Obesity in my view is the mother of all problems and preventable cause of death.
Obesity and Osteo Arthritis:Osteoarthritis is a form of arthritis that features the breakdown and eventual loss of the cartilage of one or more joints. Obesity is a condition which is majorly related to arthritis. Increased body weight and body mass index certainly adds up burden on the joints and enhances the pressure and stress on them, this leads to the wear and tear of the joints and temporary or permanent damage. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints which is primarily effected by obesity. Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. Osteoarthritis usually has no known cause and is referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis. Primary osteoarthritis, osteoarthritis not resulting from injury or disease, is mostly a result of natural aging of the joint. In a study of over 1000 women, the age-adjusted odds ratio of unilateral and bilateral osteoarthritis of the knee, as determined by X-ray, was 6.2 for BMI <23.4kg/m2 and 18 for BMI >26.4kg/m2. When BMI <23.4kg/m2 was compared to BMI 23.4–26.4kg/m2, the odds ratios for osteoarthritis were increased: 2.9 fold for the knee, 1.7 fold for carpometacarpal joint, 1.5 fold for the distal interphalangeal joint, and 1.2 fold for the proximal interphalangeal joint⁶³. With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced osteoarthritis, there is a total loss of the cartilage cushion between the bones of the joints. Repetitive use of the worn joints over the years can irritate and inflame the cartilage, causing joint pain and swelling. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs, also referred to as osteophytes) to form around the joints. Osteoarthritis occasionally can develop in multiple members of the same family, implying a hereditary (genetic) basis for this condition.
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. Body mass index (BMI), a measurement which compares weight and height, defines people as over weight (pre-obese) if their BMI is between 25 and 30 kg/m2, and obese when it is greater than 30 kg/m2. Obesity means having too much body fat. It is not the same as being overweight, which means weighing too much. A person may be overweight from extra muscle, bone, or water, as well as from having too much fat.
Both terms mean that a person's weight is higher than what is thought to be healthy for his or her height.
Obesity increases the likelihood of various diseases, particularly heart disease, type2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis. Obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications or psychiatric illness. Evidence to support the view that some obese people eat little yet gain weight due to a slow metabolism is limited; on average obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body mass.
Dieting and physical exercise are the mainstays of treatment for obesity. Moreover, it is important to improve diet quality by reducing the consumption of energy-dense foods such as those high in fat and sugars, and by increasing the intake of dietary fiber. To supplement this or in case of failure, anti-obesity drugs may be taken to reduce appetite or inhibit fat absorption. In severe cases, surgery is performed or an intragastric balloon is placed to reduce stomach volume and/or bowel length, leading to earlier satiation and reduced ability to absorb nutrients from food.
Obesity as a Disorder of The Homeostatic Control Of Energy Balance:
Because the homeostatic control of energy balance is extremely complex, it is not easy to determine what goes wrong in obesity. When the leptin story is unfolded, it was thought that alterations in the leptin kinetics might prove a simple explanation. There is a considerable inter individual variation in sensitivity to leptin, and some individuals produce insufficient amount of this harmone. Paradoxically, however, plasma leptin is often higher in obese individuals, compared with non-obese subject. The reason for this is that resistance to leptin rather than insufficient harmone is more prevalent in obesity. Such resistance could be caused by by defects in leptin synthesis, in its carriage I the circulation, in its transport into the CNS , in leptin receptors in the hypothalamus. There is some evidence that the action of a member of the family of suppressors of cytokine signaling, SOCS-3 , may underlie or contribute to leptin resistance.
Dysfunction of mediators other than leptin could be implicated in obesity. For example, TNF-a , another cytokine that can relay information from fat tissue to brain , is increased in the adipose tissue of insulin-resistant obese individuals . Another pathophysiological alteration in the obesity is a reduced insulin sensitivity of muscle and fat , and decreased beta-3 adrenoceptor function is brown adipose tissue may also occur; alternatively , UCP-2, one of the proteins that uncouple oxidative phosphorylation in adipocytes, could be dysfunctional in obese individuals.
A further suggestion is that alterations in the function of specific nuclear receptors, such as PPAR-alpha, beta , gamma may play a role in obesity. These receptors play an important role in obesity. Thes receptors regulate gene expression of enzymes related to the lipis and glucose homeostasis. PPAR- gamma expressed preferentially in fat cells and synergises with another transcription factor, C/EBP alpha, to convert precursor cells to fat cells.
Genetic Factors and Obesity:
Analyses of large scale (>100 000) studies in human monozygotic and dizygotic twin pairs indicate that 50-90% of the variance of BMI can be attributed to genetic factors , and suggested a minor role for environmental factors . This conclusion may seem to be surprising but feeding studies using laboratory rodents where food intake is held constant have demonstrated the importance of genetic background to body weight regulation, and this is especially true for high fat diets. The prevailing view point is that susceptibility to obesity is largely determined by genetic factors , while environmental factors determine the expression of the disease. The discovery that spontaneous mutations arising in single genes produced obese phenotypes in mice led to a search for equivalent genes in humans. A recent review reported over 170 human obesity cases that could be traced to single gene mutations in 10 different genes. Leptin receptor or POMC mutations are sometimes observed , but MC4R mutations seem to be more prevalent in obese patients . All the information is annually updated on the Obesity Gene Map Database(http//obesitygene.pbrc.edu).Other genes that appear to be involved include the beta -3 adregoceptor and the glucocorticoid receptor. Alterations in the function of the glucocorticoid receptor could be associated with obesity through the permissive effect of the glucocorticoids on several aspects of fat metabolism and energy balance. In general more than 600 genes are under investigation for linkage with human obesity.
Food Intake and Obesity:
The type of food eaten as well as the quantit, can disturb energy homeostasis. Fat is n energy –dense stuff , and it may be the mechanisms regulating the appetite react more rapidly to carbohydrate and protein and then to fat.
Physical Exercise and Obesity:
It is used to be said that the only exercise effective in combating obesity was pushing one’s chair back from the table. It is now recognized that physical activity has a much more positive hole in reducing fat storage and adjusting energy balance in the obese, particularly if associated with the modification of diet.
Causes of Obesity:
Causes of Obesity:
At an individual level, a combination of excessive food intake and less physical activity generally leads to this condition. A limited number of cases are related to genetics, medical reasons, or physical illness. In contrast, increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet, increased reliance on cars, and mechanized manufacturing. Relaying more on machine than man power is the primary root of cause in many aspects.¹⁰
A review identified nine other possible contributors to the recent increase of obesity.
1. Insufficient sleep
2. Endocrine disrupts.(environmental pollutants that interfere with lipid metabolism)
3. Decreased variability in ambient temperature.
4. Decreased rate of smoking as smoking decreases appetite.
5. Increased use of medications that can cause weight gain.
6. Proportional increases in ethnic and age groups that tend to be heavier.
7. Pregnancy at a later age (which may cause susceptibility to obesity in children).
8. Epigenetic risk factors that have passed on generationally.
9. Associative mating leading to increased concentration of obesity risk factors (this would increase the number of obese people by increasing population variance in weight).
Signs and Symptoms:
The health risks associated with obesity include:
· Breathing disorders (e.g., sleep apnea, chronic obstructive pulmonary disease)
· Certain types of cancers (e.g., prostate and bowel cancer in men, breast and uterine cancer in women) coronary artery (heart) disease
· Depression
· Diabetes
· Gallbladder or liver disease
· Gastro-esophageal reflux disease (GERD)
· High blood pressure
· High cholesterol
· Joint disease (e.g., osteoarthritis)
· Stroke
People who are obese may have the symptoms of the medical conditions mentioned above. High blood pressure, high cholesterol levels, breathing problems, and joint pain (in the knees or lower back) are common. The more obese a person is, the more likely they are to have medical problems related to obesity.
Aside from the medical complications, obesity is also linked to psychosocial problems such as low self-esteem, discrimination, difficulty finding employment, and reduced quality of life.
The onset of Overweight is usually gradual. Symptoms include: Increased weight, thickness around the midsection obvious areas of fat deposits. It's important to remember that fat deposited in your midsection is as much of a health risk as increasing total body weight. If you are developing a thick midsection even though your weight is not going up, you may be losing muscle mass from disuse along with dangerous fat accumulation in your abdomen. This may place you at increased risk for heart (cardiovascular) disease.
Complications Of Obesity:
High Cholesterol and Tri-glycerides:
Cholesterol is a soft, fat-like substance found in the bloodstream and in all your body’s cells. Your body makes all the cholesterol it needs. The saturated fats, trans- fats and cholesterol you eat may raise your blood cholesterol level. Having too much cholesterol in your blood may lead to increased risk for heart disease and stroke. About half of American adults have levels that are too high (200 mg/dL or higher) and about 1 in 5 has a level in the high-risk zone (240 mg/dL or higher). The good news is that you can take steps to control your cholesterol.
Triglycerides are the most common type of fat in your body. They’re also a major energy source. They come from food, and your body also makes them. High levels of blood triglycerides are often found in people who have high cholesterol levels, heart problems, are overweight or have diabetes.
Diabetes mellitus type 2 – formerly non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes – is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. This is in contrast to diabetes mellitus type 1 in which there is an absolute insulin deficiency due to destruction of islet cells in the pancreas. The classic symptoms are excess thirst, frequent urination, and constant hunger. Type 2 diabetes makes up about 90% of cases of diabetes with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes. Obesity is thought to be the primary cause of type 2 diabetes in people who are genetically predisposed to this disease. Obesity enhances the chances and risk of getting diabetes.
Heart Diseases:
Obesity and Coronary Heart Disease: An increased risk of coronary artery disease (CAD) in the overweight was apparent in both the Framingham Heart Study and the health study of nurses. Until recently the relation between obesity and coronary heart disease was viewed as indirect, ie, through covariates related to both obesity and coronary heart disease risk, including hypertension; dyslipidemia, particularly reductions in HDL cholesterol; and impaired glucose tolerance or non–insulin-dependent diabetes mellitus. Insulin resistance and accompanying hyperinsulinemia are typically associated with these comorbidities. Although most of the comorbidities relating obesity to coronary artery disease increase as BMI increases, they also relate to body fat distribution. Long-term longitudinal studies, however, indicate that obesity as such not only relates to but independently predicts coronary atherosclerosis. This relation appears to exist for both men and women with minimal increases in BMI. In a 14-year prospective study, middle-aged women with a BMI >23 but <25 had a 50% increase in risk of nonfatal or fatal coronary heart disease, and men aged 40 to 65 years with a BMI >25 but <29 had a 72% increased risk.The overall relation between obesity and coronary artery disease morbidity and mortality is less clear for Hispanics, Pima Indians, and African-American women.
Congestive Heart Failure:
Left ventricular hypertrophy is common in patients with obesity and to some extent is related to systemic hypertension. However, abnormalities in left ventricular mass and function also occur in the absence of hypertension and may be related to the severity of obesity. Hypertension is approximately three times more common in obese than normal-weight persons. This relationship may be cause-and-effect in that when weight increases, so does blood pressure, whereas when weight decreases, blood pressure falls.
Increased left ventricular volume and wall stress in addition to increased stroke volume and cardiac output are commonly seen in systemic hypertension. The hypertrophy of the left ventricle is both concentric and eccentric, and diastolic dysfunction is common. When obesity is present but systemic hypertension is absent, left ventricular volume is often increased, but wall stress usually remains normal. However, in obese patients without hypertension, increases in stroke volume and cardiac output as well as diastolic dysfunction are seen. These changes in the left ventricle are related to sudden death in obese patients.When 22 patients with severe obesity were examined postmortem, dilated cardiomyopathy was most frequently associated with sudden death (n=10), with severe coronary atherosclerosis (n=6), concentric left ventricular hypertrophy without dilatation (n=4), pulmonary embolism (n=1), and hypoplastic coronary arteries (n=1) also found. Thus, dilated cardiomyopathies, presumably with concomitant cardiac arrhythmias, may be the most common cause of sudden death in patients with severe obesity. The prolonged QT interval also seen in obesity may predispose to such arrhythmias.
Changes in the right heart also occur in obesity. The pathophysiology is related to obstructive sleep apnea and/or the obesity hypoventilation syndrome, which produce pulmonary hypertension and right ventricular hypertrophy, dilatation, progressive dysfunction, and finally failure. However, right ventricular dysfunction can also occur as a consequence of left ventricular dysfunction, and the heart failure that develops is often biventricular.
Obesity and Cancer :
Excessive fat has been shown to increase levels of estrogen, leading to development of endometrial and cervical cancer -- specifically, a subtype of cancer called adenocarcinoma, writes lead researcher James V. Lacey Jr., PhD, an epidemiologist with the National Cancer Institute. Height, weight, and obesity are risk factors for endometrial cancer. Since height and weight are also risk factors for cervical cancer, Lacey wanted to find out whether obesity could be a risk factor for cervical cancer, too. His study appears in the August issue of the journal Cancer. Adenocarcinoma cells are the most common type of cervical cancer cells, writes Lacey. Another type of cancer cell, squamous cell, can also develop on the cervix -- but it is not linked to estrogen levels.
Obesity and Breast Cancer: Many studies have shown that overweight and obesity are associated with a modest increase in risk of postmenopausal breast cancer. This higher risk is seen mainly in women who have never used menopausal hormone therapy (MHT) and for tumors that express both estrogen and progesterone receptors.⁴⁷ Overweight and obesity have, by contrast, been found to be associated with a reduced risk of premenopausal breast cancer in some studies. The relationship between obesity and breast cancer may be affected by the stage of life in which a woman gains weight and becomes obese. Epidemiologists are actively working to address this question. Weight gain during adult life, most often from about age 18 to between the ages of 50 and 60, has been consistently associated with risk of breast cancer after menopause. The increased risk of postmenopausal breast cancer is thought to be due to increased levels of estrogen in obese women. After menopause, when the ovaries stop producing hormones, fat tissue becomes the most important source of estrogen. Because obese women have more fat tissue, their estrogen levels are higher, potentially leading to more rapid growth of estrogen-responsive breast tumors. The relationship between obesity and breast cancer risk may also vary by race and ethnicity. There is limited evidence that the risk associated with overweight and obesity may be less among African American and Hispanic women than among white women.
Obesity and Colorectal Cancer: Among men, a higher BMI is strongly associated with increased risk of colorectal cancer. The distribution of body fat appears to be an important factor, with abdominal obesity, which can be measured by waist circumference, showing the strongest association with colon cancer risk. An association between BMI and waist circumference with colon cancer risk is also seen in women, but it is weaker. Studies suggest that overweight and obese women are more likely to delay cervical and breast cancer screenings than normal weight women. Use of MHT may modify the association in postmenopausal women. A number of mechanisms have been proposed to account for the association of obesity with increased colon cancer risk. One hypothesis is that high levels of insulin or insulin-related growth factors in obese people may promote colon cancer development. High BMI is also associated with rectal cancer risk, but the increase in risk is more modest.
Obesity and Depression:
The prevalence of depression (10%) and overweight (65%) indicates that there is a probability that they will co-occur, This report used the moderator/mediator distinction to approach this question. Moderators, such as severity of depression, severity of obesity, gender, socioeconomic status (SES), gene-by-environment interactions and childhood experiences, specify for whom and under what conditions effects of agents occur. Mediators, such as eating and physical activity, teasing, disordered eating and stress, identify why and how they exert these effects. Major depression among adolescents predicted a greater body mass index (BMI = kg/m(2)) in adult life than for persons who had not been depressed. Among women, obesity is related to major depression, and this relationship increases among those of high SES, while among men, there is an inverse relationship between depression and obesity, and there is no relationship with SES. A genetic susceptibility to both depression and obesity may be expressed by environmental influences. Adverse childhood experiences promote the development of both depression and obesity, and, presumably, their co-occurrence. As most knowledge about the relationship between these two factors results from research devoted to other topics, a systematic exploration of this relationship would help to elucidate causal mechanisms and opportunities for prevention and treatment.
Obesity and Infertility:
Obese women have a greater incidence of reproductive-related disorders including problems in pregnancy. The conventional approach in the past has been to carefully monitor patients who have high-risk pregnancies; e.g. gestational diabetes, multiple gestations, etc. Based on more recent data, it seems that overweight/obese individuals represent another high-risk group for infertility.
There are a significant number of overweight and obese females who suffer infertility. This could be a consequence of irregular periods and frequently anovular (non- ovulatory) menstrual cycles. A large percentage of those infertile patients have Polycystic Ovarian Syndrome (PCOS), a disorder often associated with obesity, chronic anovulation, and menstrual irregularity.
Anovulation is also seen in patients with a body mass index (BMI) of less than 30 due to hormonal imbalances. Although the exact mechanisms of how obesity affects fertility are not well understood, there is an apparent insulin-mediated hyperstimulation of ovarian steroid production and decreased sex hormone-binding globulin.
Obesity impacts IVF treatments, and has been associated with the following:
- Early pregnancy loss after IVF
- Decreased pregnancy rate
- Decreased fertilization
- Higher gonadotropin requirements
- An impaired response to gonadotropins.
The cause of a poor IVF treatment outcome may be due to poor oocyte quality with subsequent lower fertilization and/or implantation defects caused by a qualitatively poor endometrial milieu. Finally, there are a number of endocrine changes that are associated with being overweight or obese⁶⁰.
Obesity and Erectile Dysfunction (ED):
Recent studies have shown evidences related to obesity and erectile dysfunction. It is been proved that obesity has a direct link to erectile dysfunction. Obese males generally have decreased blood flow or vascularity and in some conditions , people may have decreased pineal blood flow. As there is decreased vascularity , erectile dysfunction may occur which can be managed by various drugs like phospho diesterase inhibittors or other means like physical exercises etc.
Obesity and Osteo Arthritis:Osteoarthritis is a form of arthritis that features the breakdown and eventual loss of the cartilage of one or more joints. Obesity is a condition which is majorly related to arthritis. Increased body weight and body mass index certainly adds up burden on the joints and enhances the pressure and stress on them, this leads to the wear and tear of the joints and temporary or permanent damage. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints which is primarily effected by obesity. Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees. Osteoarthritis usually has no known cause and is referred to as primary osteoarthritis. When the cause of the osteoarthritis is known, the condition is referred to as secondary osteoarthritis. Primary osteoarthritis, osteoarthritis not resulting from injury or disease, is mostly a result of natural aging of the joint. In a study of over 1000 women, the age-adjusted odds ratio of unilateral and bilateral osteoarthritis of the knee, as determined by X-ray, was 6.2 for BMI <23.4kg/m2 and 18 for BMI >26.4kg/m2. When BMI <23.4kg/m2 was compared to BMI 23.4–26.4kg/m2, the odds ratios for osteoarthritis were increased: 2.9 fold for the knee, 1.7 fold for carpometacarpal joint, 1.5 fold for the distal interphalangeal joint, and 1.2 fold for the proximal interphalangeal joint⁶³. With aging, the water content of the cartilage increases, and the protein makeup of cartilage degenerates. Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced osteoarthritis, there is a total loss of the cartilage cushion between the bones of the joints. Repetitive use of the worn joints over the years can irritate and inflame the cartilage, causing joint pain and swelling. Loss of the cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage can also stimulate new bone outgrowths (spurs, also referred to as osteophytes) to form around the joints. Osteoarthritis occasionally can develop in multiple members of the same family, implying a hereditary (genetic) basis for this condition.
Treatment In obesity:
Dietary Changes: Reducing calories and eating healthier are vital to overcoming obesity. Although you may lose weight quickly at first, slow and steady weight loss of 1 or 2 pounds (1/2 to 1 kilogram) a week over the long term is considered the safest way to lose weight and the best way to keep it off permanently. Avoid drastic and unrealistic diet changes, such as crash diets, because they're unlikely to help you keep excess weight off for the long term.
Behavior Changes: A behavior modification program can help you make lifestyle changes, lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity. Behavior modification, sometimes called behavior therapy, can include:
Counseling: Therapy or interventions with trained mental health or other professionals can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers, and cope with food cravings. Counseling may be available by telephone, email or Internet-based programs if travel is difficult. Therapy can take place on both an individual and group basis.
Exercise and Increased Daily Activity:
Physical exercise is the best means of avoiding obesity. Experts recommend atleast 150minutes of moderate-intense workout every week. Physical exercises not only reduce the body fat and body weight but also increases the metabolism and also improve natural stamina and endurance. Exercise sessions, circuit exercises, aerobics, weight training, cycling, etc.. are the various means of physical exercises. Physical exercises also improve the vascularity of various organs which improvises the functioning of that particular organ.
Surgery: Surgical treatment of obesity is also known as bariatric surgery or weight loss surgery. Surgery is currently the most effective treatment for morbid obesity resulting in durable and sustainable weight loss and accompanying health improvements.
Non Surgical Treatment in Obesity:
The first step toward weight loss is to eat less and to exercise more. The goal is not to lose all the excess weight. Losing even 10% of your weight can significantly lower you risk of developing obesity-related medical problems. However, over the long term, these strategies alone are not always successful for weight loss. An estimated less than 5% of individuals who participate in weight loss programs lose significant amounts of weight and maintain that loss for a long period.
Prescription Weight Loss Treatment:
Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help. Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them. If you don't make these other changes in your life, medication is unlikely to work.
Weight loss medications are preferred if there are conditions where other weight loss medications have not worked , if the body mass index(BMI) is greater than 27 , if there are medical conditions like diabetes, high blood pressure or other health hazards. Medications like:
Orlistat (Xenical) is a weight-loss medication that has been approved by the Food and Drug Administration (FDA) for long-term weight loss. This medication blocks the digestion and absorption of fat in your stomach and intestines. Unabsorbed fat is eliminated in the stool. Average weight loss with orlistat is only about 5 to 7 pounds (2.3 to 3.2 kilograms) more than you can get from diet and exercise after one or two years of taking the medication.
Side effects associated with orlistat include oily and frequent bowel movements, bowel urgency, and gas. These side effects can be minimized as you reduce fat in your diet. Because orlistat blocks absorption of some nutrients, take a multivitamin while taking orlistat to prevent nutritional deficiencies.
The FDA has approved orlistat for use in adults and children 12 and older. The FDA also has approved a reduced-strength version of orlistat (Alli) to be sold over-the-counter, without a prescription. Alli is not approved for children. This medication works the same as prescription-strength orlistat and is meant only to supplement — not replace — a healthy diet and regular exercise.
Phentermine (Adipex-P, Suprenza) is a weight-loss medication that was approved in the 1970s only for short-term (three months) use. Using weight-loss medications short-term does not usually lead to long-term weight loss. While some health care providers prescribe phentermine long term, there are few studies that have evaluated its safety and weight-loss results long term.
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