Obesity

Overview:

Body mass index (BMI) is a calculation that takes a person’s weight and height into account to measure body size.

In adults, obesity is defined as having a BMI of 30 or more

Obesity is associated with a higher risk for serious diseases, such as type 2 diabetes, heart disease, and cancer.

But BMI isn’t everything, It has some limitations as a metric.

Factors such as age, sex, ethnicity, and muscle mass can influence the relationship between BMI and body fat.

 Also, BMI doesn’t distinguish between excess fat, muscle, or bone mass, nor does it provide any indication of the distribution of fat among individuals.

Despite these limitations, BMI continues to be widely used as a way to measure body size.

The following classes are used for adults who are at least 20 years old:

BMI under 18.5: patient is classified as: under weight

BMI between 18.5-24,9: patient is classified as: normal

BMI between 25-29,9: patient is classified as: over weight

BMI above 30: patient is classified as: obesity

Causes:

Eating more calories than you burn in daily activity and exercise (on a long-term basis) can lead to obesity.

Over time, these extra calories add up and cause weight gain.

But it’s not always just about calories in and calories out, or having a sedentary lifestyle.

While those are indeed causes of obesity, some causes you can’t control.

Common specific causes of obesity include:

• genetics, which can affect how your body processes food into energy and how fat is stored
• growing older, which can lead to less muscle mass and a slower metabolic rate, making it easier to gain weight
• not sleeping enough, which can lead to hormonal changes that make you feel hungrier and crave certain high-calorie foods
• pregnancy, as weight gained during pregnancy may be difficult to lose and might eventually lead to obesity

Certain health conditions can also lead to weight gain, which may lead to obesity. These include:

• polycystic ovary syndrome (PCOS), a condition that causes an imbalance of female reproductive hormones
• Prader-Willi syndrome, a rare condition present at birth that causes excessive hunger
• Cushing syndrome, a condition caused by having high cortisol levels (the stress hormone) in your system
• hypothyroidism (underactive thyroid), a condition in which the thyroid gland doesn’t produce enough of certain important hormones
• osteoarthritis  and other conditions that cause pain that may lead to reduced activity

risk factors:

A complex mix of factors can increase a person’s risk for obesity.

• Genetics:

Some people have genes that make it difficult for them to lose weight.

• Community:

Your environment at home, at school, and in your community can all influence how and what you eat, and how active you are.

You may be at a higher risk for obesity if you:

• live in a neighborhood with limited healthy food options or with high-calorie food options, like fast-food restaurants
• haven’t yet learned to cook healthy meals
• don’t think you can afford healthier foods
• haven’t found a good place to play, walk, or exercise in your neighborhood

• Psychological and other factors:

Depression can sometimes lead to weight gain, as some people may turn to food for emotional comfort. Certain antidepressants can also increase the risk of weight gain.

• Medications, such as steroidsor birth control pills, can also raise your risk for weight gain.

Diagnosis:

BMI is a rough calculation of a person’s weight in relation to their height.

Other more accurate measures of body fat and body fat distribution include:

• skinfold thickness tests
• waist-to-hip comparisons
• screening tests, such as ultrasounds, CT scans, and MRI scans

Your doctor may also order certain tests to help diagnose obesity-related health risks. These may include:

• blood tests to examine cholesterol and glucose levels
• liver function tests
• a diabetes screening
• thyroid tests
• heart tests, such as an electrocardiogram 

A measurement of the fat around your waist is also a good predictor of your risk for obesity-related diseases (above 102 cm on male, 89 cm on female).

Complication:

Obesity can lead to more than simple weight gain.

Having a high ratio of body fat to muscle puts strain on your bones as well as your internal organs.

It also increases inflammation in the body, which is thought to be a risk factor for cancer.

 Obesity is also a major risk factor for type 2 diabetes.

Obesity has been linked to a number of health complications, some of which can be life threatening if not treated:

• type 2 diabetes
• heart disease
• high blood pressure
• certain cancers (breast, colon, and endometrial)
• stroke
• gallbladder disease
• fatty liver disease
• high cholesterol
• sleep apnea and other breathing problems
• arthritis
• infertility

Treatment:

If you have obesity and been unable to lose weight on your own, medical help is available.

Your doctor may want to work with you as part of a team helping you lose weight.

That team might include a dietitian, therapist, or other healthcare staff.

Your doctor will work with you on making needed lifestyle changes. Sometimes, they may recommend medications or weight loss surgery as well.

Lifestyle changes:

Your healthcare team can educate you on food choices and help develop a healthy eating plan that works for you.

• Aim for moderate exercise like walking, swimming, or biking for 20 to 30 minutes every day.
• Eat well by choosing nutritious foods, like fruits, vegetables, whole grains, and lean protein.
• Eat high-fat, high-calorie foods in moderation.

Counseling or support groups may also identify unhealthy triggers and help you cope with any anxiety, depression, or emotional eating issues.

Lifestyle and behavioral changes are the preferred weight loss methods for children, unless they’re extremely overweight.

Medications:

Medications are usually prescribed only if other methods of weight loss haven’t worked and if you have a BMI of 27.0 or more in addition to obesity-related health issues.

Prescription weight loss medications either prevent the absorption of fat or suppress appetite.

• phentermine/topiramate (Qsymia)
• naltrexone/bupropion (Contrave)
• liraglutide (Saxenda)
• orlistat (Alli, Xenical)

These drugs can have unpleasant side effects.

For example, orlistat can lead to oily and frequent bowel movements, bowel urgency, and gas.

Hydrogel capsule:

It is an easy-to-swallow capsule that absorbs water in the stomach and increases in size, giving a feeling of fullness and satiety.

Gastric capsule:

It is a small capsule connected to a tube that is taken without endoscopy.

 Once it reaches the stomach, the liquid is injected into it through the tube until it turns into a balloon inside the stomach, and then the tube is withdrawn

It usually stays inside the stomach for 16 weeks and then opens automatically and is expelled

Endoscopic procedure:

Gastric balloon

Gastroplasty

Botox injection

Surgery:

Weight loss surgery is commonly called bariatric surgery.

This type of surgery works by limiting how much food you can comfortably eat or by preventing your body from absorbing food and calories.

Sometimes it can do both.

Weight loss surgery isn’t a quick fix.

 It’s a major surgery and can have serious risks.

 Afterward, people who undergo surgery will need to change how they eat and how much they eat, or they risk getting sick.

However, nonsurgical options aren’t always effective at helping people with obesity lose weight and reduce their risk for comorbidities.

Types of weight loss surgery include:

• Gastric bypass surgery: In this procedure, surgeon creates a small pouch at the top of your stomach that connects directly to your small intestine. Food and liquids go through the pouch and into the intestine, bypassing most of the stomach.
• Mini gastric bypass: In this procedure, your surgeon creates a small pouch at the top of your stomach that connects directly to your small intestine loop.
• Laparoscopic adjustable gastric banding separates your stomach into two pouches using a band.
• Gastric sleeve surgery. This procedure removes 75-80% of your stomach.

 Surgery is recommended for adult with BMI at least 35 or BMI above 30 with:

1. related comorbidities, especially type 2 diabetes
2. haven’t seen sustained results from nonsurgical treatments, such as eating and lifestyle modifications

People will often have to lose some weight before undergoing surgery. Additionally, they’ll normally undergo counseling to ensure that they’re both emotionally prepared for the surgery and willing to make the necessary lifestyle changes that it’ll require.