sleep apnea (OSA): More than half of people affected by obesity (about 50-60 percent) have obstructive sleep apnea (OSA). In cases of severe obesity, this figure is around 90 percent (9). OSA is a very serious respiratory disorder. OSA occurs when excess fat in the neck, throat, and tongue blocks the air passages during sleep. This blockage causes apnea, which means that a person stops breathing for a time. A person with OSA can have hundreds of apnea episodes each night. Apnea episodes reduce the amount of oxygen in a person's blood. OSA can cause high blood pressure, pulmonary hypertension, and heart failure. OSA can cause sudden cardiac death and stroke. Because apnea episodes disrupt the normal sleep cycle, you may not be able to achieve restful sleep. This can lead to fatigue and drowsiness. If left untreated, this drowsiness can increase your risk for car accidents.
  • Drowsiness (sleepiness and tiredness from lack of oxygen): it is an exaggerated attitude to sleep. It is a state in which a strong need to sleep occurs or in which one falls asleep for long periods of time (hypersomnia).
  • Bronchitis: it is an inflammation of the lower airways. It happens when the bronchial tubes, located between the lungs, become inflamed due to infection or for other reasons.
  • Accumulation of pulmonary secretions
  • Pulmonary embolism
  • Gallbladder stones
  • Liver cirrhosis: Liver cirrhosis refers to scarring of the liver that results in abnormal liver function as a consequence of chronic (long-term) liver injury. Cirrhosis is one of the leading causes of illness and death in the United States. Approximately 5.5 million people (2% of the US population) are affected by cirrhosis. This disease causes 26,000 deaths each year and is the seventh leading cause of death in the United States for adults ages 25 to 64. The number of people affected by cirrhosis is expected to continue to increase in the near future.
  • Gastroesophageal reflux and heartburn: Gastroesophageal reflux disease (GERD) causes acid from the stomach or intestinal secretions to leak into the esophagus. Common symptoms of GERD include heartburn, "indigestion," vomiting food, coughing (especially at night), hoarseness, and belching. Between 10 and 20 percent of the general population regularly experience GERD symptoms.
    Obesity has been associated with an increased risk of GERD, erosive esophagitis, and, rarely, esophageal cancer (adenocarcinoma) (10).
  • Pancreatitis

Obesity, particularly severe obesity, contributes to a number of bone and joint problems. These problems can increase the risk of accidents and personal injury. Bone and joint problems can include:

  • Joint diseases (osteoarthritis, gout)
  • Herniated disc
  • Spinal disorders
  • Back pain
  • Osteoarthritis of the hip and knees
  • Osteoarthritis and deformation of the spine

Type 2 diabetes: it is a chronic, progressive and multifactorial disease, with intermediate metabolism alterations (carbohydrates, fats and proteins), associated with relative or absolute insulin deficiency and with variable degrees of resistance to it. The common denominator is characterized by hyperglycemia. Obesity, characterized mainly by visceral adiposity, is linked to patients genetically predisposed to the activation of inflammatory and metabolic mechanisms that lead to the onset of DM2 and cardiovascular disease (11).

Obesity is a major cause of type 2 diabetes. People with severe obesity are approximately 10 times more likely to have type 2 diabetes. (12). Type 2 diabetes can nearly double the risk of death (13). Type 2 diabetes can lead to:

  • Amputations
  • Heart disease
  • Race
  • Blindness
  • Kidney disease
  • High blood pressure
  • Nerve and circulatory defects
  • Difficult-to-cure infections
  • Impotence
  • And more

Prediabetes includes individuals with intermediate categories between normal blood glucose and DM2, with an increased risk of developing diabetes and its macro and microvascular complications (11).

The metabolic syndrome defines a group of cardiovascular and diabetes factors of metabolic origin. Abdominal obesity and insulin resistance are considered the pathophysiological basis (11). The metabolic syndrome (MS) is currently recognized as a pathological entity with its own personality and characterized by the convergence of several cardiovascular risk factors in the same person, with a marked character of underlying metabolic alteration. Arnesen defines it taking into account the following components: insulin resistance (IR), glucose intolerance or type 2 diabetes (DM-2), dyslipidemia, thrombogenesis, pro-inflammatory state, arterial hypertension and central obesity. (14)

  • Dyslipidemia (abnormalities in lipid metabolism)
  • Menstruation disorders in women
  • Impotence in man
  • Infertility
  • Fungal infection
  • Red spots, irritation in the joints
  • Cuts or breaks in the skin
  • Leg swelling and skin ulcers
  • Difficulty dressing
  • Impossibility to follow fashion
  • Obesity in one of the spouses can have repercussions on emotional and sexual life
  • Being subject to eventual impertinences by close people or strangers
  • Nervous breakdown
  • Feeling different in a negative way
  • Refrain from self (isolation)
  • Maladjustment or inability to work
  • Difficulties to be hired
  • Difficulties keeping a job
  • Stress Urinary Incontinence
  • Idiopathic intracranial hypertension (IED)
  • Alzheimer disease- Studies find obesity during middle age can contribute to conditions that increase the risk of dementia and Alzheimer's disease later in life (15).
  • Renal disease: Hypertension, type 2 diabetes, and congestive heart failure are the main contributors to kidney disease and kidney failure. All of these conditions are caused or worsened by obesity.
  • Suicide: studies have shown a correlation between severe obesity and major depressive disorder (16). Obesity-related physical and social discrimination issues can contribute to this depression. Studies are mixed on whether obesity is associated with higher suicide rates. However, most studies seem to suggest lower rates of suicide in people with obesity.
  • Septicemia- Septicemia is a serious infection that can quickly lead to septic shock and death. Studies have shown that people affected by obesity, particularly severe obesity, are at increased risk for septicemia.
  • Liver disease: Obesity is the main cause of fatty liver disease and nonalcoholic fatty liver disease. Most severely obese people have nonalcoholic fatty liver disease. Fatty liver disease can cause scarring of the liver, which worsens liver function and this can lead to cirrhosis and liver failure.

Obesity can have a dramatic impact on your body. Conditions related to obesity can be detrimental to your health. However, many of these complications can be prevented or cured through weight loss.

Cancer

Cancer affects more than half a million lives per year in the United States alone. Obesity is believed to cause up to 90,000 cancer deaths per year. As your body mass index (BMI) increases, so does your risk of cancer and death from cancer. These cancers include:

For people with severe obesity, the death rate increases for all types of cancer. The death rate is 52 percent higher for men and 62 percent higher for women. (17).

Cerebrovascular disease and stroke
Obesity puts pressure on your entire circulatory system. This stress increases your risk of stroke. Obesity can lead to other risk factors for stroke. Risk factors for stroke include heart disease, metabolic syndrome, hypertension, lipid abnormalities, type 2 diabetes, and obstructive sleep apnea (18).

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