Obesity Causes, Effects and Treatment?
An obese person has accumulated so much body fat that it might have a negative effect on their health. If a person’s bodyweight is at least 20% higher than it should be, he or she is considered obese. If your Body Mass Index (BMI) is between 25 and 29.9 you are considered overweight. If your BMI is 30 or over you are considered obese.
Why do people become obese?
People become obese for several reasons, including:
Consuming too many calories.
People are eating much more than they used to. This used to be the case just in developed nations – however, the trend has spread worldwide. Despite billions of dollars being spent on public awareness campaigns that attempt to encourage people to eat healthily, the majority of us continue to overeat. In 1980 14% of the adult population of the USA was obese; by 2000 the figure reached 31% (The Obesity Society).
In the USA, the consumption of calories increased from 1,542 per day for women in 1971 to 1,877 per day in 2004. The figures for men were 2,450 in 1971 and 2,618 in 2004. Most people would expect this increase in calories to consist of fat – not so! Most of the increased food consumption has consisted of carbohydrates (sugars). Increased consumption of sweetened drinks has contributed significantly to the raised carbohydrate intake of most young American adults over the last three decades. The consumption of fast-foods has tripled over the same period.
Various other factors also may have contributed to America’s increased calorie and carbohydrate intake:
In 1984 the Reagan administration freed up advertising on sweets and fast foods for children – regulations had previously set limits.
Agricultural policies in most of the developed world have led to much cheaper foods.
The US Farm Bill meant that the source of processed foods came from subsidized wheat, corn and rice. Corn, wheat and rice became much cheaper than fruit and vegetables.
Leading a sedentary lifestyle.
With the arrival of televisions, computers, video games, remote controls, washing machines, dish washers and other modern convenience devices, the majority of people are leading a much more sedentary lifestyle compared to their parents and grandparents. Some decades ago shopping consisted of walking down the road to the high street where one could find the grocers, bakers, banks, etc. As large out-of-town supermarkets and shopping malls started to appear, people moved from using their feet to driving their cars to get their provisions. In some countries, such as the USA, dependence on the car has become so strong that many people will drive even if their destination is only half-a-mile away.
The less you move around the fewer calories you burn. However, this is not only a question of calories. Physical activity has an effect on how your hormones work, and hormones have an effect on how your body deals with food. Several studies have shown that physical activity has a beneficial effect on your insulin levels – keeping them stable. Unstable insulin levels are closely associated with weight gain.
Not sleeping enough.
If you do not sleep enough your risk of becoming obese doubles, according to research carried out at Warwick Medical School at the University of Warwick. The risk applies to both adults and children. Professor Francesco Cappuccio and team reviewed evidence in over 28,000 children and 15,000 adults. Their evidence clearly showed that sleep deprivation significantly increased obesity risk in both groups.
Professor Cappuccio said, “The ‘epidemic’ of obesity is paralleled by a ‘silent epidemic’ of reduced sleep duration with short sleep duration linked to increased risk of obesity both in adults and in children. These trends are detectable in adults as well as in children as young as 5 years.”
Professor Cappuccio explains that sleep deprivation may lead to obesity through increased appetite as a result of hormonal changes. If you do not sleep enough you produce Ghrelin, a hormone that stimulates appetite. Lack of sleep also results in your body producing less Leptin, a hormone that suppresses appetite.
Endocrine disruptors, such as some foods that interfere with lipid metabolism.
A team from the University of Barcelona (UB) led by Dr Juan Carlos Laguna published a study in the journal Hepatology that provides clues to the molecular mechanism through which fructose (a type of sugar) in beverages may alter lipid energy metabolism and cause fatty liver and metabolic syndrome.
Fructose is mainly metabolized in the liver, the target organ of the metabolic alterations caused by the consumption of this sugar. In this study, rats receiving fructose-containing beverages presented a pathology similar to metabolic syndrome, which in the short term causes lipid accumulation (hypertriglyceridemia) and fatty liver, and eventually leads to hypertension, resistance to insulin, diabetes and obesity.
Poorly balanced diets and the lack of physical exercise are key factors in the increase of obesity and other metabolic diseases in modern societies. In epidemiological studies in humans, the effect of the intake of fructose-sweetened beverages also seems to be more intense in women. Lower rates of smoking (smoking suppresses appetite).
According to the National Institutes of Health (NIH) “Not everyone gains weight when they stop smoking. Among people who do, the average weight gain is between 6 and 8 pounds. Roughly 10 percent of people who stop smoking gain a large amount of weight – 30 pounds or more.”
Medications that make patients put on weight.
According to an article in Annals of Pharmacotherapy, some medications cause weight gain. “Clinically significant weight gain is associated with some commonly prescribed medicines. There is wide interindividual variation in response and variation of the degree of weight gain within drug classes. Where possible, alternative therapy should be selected, especially for individuals predisposed to overweight and obesity.”
Treatments for obesity
Obesity treatments have two objectives:
To achieve a healthy weight.
To maintain that healthy weight.
People who are obese are often discouraged because they think they have to lose a lot of weight before any benefits are experienced. This is not true. Any obese person who loses just five to ten per cent of their body weight will have significant improvement in health – this would mean between 12-25 pounds for an obese person who weighs 250 pounds.
It is important for patients to realize that a small drop in weight is a good start and a great achievement. Experts have found that obese people who lose weight slowly and constantly, say one or two pounds each week, are more successful in keeping their weight down when they have reached their target weight.
According to the Mayo Clinic, successful and permanent weight loss is best achieved as a result of increased physical activity, changing how and when you eat, and modifying your behavior. Some patients may be prescribed medication, while others might undergo weight-loss surgery.
Dietary changes
The Mayo Clinic advises obese people to reduce their total daily calorie intake and to consume more fruits, vegetables and whole grains. It is important that your diet is varied – you still need to feed yourself, and should continue to enjoy the tastes of different foods. The consumption of sugar, certain refined carbohydrates and some fats should be reduced significantly.
Ideally, you should work with your doctor, a dietician, and/or a well-known weight-loss program.
Trying to lose weight quickly by crash-dieting carries the following risks:
You may develop health problems
You will probably experience vitamin deficiencies
You chances of failure are significantly higher
People who are seriously obese may be prescribed a very low calorie liquid diet. These must be done with a health care professional.
Physical activity
The more you move your body the more calories you burn. To lose a kilogram of fat you need to burn 8,000 calories (1 pound of fat = 3,500 calories). Walking briskly is a good way to start increasing your physical activity if you are obese. Combining increased physical activity with a good diet will significantly increase your chances of losing weight successfully and permanently!
Try to find activities which you can fit into your daily routine. Anything that becomes part of your daily life, weaved into your existing lifestyle, is more likely to become a long-term habit. If you use an elevator, try getting off one or two floors before your destination and walking the rest. You could try the same when driving your car or taking any form of public transport – get off earlier and walk that bit more.
If any of your regular shops are within walking distance, try leaving your car at home. Several surveys indicated that the majority of urban car trips outside the rush hours are less than a mile long – we can all walk a mile, and should!
If you are very obese, are unfit, or have some health problems, make sure you check with a health care professional before increasing your physical activity.
Prescription medications for losing weight
Prescription medications should really only be considered as a last resort. If the patient finds it extremely hard to shed the pounds, or if his obesity has reached such a point as to significantly undermine his health, then prescription drugs may become an option.
According to the Mayo Clinic prescription medications should only be considered if:
Other strategies to lose weight have failed
The patient’s BMI is over 27 and he also has diabetes, hypertension, or sleep apnea.
The patient’s BMI is over 30
There are two approved drugs a physician may consider, Sibutramine (Meridia in USA/Canada, Reductil in Europe and much of the world) or Orlistat (Xenical). Bear in mind that as soon as you stop taking these drugs the overweight problem generally comes back – they have to be taken indefinitely. Some patients may not respond to these drugs, while others may find their beneficial effects may lessen somewhat after a few months.
Weight loss surgery (bariatric surgery)
Weight loss surgery (WLS) is also known as Bariatric Surgery. It comes from the Greek work baros, which means weight.
WLS is a development of cancer/ulcer operations that consisted of removing part of a patient’s stomach or small intestine. Those cancer/ulcer patients subsequently lost weight after surgery. Doctors decided the procedure might be beneficial for morbidly obese patients.
In 2008 about 220,000 bariatric operations were carried out in the USA (American Society for Bariatric Surgery). As obesity levels in America and many other parts of the world grow, so does the number of bariatric procedures. About 15 million people in the U.S. have morbid obesity; only 1% of the clinically eligible population is being treated for morbid obesity through bariatric surgery. According to the American Society for Bariatric Surgery, the average female surgery patient weighs about 300 pounds.
The American Society for Bariatric and Metabolic Surgery says that Bariatric surgery can improve or resolve more than 30 obesity-related conditions, including type 2 diabetes, heart disease, sleep apnea, hypertension and high cholesterol .
Basically, bariatric surgery alters your stomach or small intestine so that you are unable to consume much food in one sitting. This reduces the total number of calories you consume each day, thus helping to lose weight.
There are two types of bariatric surgeries:
Restrictive procedures - These make your stomach smaller. The surgeon may use a gastric band, staples, or both. After the operation the patient cannot consume more than about one cup of food during each sitting, significantly reducing his food intake. Over time, some patients’ stomachs may stretch and they are gradually able to consumer larger quantities.
Malabsorptive procedures - Parts of the digestive system, especially the first part of the small intestine (duodenum) or the mid-section (jejunum), are bypassed. Doctors may also reduce the size of the stomach. This procedure is generally more effective than restrictive procedures. However, the patient has a higher risk of experiencing vitamin/mineral deficiencies because overall absorption is reduced.
Health risks associated with obesity
Bone and cartilage degeneration (Osteoarthritis)
Obesity is an important risk factor for osteoarthritis in most joints, especially at the knee joint (the most important site for osteoarthritis). Obesity confers a nine times increased risk in knee joint osteoarthritis in women. Osteoarthritis risk is also linked to obesity for other joints. A recent study indicated that obesity is a strong determinant of thumb base osteoarthritis in both sexes. Data suggest that metabolic and mechanical factors mediate the effects of obesity on joints (University of Bristol).
Coronary heart disease
Obesity carries a penalty of an associated adverse cardiovascular risk profile. Largely as a consequence of this, it is associated with an excess occurrence of cardiovascular disease morbidity and mortality. (Department of Preventive Medicine, University of Tennessee)
Gallbladder disease
Being overweight is a significant risk factor for gallstones. In such cases, the liver over-produces cholesterol, which is then delivered into the bile causing it to become supersaturated. Some evidence suggests that specific dietary factors (saturated fats and refined sugars) are the primary culprit in these cases (University of Maryland Medical Center)
High blood pressure (Hypertension)
There are multiple reasons why obesity causes hypertension, but it seems that excess adipose (fat) tissue secretes substances that are acted on by the kidneys, resulting in hypertension. Moreover, with obesity there are generally higher amounts of insulin produced. Excess insulin elevates blood pressure. (Weight.com)
High total cholesterol, high levels of triglycerides (Dyslipidemia)
The primary dyslipidemia related to obesity is characterized by increased triglycerides, decreased HDL levels, and abnormal LDL composition. (Howard BV, Ruotolo G, Robbins DC.)
Respiratory problems
Obesity can also cause respiratory problems. Breathing is difficult as the lungs are decreased in size and the chest wall becomes very heavy and difficult to lift. (Medical College of Wisconsin)
Several cancers
In 2002, approximately 41,000 new cases of cancer in the USA were thought to be due to obesity. In other words, about 3.2% of all new cancers are linked to obesity (Polednak AP. Trends in incidence rates for obesity-associated cancers in the U.S. Cancer Detection and Prevention 2003; 27(6):415-421)
Sleep apnea
Obesity has been found to be linked to sleep apnea. Also, weight reduction has been associated with comparable reductions in the severity of sleep apnea. (NHLBI)
Stroke
Rising obesity rates have been linked to more strokes among women aged 35 to 54.
Type 2 diabetes
One of the strongest risk factors for type 2 diabetes is obesity, and this is also one of the most modifiable as it can be partially controlled through diet and exercise.
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