Obesity – Causes, Symptoms, Treatments

What is Obesity?

Obesity is widely acknowledged as the leading preventable illness and cause of death. Recently the rising numbers of obesity in developed nations have resulted in the World Health Organization classifying obesity as an epidemic. Obesity is a health condition in which excessive or abnormal fat build up poses a health risk to the individual. 

In 2022, according to the World Health Organization (WHO), 2.5 billion adults (18 years and older) were overweight. Of these, 890 million were living with obesity. This translates to roughly 16% of adults worldwide classified as obese. The prevalence of obesity has more than doubled since 1990. Childhood obesity is also a growing concern. In 2022, an estimated 390 million children and adolescents aged 5–19 years were overweight in 2022, including 160 million who were living with obesity.

Obesity is a serious medical condition that can lead to a number of health problems, including heart disease, stroke, type 2 diabetes, and some types of cancer.

How is Obesity Measured?

Obesity is a condition in which someone has an unhealthy amount of body fat. It is often determined by using a measurement called body mass index (BMI). BMI is a simple calculation of a person’s weight in relation to their height. However, BMI doesn’t take into account muscle mass or body composition, so it isn’t always the most accurate measure.

• BMI is a simple, inexpensive, and easy-to-calculate measure that provides a general idea of a person’s weight relative to their height. It’s a good tool for population-level studies and public health initiatives.
• BMI Limitations: As you mentioned, BMI doesn’t account for muscle mass or body composition. Someone who is very muscular might have a high BMI even though they don’t have excess body fat.

Here are some additional factors to consider when evaluating obesity:

• Waist circumference: Measuring waist circumference can be a good way to assess abdominal fat, which is linked to an increased risk of health problems.
• Body fat percentage: This is a more accurate measure of body fat, but it typically requires specialized equipment like bioelectrical impedance analysis (BIA) or dual-energy X-ray absorptiometry (DXA).
• Body composition: Looking at the overall distribution of fat and muscle mass can provide a more complete picture of a person’s health.

Causes of Obesity

Genetics plays a role in obesity. We inherit genes that influence how our bodies process food, store fat, and regulate appetite. Some people may inherit a genetic predisposition to be more susceptible to weight gain. For example, certain genes may influence how efficiently our bodies burn calories or how much hunger we feel after eating. Additionally, there are some medical conditions caused by genetic mutations that directly cause obesity, such as Prader-Willi syndrome.

Environmental factors can also contribute to obesity. Limited access to healthy, affordable foods can make it difficult for people to eat a balanced diet. In contrast, an abundance of processed, high-calorie options can be tempting and unhealthy. Socioeconomic factors like lower income and education levels are often linked with higher obesity rates. This can be due to several reasons. Low-income neighborhoods may have fewer supermarkets with fresh produce, and more convenience stores with limited healthy options. Additionally, safe places for physical activity may be scarce, and access to quality healthcare may be limited. Social norms can also influence behavior. Cultural attitudes towards food and weight can affect people’s choices about what they eat and how much they exercise.

Behavior is another major contributing factor to obesity. Unhealthy eating habits, such as a high intake of processed foods, sugary drinks, and excessive portion sizes, are directly linked to weight gain. Processed foods are often high in calories, unhealthy fats, sugar, and sodium, and low in nutrients that promote satiety. Sugary drinks add empty calories to the diet without providing any feeling of fullness. Consuming large portion sizes can lead to people consuming more calories than they need.

Physical inactivity is another key behavioral factor. A sedentary lifestyle with low levels of physical activity  burns fewer calories, which can lead to weight gain. Exercise helps the body burn calories and build muscle mass, which also helps burn calories at rest.

Sleep is another factor that can influence weight. Chronic lack of sleep can disrupt hormones that regulate appetite and metabolism, increasing the risk of obesity. When people are sleep deprived, they may produce more of the stress hormone cortisol, which can increase appetite and cravings for unhealthy foods. Additionally, sleep deprivation can decrease the production of leptin, a hormone that signals feelings of fullness, and increase production of ghrelin, a hormone that stimulates hunger.

Stress can also be a contributing factor to obesity. Stress can lead to emotional eating and unhealthy food choices. When people are stressed, they may be more likely to eat sugary, high-fat foods for comfort. Chronic stress can also lead to weight gain by affecting hormones that regulate appetite and metabolism.

Potential Consequences of Childhood Obesity

Childhood obesity carries significant health consequences, impacting both a child’s immediate well-being and setting the stage for future health problems.

Immediate health concerns:

• Musculoskeletal problems: Excess weight puts stress on developing bones and joints, leading to pain and potentially affecting growth.
• Sleep apnea: Obstructive sleep apnea, where breathing repeatedly stops and starts during sleep, is more common in obese children. This can disrupt sleep quality and lead to daytime fatigue and behavioral problems.
• Fatty liver disease: Non-alcoholic fatty liver disease (NAFLD) can develop in obese children. While often symptomless, it can progress to serious liver damage in some cases.
• Mental health issues: Obese children are at increased risk for anxiety, depression, and low self-esteem due to social stigma and body image concerns.

Long-term health risks:

• Type 2 diabetes: Childhood obesity significantly increases the risk of developing type 2 diabetes, a chronic condition affecting how the body regulates blood sugar.
• Heart disease: Obese children are more likely to have high blood pressure and cholesterol, increasing their risk for heart disease later in life.
• Stroke: The risk of stroke is also elevated in adults who were obese as children.
• Certain cancers: Childhood obesity is linked to an increased risk of developing some cancers in adulthood, such as colon, breast, and endometrial cancers.
• Obesity in adulthood: Obese children are more likely to become obese adults, perpetuating the cycle of health problems associated with obesity.7

Symptoms Associated With Obesity

Obesity itself typically doesn’t cause specific symptoms like a headache or stomach ache. The impact is more on how excess body fat affects the body’s function. People with obesity may experience certain physical signs and problems as a result.

One common sign is shortness of breath, especially during physical activity. Carrying extra weight makes physical exertion more demanding on the body, making it harder to breathe. Another sign is excessive sweating. Obesity can disrupt the body’s temperature regulation system, leading to more sweating than usual.

Sleep problems can also be a sign. Snoring and sleep apnea, where breathing repeatedly stops and starts during sleep, are more common in people with obesity. The extra weight around the neck can put pressure on the airway, making breathing difficult during sleep.

Daily activities may also become more difficult. Excess weight can make it harder to move around, bend, and perform everyday tasks. This can lead to decreased mobility and a lower quality of life.

Joint pain, especially in the weight-bearing joints like the back, knees, and hips, is another potential sign. Obesity puts extra stress on these joints, which can lead to pain and inflammation.

It’s important to remember that not everyone who is obese will experience all these signs. However, if you’re experiencing some of these issues, it could be a signal that excess weight is affecting your body.

While not a symptom of obesity itself, obesity is a major risk factor for developing various health conditions. These conditions can have their own specific symptoms. Some examples of health problems linked to obesity include type 2 diabetes, heart disease, stroke, fatty liver disease, and certain cancers.

Socioeconomic Factors That Impact Obesity

Several factors intertwine to create a challenging environment for maintaining a healthy weight among individuals with lower socioeconomic status (SES). 

Limited Access to Healthy Foods:

• Cost: Fresh fruits, vegetables, and lean protein sources are often more expensive than processed foods high in calories, unhealthy fats, and sugar. This can make it difficult for low-income families to afford a nutritious diet.
• Availability: Supermarkets with a wide variety of fresh produce may be scarce in low-income neighborhoods. Conversely, there may be an abundance of convenience stores with limited healthy options. This creates a situation of “food deserts” where healthy food choices are simply not readily available.

Inadequate Exercise Facilities:

• Cost: Joining a gym or fitness center can be expensive, putting it out of reach for many low-income individuals.
• Safety: Safe parks or outdoor spaces for physical activity may be lacking in some low-income communities. This can discourage people from exercising outdoors due to concerns about personal safety.

Targeted Marketing of Unhealthy Foods:

• Fast Food: Fast food restaurants are often heavily concentrated in low-income neighborhoods. These establishments frequently employ marketing strategies targeted at low-income consumers, promoting high-calorie, unhealthy meals at a seemingly affordable price point.
• Advertising: Low-income families are often exposed to a disproportionate amount of advertising for sugary drinks, processed snacks, and fast food. This constant bombardment can influence food choices, especially for children.

Additional Considerations:

• Stress: Chronic stress is common among low-income individuals due to factors like financial strain, job insecurity, and housing instability. Stress can lead to unhealthy coping mechanisms, such as emotional eating, which can contribute to weight gain.
• Time Constraints: People working multiple jobs or long hours to make ends meet may have limited time for meal planning, cooking healthy meals, or engaging in regular physical activity.

Preventing Obesity

Promoting healthy habits from a young age is crucial. This includes encouraging a balanced diet rich in fruits, vegetables, and whole grains, along with limiting sugary drinks and processed foods. Early exposure to physical activity through play and age-appropriate exercise programs is also important.

Schools can play a significant role in promoting healthy lifestyles. This can involve nutrition education, integrating physical activity into the school day, and creating healthy food environments in cafeterias.

Community-based programs can provide affordable access to healthy foods, safe spaces for physical activity, and educational resources on healthy eating and living.

Policies and initiatives that promote affordable access to fresh fruits, vegetables, and whole grains in low-income communities can make a significant impact.

Management:

A personalized approach to dietary changes is key. A healthcare professional or registered dietitian can help develop a plan that incorporates healthy eating habits while considering individual preferences and needs.

Regular physical activity is essential for weight management and overall health. Finding activities you enjoy, incorporating movement into your daily routine, and gradually increasing intensity can help make exercise sustainable.

Addressing underlying behavioral patterns that contribute to unhealthy eating habits can be a critical step in managing weight. Techniques like cognitive behavioral therapy can help individuals identify triggers for unhealthy choices and develop coping mechanisms for sustainable change.

In some cases, medications may be prescribed by a doctor to help manage weight, particularly for individuals with a body mass index (BMI) exceeding a certain threshold or those with obesity-related health conditions.

Bariatric surgery, such as gastric bypass, may be an option for some individuals with severe obesity who haven’t been successful with lifestyle changes and medications. It’s important to note that surgery is a complex decision with potential risks and benefits that should be carefully discussed with a doctor.

How is Obesity Diagnosed?

• BMI is a simple and widely used tool to assess weight status in adults. It’s calculated by dividing a person’s weight in kilograms by their height in meters squared. Online calculators and BMI charts are readily available to compute your BMI. However, interpretation requires healthcare professional guidance.
• Limitations of BMI: While BMI is a convenient starting point, it has limitations. Here’s why it’s not perfect:
  • Muscle Mass: BMI doesn’t differentiate between muscle mass and body fat. Someone with a very muscular build, like an athlete, might have a high BMI even though they have a low percentage of body fat.
  • Ethnicity: Racial and ethnic differences in body composition can affect the accuracy of BMI. For example, some ethnicities may tend to store more fat around the waist, which might not be fully reflected in a BMI calculation.
  • Age: BMI may not be as accurate for children, adolescents, and older adults. Separate BMI charts are used for these age groups to account for growth and development patterns.

2. Additional Considerations:

In addition to BMI, healthcare professionals consider other factors to get a more complete picture:

• Waist Circumference: Measuring waist circumference is a simple and effective way to assess abdominal fat, also known as visceral fat. Excess visceral fat is linked to an increased risk of health problems like heart disease, type 2 diabetes, and some cancers. Guidelines for healthy waist circumference vary depending on sex and ethnicity, and your doctor will interpret yours in that context.
• Medical History and Family History: Understanding your medical history can help identify any underlying conditions that may contribute to weight gain or make weight management more challenging. A doctor will also inquire about your family history of obesity and related conditions like diabetes, heart disease, and high blood pressure. A family history of these conditions can increase your own risk.
• Physical Examination: A general physical exam allows the doctor to assess your overall health and identify any potential health concerns related to obesity. This may include checking your vital signs (blood pressure, heart rate, temperature), looking for signs of insulin resistance (acanthosis nigricans, a darkening of the skin), and examining your joints for signs of wear and tear due to excess weight.

How is Obesity Treated?

There’s no one-size-fits-all solution for obesity treatment. The approach typically involves a multi-pronged strategy tailored to the individual’s needs and health status. A cornerstone of obesity treatment is adopting healthy eating habits. This often involves working with a registered dietitian to create a personalized plan that incorporates nutritious foods from all food groups while keeping calorie intake in check.

Regular physical activity is essential for weight management and overall health. Doctors will recommend an exercise program that considers your current fitness level and gradually increases intensity over time. Aiming for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity activity per week is a good starting point.

Addressing underlying behavioral patterns that contribute to unhealthy eating habits can be crucial. Techniques like cognitive behavioral therapy can help individuals identify triggers for unhealthy choices and develop coping mechanisms for sustainable change. This might involve strategies for managing stress, emotional eating, and portion control.

Additional Considerations:

In some cases, depending on the severity of obesity and any related health conditions, additional approaches may be recommended by a doctor:

Prescription medications may be used to help manage weight, particularly for individuals with a body mass index (BMI) exceeding a certain threshold or those with obesity-related health conditions like type 2 diabetes. These medications work in various ways, such as suppressing appetite, reducing fat absorption, or increasing metabolism.

Bariatric surgery, such as gastric bypass or sleeve gastrectomy, may be an option for some individuals with severe obesity (typically BMI exceeding 40) who haven’t been successful with lifestyle changes and medications. These procedures alter the digestive system to limit food intake or absorption, promoting weight loss. However, surgery is a major decision with potential risks and benefits that should be carefully weighed with a doctor.

What Medications are Most Often Prescribed for Obesity?

While lifestyle changes like diet, exercise, and behavior modification are the cornerstone of obesity treatment, medications can sometimes be a helpful addition to the plan. Here’s a breakdown of some of the medications most often prescribed for obesity by doctors:

• Lipase inhibitors: These medications, such as orlistat (brand name Xenical or Alli), work by blocking the enzyme lipase in the digestive system. Lipase is responsible for breaking down fat in the intestines, so with these medications, some dietary fat is not absorbed by the body and is eliminated in stool. This can lead to a modest amount of weight loss.
  
• GLP-1 receptor agonists: Glucagon-like peptide-1 (GLP-1) is a hormone naturally produced in the gut that helps regulate appetite and blood sugar levels. GLP-1 receptor agonists, like liraglutide (Saxenda) or semaglutide (Rybelsus), mimic the effects of GLP-1, promoting feelings of fullness and reducing appetite, which can lead to decreased calorie intake and weight loss.
  
• Anti-obesity medications with mixed mechanisms: These medications, like phentermine-topiramate (Qsymia), combine stimulants that suppress appetite with medications that influence how the body processes carbohydrates. This combination approach can be effective for weight loss, but it may also cause side effects like headaches, dry mouth, and constipation.