Obesity: Definition, Causes, Diagnosis, Treatment

What is Obesity (Overweight)?

Obesity is a medical condition characterized by excessive or abnormal accumulation of fat in the body, to the point where it has a negative impact on a person’s health. It is generally determined by calculating a person’s body mass index (BMI), which is a ratio of weight to height. BMI is calculated by dividing a person’s weight in kilograms by the square of their height in meters (BMI = weight in kg / (height in meters)²). A BMI of 30 or higher is generally considered indicative of obesity. Obesity is a complex condition influenced by various factors, including genetics, lifestyle, diet, physical activity levels, and environmental factors. It is associated with an increased risk of various health problems. Treating obesity typically involves a combination of lifestyle modifications, including adopting a healthy, balanced diet, increasing physical activity levels, and behavior changes. In some cases, medical interventions such as medications or bariatric surgery may be considered.

It is important to note that obesity is a complex condition, and each individual’s experience with obesity can vary. It is advisable to consult with a healthcare professional for a comprehensive evaluation and personalized guidance regarding obesity management.

Obesity is not solely defined by weight alone. While weight is a significant factor in determining obesity, it is typically assessed based on a person’s body mass index (BMI) rather than weight alone. BMI is calculated by taking a person’s weight and height to estimate body fat and assess whether an individual is underweight, normal weight, overweight, or obese.

Based on the calculated BMI, individuals are categorized into different ranges:

• Underweight: BMI less than 18.5
• Normal weight: BMI between 18.5 and 24.9
• Overweight: BMI between 25 and 29.9
• Obesity:

1. Class I obesity: BMI between 30 and 34.9
2. Class II obesity: BMI between 35 and 39.9
3. Class III obesity (severe obesity): BMI of 40 or higher

It is important to note that BMI is a general indicator and does not take into account factors such as muscle mass, bone density, or distribution of body fat. Therefore, it may not be an accurate measure for certain individuals, such as athletes or those with a higher muscle mass. In clinical practice, healthcare professionals consider various factors, including BMI, waist circumference, body composition, and overall health assessment, when evaluating obesity.

What are the types of Obesity?

There are three classes of obesity defined by the body mass index (BMI), which is a calculation that relates a person’s weight to their height.

Here are the three types of obesity discussed below:

• Class I obesity: This class is characterized by a BMI ranging from 30 to 34.9. Class I obesity is generally considered a milder form of obesity. People with Class I obesity may have an increased risk of developing obesity-related health conditions such as type 2 diabetes, heart disease, and certain cancers.

• Class II obesity: This class is characterized by BMI between 35 and 39.9. It indicates a more severe level of obesity. Class II obesity is associated with a higher risk of developing obesity-related health problems. Individuals in this class may experience more significant challenges related to excess weight, such as mobility issues, joint pain, sleep apnea, and a higher likelihood of comorbidities.

Class III obesity (severe obesity): This class is also known as morbid obesity and includes individuals with a BMI of 40 or higher. Class III obesity represents the most severe level of obesity. People in this class generally have a significantly increased risk of developing serious obesity-related health complications such as type 2 diabetes, heart disease, stroke, sleep apnea, certain cancers, and reduced life expectancy. Class III obesity often requires comprehensive medical management and interventions, including lifestyle changes, dietary modifications, physical activity, and, in some cases, weight loss surgery.

Serious Health Conditions Due To Obesity

Obesity is associated with a higher risk of developing several serious health conditions. These conditions can have a significant impact on an individual’s overall health and quality of life. Some of the serious health conditions associated with obesity include:

• Type 2 diabetes: Obesity is a major risk factor for developing type 2 diabetes. Excess weight and body fat can interfere with the body’s ability to properly regulate blood sugar levels, leading to insulin resistance and the development of diabetes.

• Cardiovascular diseases: Obesity increases the risk of various cardiovascular conditions, including coronary artery disease, heart attack, stroke, and high blood pressure (hypertension). Excess weight can contribute to the accumulation of plaque in the arteries, narrowing blood vessels, and impairing heart function.

• Respiratory problems: Obesity can lead to respiratory issues such as sleep apnea, a condition characterized by interrupted breathing during sleep. It can also contribute to asthma, chronic obstructive pulmonary disease (COPD), and decreased lung function.

• Joint problems: Excessive weight puts additional stress on the joints, particularly in the knees and hips, leading to an increased risk of osteoarthritis. Obesity-related joint problems can cause pain, reduced mobility, and impact daily activities.

• Gastrointestinal disorders: Obesity is associated with an increased risk of developing conditions like gallbladder disease, fatty liver disease (non-alcoholic steatohepatitis or NASH), and gastroesophageal reflux disease (GERD).

• Certain cancers: Obesity has been linked to an elevated risk of several types of cancer, including breast, colorectal, endometrial, ovarian, pancreatic, kidney, and liver cancers. The exact mechanisms behind this association are not fully understood but may involve hormonal and metabolic factors.

• Mental health disorders: Obesity can have negative effects on mental health and well-being. Individuals with obesity may experience low self-esteem, body image dissatisfaction, depression, anxiety, and social stigmatization, which can impact their overall quality of life.

• Metabolic syndrome: Obesity is often associated with metabolic syndrome, a cluster of conditions including high blood pressure, high blood sugar, abnormal cholesterol levels, and excess abdominal fat. Metabolic syndrome increases the risk of cardiovascular disease, stroke, and type 2 diabetes.

It is worth noting that not every person with obesity will necessarily develop these conditions, and individuals may be affected to varying degrees. However, the risk of developing these serious health conditions is generally higher in individuals with obesity. Managing and reducing obesity through lifestyle changes and medical interventions can help reduce these risks and improve overall health outcomes.

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How is obesity diagnosed?

Obesity is commonly diagnosed by evaluating multiple factors, including body mass index (BMI), waist circumference, and an evaluation of overall health.

Here are some diagnosis processes used for obesity:

• Body mass index (BMI): BMI is a commonly used screening tool to analyze obesity. It is calculated by dividing a person’s weight in kilograms by the square of their height in meters (BMI = weight in kg / (height in meters)²). The resulting value is compared to standard BMI ranges to determine if an individual falls within the underweight, normal weight, overweight, or obese category.

• Waist circumference: Waist circumference is measured using a tape measure around the waist, typically at the level of the navel. This measurement provides an indication of abdominal fat and can help assess the risk of obesity-related health conditions. For men, a waist circumference of 40 inches (102 cm) or more is considered high, while for women, a measurement of 35 inches (88 cm) or more is considered high.

• Evaluation of overall health: The doctors will assess the patient’s overall health and medical history, including family history, presence of obesity-related health conditions (such as diabetes, hypertension, or cardiovascular disease), and any symptoms or concerns related to obesity. This evaluation helps determine the impact of obesity on an individual’s health and guides further diagnostic tests if necessary.
• Blood tests: Blood tests can provide information about cholesterol levels, blood sugar levels, liver function, hormone levels, and other factors that may be associated with obesity-related conditions.
• Imaging tests: Imaging tests such as ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scans may be used to assess the distribution of fat in the body and identify potential complications associated with obesity, such as fatty liver disease.

It is necessary that the diagnosis of obesity is not solely based on a single measurement or test but rather a combination of factors. Consulting with certain doctors, such as a primary care physician, endocrinologist, or obesity specialist, is crucial for an accurate diagnosis and to develop a personalized treatment plan based on individual circumstances.

What causes Obesity?

Obesity is a complex yet common medical condition influenced by a combination of genetic, environmental, behavioral, and metabolic factors.

Here are some key factors that contribute to obesity:

• Genetics: Genetic factors play a vital role in determining an individual’s susceptibility to obesity. Certain genes can affect appetite, metabolism, fat storage, and the body’s response to food. However, genetics alone do not determine obesity, whereas lifestyle and environmental factors also significantly impact.

• Environment: As the modern environment has been characterized by easy access to calorie-dense foods, large portion sizes, sedentary lifestyles, and an abundance of processed foods, which highly contributes to the rise in obesity rates in individuals. Factors such as an obesogenic food environment, lack of physical activities, and sedentary behaviors (e.g., excessive screen time) can contribute to weight gain.

• Diet and nutrition: Consuming a diet high in calories, unhealthy fats, added sugars, and processed foods can contribute to weight gain. These types of foods are often energy-dense but nutrient-poor, leading to overeating and, lately weight gain. Additionally, frequent consumption of sugary beverages has been linked to an increased risk of obesity.

• Physical activity: Lack of regular physical activity and sedentary behaviors significantly contribute to obesity. Leading a sedentary lifestyle, such as spending excessive time sitting or engaging in minimal physical activity, reduces energy and can lead to weight gain. Insufficient physical activity also affects metabolism and contributes to the development of obesity-related health problems.

• Psychological factors: Psychological factors can influence eating behaviors and contribute to weight gain. Binge eating, stress, depression, and certain psychological disorders can lead to overeating or unhealthy food choices, contributing to obesity. Also, some medications used to treat mental health conditions may have side effects that promote weight gain.

• Socioeconomic factors: Socioeconomic factors can influence the obesity rate among individuals. Limited access to affordable healthy foods, living in neighborhoods with few recreational facilities or safe outdoor spaces for physical activity, and socioeconomic inconvenience can highly contribute to higher obesity rates in certain populations.

• Medical conditions and medications: Certain medical conditions and medications can contribute to weight gain and obesity. Examples include polycystic ovary syndrome (PCOS), hypothyroidism, Cushing’s syndrome, certain antidepressants, antipsychotics, and corticosteroids.

It is important to note that individual experiences with obesity can vary, and multiple factors often interact in complex ways. Addressing obesity requires a comprehensive approach that includes lifestyle modifications, dietary changes, increased physical activity, behavior modification, and, in some cases, medical interventions. Consulting with healthcare professionals, such as doctors, registered dietitians, or obesity specialists, can provide personalized guidance and support for managing and treating obesity.

Treatment for Obesity (Overweight)

The treatment of overweight and obesity generally involves a combination of lifestyle changes, behavior modifications, dietary adjustments, increased physical activity, and, in some cases, medical interventions may be used.

Given below are some commonly used treatment options for obesity:

Dietary modifications: Adopting a healthy eating plan is essential for weight management and is the basic step for treating obesity. This may involve reducing calorie intake, portion control, choosing nutrient-dense fibrous foods, and limiting the consumption of sugary beverages, processed foods, and high-fat foods. Working with a registered and experienced dietitian can be beneficial for developing an individualized meal plan and receiving guidance on healthy eating habits.

• Increased physical activity: Regular physical activity is crucial for weight loss and weight maintenance. The patient is advised to aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity each week, along with muscle-strengthening exercises on two or more days. Finding enjoyable activities that increase heart rate and engage different muscle groups can help increase calorie expenditure and increase the rate of weight loss.

• Behavior modification: Changing behaviors related to eating, physical activity, and lifestyle habits is essential for long-term weight management. Strategies such as setting realistic goals, self-monitoring, identifying triggers for overeating, practicing portion control, stress management, and developing healthy coping mechanisms can support behavior change. Cognitive-behavioral therapy (CBT) may be beneficial for addressing psychological factors contributing to overeating or unhealthy eating habits.

• Support and counseling: Joining a support group or seeking counseling can provide emotional support, accountability, and guidance during the weight loss journey. Support can be obtained through in-person or online support groups, counseling sessions, or working with healthcare professionals specializing in weight management.

• Medications: In some cases, healthcare providers may prescribe medications to aid in weight loss. These medications are generally suggested along with lifestyle modifications and are prescribed based on an individual’s specific circumstances, health status, and response to other weight loss measures. Medications for weight loss should be used under the strict supervision of experienced doctors.
• Surgical interventions: For individuals with severe obesity who have not achieved weight loss through lifestyle changes and medications, surgery may be considered. However, it is mostly recommended for individuals with a BMI of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions.

The 3 primary methods of performing weight loss surgery are:

• Roux-en-Y Gastric Bypass: A Roux-en-Y gastric bypass procedure is one of the most commonly performed methods of gastric bypass. This surgery is not reversible and works by decreasing the amount of food you can eat in one sitting. This procedure also reduces the nutrients your body can absorb. A roux-en-Y surgery is typically performed under general anesthesia and begins with a cut being made across the top of the stomach. The resulting pouch is about the size of a walnut and can hold only a few grams of food. Next, the surgeon cuts the small intestine and sews part of it directly into the pouch. Food then goes into this small pouch of the stomach and then directly into the small intestine sewn to it. Food bypasses most of the stomach and the first section of the small intestine and instead enters directly into the middle part of the small intestine.

• Sleeve Gastrectomy: Sleeve gastrectomy, sometimes referred to as gastric sleeve, is another type of weight loss surgery that is performed to treat obesity. A sleeve gastrectomy surgery works by removing about 80% of the stomach, leaving behind a tubular sleeve that is similar in size and shape to a banana. The aim of this procedure is to reduce the size of your stomach and restrict the amount of food you can eat in one sitting. Alongside this, it also reduces the appetite-regulating hormone known as ghrelin. This helps lessen the desire to eat and prevent impulses that cause most patients to regain their lost weight.

• Biliopancreatic Diversion: A biliopancreatic diversion surgery is a two-part surgery. The first step involves performing a procedure similar to sleeve gastrectomy. The second surgery involves connecting the end portion of the intestine to the duodenum near the stomach (duodenal switch and biliopancreatic diversion), bypassing most of the intestine. A biliopancreatic diversion surgery limits both the amount of food you can eat and how much nutrition your body can absorb. While highly effective, it has a greater risk of complications such as malnutrition and vitamin deficiencies.

It is very important to note that treatment approaches may vary depending on individual circumstances, health conditions, personal choice, and preferences. Working with healthcare professionals, such as primary care physicians, registered dietitians, and obesity specialists, can provide personalized guidance and support throughout the treatment process.

How to Prevent Obesity?

Preventing obesity involves adopting healthy lifestyle habits that involve a balanced diet, regular physical activity, and overall well-being.

Here are some tips and tricks to prevent obesity:

• Maintain a healthy diet: Focus on consuming a nutrient-rich, balanced, and high-fibrous diet that includes a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats. Limit the intake of processed foods, sugary beverages, high-fat foods, and foods with added sugars.
• Engage in regular physical activity: The patient should focus on at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity each week, along with muscle-strengthening exercises on two or more days. Explore the activities you enjoy and make them a regular part of your routine. Incorporate more movement into your daily life, such as walking or biking instead of driving, taking the stairs instead of the elevator, and engaging in active hobbies that aid in burning calories.
• Practice portion control: Be mindful of portion sizes and avoid oversized portions. Use smaller plates and bowls, and listen to your body’s hunger and fullness cues. Avoid eating in front of screens or while distracted, as it can lead to overeating.

• Limit screen time: Reduce sedentary behaviors by limiting the amount of time spent watching TV, using electronic devices, and sitting for long periods. Instead, engage in active pursuits, such as hobbies, outdoor activities, or socializing with friends and family.

• Get adequate sleep: Try to get proper 7-9 hours of quality sleep per night. Poor sleep has been associated with weight gain and increased risk of obesity. Establish a regular sleep schedule, create a conducive sleep environment, and practice good sleep hygiene habits.

• Manage stress: Find healthy ways to manage stress, as chronic stress can contribute to overeating and weight gain. Engage in stress-reducing activities such as exercise, meditation, deep breathing exercises, hobbies, or seeking support from loved ones or professionals.

• Surround yourself with a supportive environment: Surround yourself with a supportive network of family and friends who encourage and engage in healthy habits. Make your home environment conducive to healthy eating by stocking it with nutritious foods and minimizing the presence of unhealthy snacks and sugary beverages.

Seek professional guidance: Consult with expert healthcare professionals, such as registered dietitians or nutritionists, who can provide personalized guidance and support in developing a healthy eating plan and lifestyle modifications specific to your needs and goals.

What are Other Obesity-related Problems?

Apart from the above-mentioned serious health complications, obesity can cause a number of other problems, including difficulties with daily activities and serious health conditions.

Some day-to-day problems related to obesity include

• Breathlessness: Excessive weight gain hinders the normal functioning of the lungs, leading to inflammation that further results in breathlessness.
• Increased sweating: The patients who are overweight sweat more as they have more sweat glands per square inch as compared to that of a non-obese person.
• Sleep apnea: Individuals who are overweight are generally at a higher risk of suffering from sleep apnea. The major reason is the fat stored around the neck way which leads to momentarily hindrance in breathing during sleeping.
• Joint and back pain: Excessive weight affects the pelvis, back, and knees. The body is unable to balance the weight of the individual which further results in the joint and back pain lately.

Low confidence and self-esteem: Individuals who are overweight generally feel more self-conscious and avoid social interactions which creates a sense of isolation in themselves. People affected by obesity may often experience discrimination based on their body size.

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