Obesity results from accumulation of body fat and increase in body weight. Whereas obesity used to be considered as a cosmetic problem, experience and scientific research have proven that obesity is a life threatening illness that affects the quality of one’s life and causes death.
Obese people were wrongly stigmatised as someone who overeats and lacks self control.The World Health Organization (WHO) and scientific societies across the world, now define obesity as a chronic progressive illness that results from multiple genetic and environmental causative factors.
How do we measure obesity
Though multiple methodologies exist to measure the amount of body fat, the most common and clinically useful way is to measure the Body Mass Index (BMI) which is calculated from one’s height and body weight. The other less common way to measure obesity is by calculating Ideal body Weight (IBW)- this number is obtained from the Metropolitan Life Insurance Table. IBW calculates obesity as a percentage in excess of one’s ideal body weight.
Body Mass Index (BMI)
BMI is usually calculated by using one of the BMI charts or by using one of the formulas
- BMI = kg/m2 – Weight in Kilograms divided by height in meters squared.
- BMI = (lbs/inch2) X 705 – weight in pounds divided by inch squared and this value multiplied by 705.
Though studies have found BMI is a good tool to measure body fat there are certain individuals where it may not accurately reflect the problem such as in pregnancy, athletes or elderly. The BMI is used to categorize obesity according to risk of mortality as follows:
18.9 to 24.9
25 to 29.9
Class I, Obesity
30 to 34.9
Class II, Serious Obesity
35 to 39.9
Class III, Severe Obesity
40 and greater
Accelerating nature of Obesity
Many factors contribute to clinical obesity. These are hormonal, metabolic, psychological, behavioral in nature with undoubted genetic components playing a strong role.
Altered Energy Balance
The fundamental issue leading to obesity is the presence of a positive energy balance. This happens when we intake more calories than what our body needs to perform daily activities and perform basic biologic functions. The reason for positive energy accumulation is:
Decreased Physical activity/ Sedentary lifestyle
Lack of adequate sleep
Certain foods that can cause hormonal changes leading to excess body fat- typically processed foods or those rich in sugar
Genetic and environmental factors
Weight Gain- Yes. Weight gain leads to changes in the body’s metabolic and molecular process that favours further accumulation of fat and weight gain. Weight gain resets our threshold for satiety and hunger causing us to eat even more. This ends up being a vicious cycle – obesity “begets’ Obesity. This explains why the nature of the disease of obesity is progressive and chronic
Why is obesity a lethal disease
Obesity leads to multiple physical and psychological illnesses that in turn causes severe morbidity and mortality if untreated. Some of the serious conditions caused by obesity include:
Type 2 Diabetes Mellitus
Obstructive Sleep Apnea
GastroEsophageal Reflux (GERD)
Body Pain and decreased mobility
Many of these illnesses can potentially lead to serious complications and death. In addition various medications used to treat these illnesses can cause further weight gain – “trapping” the individual in obesity.
According to the W.H.O., 65 percent of the world’s population lives in countries where overweight and obesity kills more people than underweight. Approximately 500 million adults in the world are affected by obesity and one billion are affected by being overweight, along with 48 million children.
In the United States, the CDC reports that according to data from a national health and nutrition examination survey, in 2017-2018, the prevalence of obesity was 42.4 %. From 1999–2000 through 2017–2018, the age-adjusted prevalence of obesity increased from 30.5% to 42.4%, and the prevalence of severe obesity increased from 4.7% to 9.2%. Adults aged 40-59 had the highest prevalence of severe obesity.
In the state of Missouri, according to CDC data from the year 2018, 35 % of adults aged 18 and older were obese and 31.9 % were overweight. 15.7 % of adolescents were classified as overweight.
It is obvious that the obesity epidemic has increased in number and severity over the last two decades.
The Economic Impact of Obesity
A disease as prevalent and severe as obesity imposes direct and indirect costs on the health care system. Whereas direct costs relate to prevention, diagnosis and treatment of obesity and related conditions, indirect costs relate to sickness, disability and lost productivity at work.
According to CDC, Obesity-related medical care costs in the United States, in 2008 dollars, were an estimated $147 billion. Annual nationwide productivity costs of obesity-related absenteeism range between $3.38 billion ($79 per obese individual) and $6.38 billion ($132 per individual with obesity).
Why diet alone is insufficient to treat obesity
Dieting is the most commonly recommended and utilised method to lose weight. But, dieting can also contribute to weight gain and progression of obesity. How?
Dieting leads to biological responses that affect energy balance.
When a person loses weight due to dieting, the body assumes it is starving and reduces the energy expenditure. There are also changes that increase our appetite for food. A combination of reduced energy expenditure and increased appetite leads to regaining all of the lost weight and even more.
Dieting alters the way our body metabolises fat.
When we diet, our body reduces fat burning by almost 50%. The amount of fat burnt as fuel during low grade daily activity is reduced as well. This leads to more fat being available to be taken up by fat storage depots. Dieting also increases the capacity of the fat storage depots. This leads to further fat accumulation even when one is not overeating.
How is weight loss surgery different
Weight loss surgeries are effective in maintaining long-term weight loss, in part, because these procedures change the body’s natural responses to dieting that make weight loss so difficult. Weight loss procedures, unlike diet, also cause biological changes that help reduce food intake. Energy (in the form of food) intake is decreased with surgery by restricting stomach size and limiting absorption. In addition, weight loss surgery changes the production of certain gut hormones (or signals) that communicate with the brain to reduce hunger, decrease appetite, and enhance the feeling of being full. In these ways, weight loss surgery, unlike dieting, produces long-term sustained weight loss.
Cause for obesity is multifactorial including a genetic component. Biological changes caused by weight gain and dieting can cause active progression of disease trapping one in a vicious weight gain cycle. Luckily, there are effective and successful treatments in the form of weight loss surgery.
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