In prehistoric times when food was scarce and individuals had a tough time between a feast and famine, obesity was considered as the sign of wealth and power. Slowly, various physicians like Sushruta, Hippocrates and others started recognizing obesity as the root cause of various problems. Fast-forwarding to the current scenario, obesity is not only related to various diseases affecting humans but it has also become the stigma and for some, it’s the subject of mirth.
Worldwide obesity has tripled since 1975 and in 2016, 1.9 billion adults were overweight. –World Health Organization
Obesity, once considered as the disease of high-income countries, has now become a global epidemic affecting low and middle-income countries equally. In fact, many developing countries are now facing a unique problem wherein, at one end there is a high rate of obesity, which is balanced with the malnutrition from the other end.
Understanding Obesity- its Definition, BMI and the Reason behind its Rise
Obesity is a complex disease which can be preventable. In simple terms, it can be defined as the excess BMI or excessive fat accumulation which can result in several diseases like type 2 diabetes, heart attack, hypertension, non-alcoholic fatty liver disease, different cancers and others.
Body Mass Index (BMI)
It is one of the most commonly used criteria to classify an individual’s body type ranging from underweight to severe obesity. BMI is calculated by an individual’s weight which is divided by his or her height in meters squares. Below is the BMI defining a person category-
|Body Type||BMI (kg/m2)|
|Underweight||Less than 18.5|
|Normal Weight||18.5 – 24.9|
|Overweight||25 – 29.9|
|Obesity (Class I)|
Obesity (Class II)
|30 – 34.9|
35 – 39.9
|Extreme Obesity||More than 40|
The reason behind the rise of Obesity Epidemic
To understand this, we have to understand the energy balance of our body which regulates the body weight. The energy balance is determined by the total energy intake in the form of food which we consume and the energy we expend in the form of metabolism and physical activity.
To maintain a healthy and stable body weight, our energy intake must be equal to our energy expenditure. When energy expenditure is more than the energy intake then, it leads to negative energy balance causing weight loss, while positive energy balance causes weight gain.
Obesity is the result of positive energy balance in which energy intake is more than the energy we expend. It can be due to various factors including your genetics, food size, eating habits, physical inactivity, insomnia, some medical conditions and others.
Causes of Obesity
Obesity is a multifactorial disease which can vary from individual to individual. Listed below are the most common factors which may give rise to obesity.
- Excess energy intake
- High-calorie diet
- Eating pattern
- Physical inactivity
- Little or excess sleep
- Certain conditions like Hypothyroidism, Prader-Willi Syndrome, Alstrom Syndrome and others
- Psychological conditions like Depression or Stress
- Certain drugs
- Alcohol and Smoking
Diet and Obesity
The vast majority of research has been done in the last decade on obesity risk factors which were mostly focused on diet and with good reasons. In the past 20 years, the increase in obesity rates along with the expansion of fast food joints is not any coincidence. Total fast-food consumption has significantly increased, mainly because it is quick, easily accessible and tastier than any other food option.
Increased fast food consumption is strongly associated with weight gain due to high-calorie dense food which increases the individual’s energy intake. Additionally, it also contains trans fatty acids for better taste and longer shelf lives which elevates the risk of obesity by many folds.
Physical Inactivity and Obesity
It is another common reason which is held responsible for causing obesity. Physical inactivity results in decreased energy expenditure which alters the energy balance resulting in weight gain. Some common behaviors associated with physical inactivity are watching television for a longer duration, longer sleeping hours and less or no physical exercises.
Genetics and Obesity
Blaming genetics for being obese is not uncommon. Some people are naturally more prone to gaining weight. Till date, various genes have been identified which are responsible for obesity. Certain populations may have genes which result in increased fat storage which in pre-historic time when famine was common, it would have been a great advantage but now it leads to obesity.
Sudden death is more common in those who are naturally fat than in lean. – Hippocrates
Apart from mutations, which are responsible for severe obesity, various genes are known to increase the individual’s risk of getting obese. These may include leptin associated genes, ADRB3 gene, Adiponectin genes and others. Apart from genes, some genetic syndromes like Prader-Willi, Angelman, Wilson-Turner and Alstrom syndromes are known to cause obesity.
The Problem- Different Health Risks associated with Obesity
Obesity is linked to a myriad of health conditions. It may result in type 2 diabetes, hypertension (high blood pressure), heart and liver diseases, cancers, sleep apnea, osteoarthritis, PCOS (polycystic ovary syndrome) and others.
- Obesity and Diabetes
Obesity is so strongly linked to type 2 diabetes, that the American Diabetes Association recommends physicians to order tests for type 2 diabetes for every patient who is overweight or obese. It has been estimated that 90% of individuals having type 2 diabetes are obese. Overweight increases the risk of type 2 diabetes by 3 folds and obesity increases the risk by 7 fold. Additionally, increase weight during childhood is one of the major risk factor for diabetes later in life.
- Obesity and Heart Diseases
Increased BMI is associated with significantly higher risks of heart disease, dyslipidemia (high cholesterol levels), hypertension (high blood pressure) and stroke. Apart from BMI, increased waist circumferences are linked with heart disease. Obesity may affect the structure of the heart which may lead to heart failure, irregular heartbeats and heart attacks. Additionally, there is a higher chance of atherosclerosis which is due to the buildup of fat in arteries causing obstruction in blood flow.
- Obesity and Liver Diseases
Obesity can cause non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH). It can result in hepatomegaly (enlargement of the liver), macrovesicular steatosis, steatohepatitis (accumulation of fat on the liver), fibrosis (scarring of liver tissue) and cirrhosis. Liver cirrhosis is a chronic liver damage which impairs the liver function.
- Obesity and Osteoarthritis
Osteoarthritis (OA) is one of the most common forms of arthritis in which the ends of bone starts to wear down or degrades. Apart from aging or injury, it can be due to obesity because of the strain on joints due to excess weight.
- Obesity and Reproductive Health
In women, obesity is mainly linked to polycystic ovary syndrome or PCOS causing insulin resistance, anovulation (lack of ovulation) and hyperandrogenism (excess levels of male sex hormones such as testosterone). Additionally, obesity can cause several complications during pregnancy. In men, abdominal obesity leads to impotence and infertility.
- Obesity and Mental Health
In the current world, obesity has become a stigma which may lead to low self-esteem, mood disorder and, eating and interpersonal communication problems. Likewise, obesity is responsible for causing functional changes of the human brain. Several studies have shown the relation of obesity and low brain volume affecting frontal lobes, hippocampus, thalamus and other parts. It also increases the risk of Alzheimer’s disease and dementia.
- Obesity and Sleep Apnea
Sleep apnea is a sleep disorder in which an individual’s breathing suddenly stops and starts due to obstruction in the upper airway (trachea, larynx or voice box and throat). There is a higher risk of sleep apnea for obese individuals which affect their sleep duration. Loud snoring is one of its common symptoms. A repeated interruption in sleeping can lead to a morning headache, high blood pressure, daytime sleepiness and even heart failure.
- Obesity and Cancer
According to a survey, 6% of all cancer diagnosed in 2007 were due to obesity. Obesity increases the risk of colon, pancreatic, breast, esophageal, endometrial, renal, thyroid, gallbladder and ovarian cancers. It can also cause liver cancer, leukemia, non-Hodgkin’s lymphoma, multiple myeloma and malignant melanoma.
The Solution- Its Management
Multiple approaches should be considered for managing obesity. Instead of instantly reducing weight, the primary focus should be on controlling the further increase in weight. With the help of your physicians, several approaches like dietary modifications, behaviors, lifestyle changes, medications and surgical means can be discussed and planned. You must set some realistic goals and if you are suffering from any conditions like diabetes, arthritis, high blood pressure and others then discuss it with your physicians.
- Weight Loss Strategies
Several weight loss strategies can be used for reducing weight. These strategies include a combination of dietary therapy, physical activity, cryolipolysis, pharmacotherapy and surgery. Weight loss strategies are effective in preventing weight gain, to achieve weight reduction and to maintain it for a longer run.
- Dietary Modification
Personalized diet for obese individuals is beneficial in losing weight. These diets can be planned by physicians or dieticians. It may include low fat and carbohydrates consumption resulting in lower caloric consumption.
One should limit the intake of salt, free sugars, processed meats, processed foods (cookies, muffins, cakes, etc), solid fats (like ghee, coconut and palm oils), fat-rich dairy products (butter, whole milk, ice cream and some cheese) and alcohol. Eating whole grain foods (chapatti, oatmeal and brown rice), legumes, nuts, skimmed milk, fruits and vegetables are recommended.
Apart from a good diet, eating habits and food size is equally important. Individuals should not skip breakfast and eating a small portion of food in several intervals is suggested, instead, of eating a larger portion for 2 or 3 times a day.
- Physical Activity
It is important for reducing weight as it results in increased energy expenditure and reduces the risk of heart diseases. Physical activity may include walking, jogging, dancing, gardening, cycling, doing household chores and others. You must consult your physicians before initiating any extensive physical training, especially, if you have certain medical conditions. You can start any physical activities with slow intensity for less duration and gradually, you can increase the intensity and duration.
- Weight Reducing Drugs
Currently, several drugs are available which can be used for individuals having BMI greater or equal to 30 or 27 in some cases. Commonly, drug therapy is carried out along with diet, exercise or behavioral therapy.
Weight loss surgeries are also called bariatric surgery and are considered as the last option for weight reduction in severe cases. It is considered by physicians when an individual’s BMI is greater or equal to 40; BMI is 35 or more with certain diseases like type 2 diabetes and others.
These surgeries include adjustable gastric banding, sleeve gastrectomy, gastric bypass, and biliopancreatic diversion with duodenal switch. The most commonly performed surgery is a gastric bypass which results in rapid weight loss. Several complications can arise too, which may include infection, bleeding, vitamin and mineral deficiency, malabsorption and many more.
The 2 Most Common Myths of Obesity
- Gaining weight is all about the type and quantity of food you eat.
Fact: Gaining weight is much more than just eating large portions of food. Your eating pattern, physical inactivity, lack of sleeping, stress, certain diseases and in some cases genetics can also play an important role in weight gain.
- For improving my health, extensive weight loss is important
Fact: Even a modest weight loss can show improvement in various health conditions like type 2 diabetes, blood pressure, cholesterol and risk of different heart diseases.
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