Obesity

Obesity is the term used to indicate the high range of weight for an individual of given height. It is a medical condition which occur when the body mass index is ≥30 kg/m2. The BMI is correlated to body fat, but BMI varies with age and sex in children more than it does in adults. Thus, the designation of a child or adolescent (ages 2 to 19 years) as either overweight or obese is based on comparing his or her BMI to a sex- and age-specific reference population (CDC growth charts). Children and adolescents between the 85th and 94th percentiles of BMI-for-age are considered overweight; those greater than or equal to the 95th percentile is considered obese.

“obesity” is a word used by the World Health Organization (WHO) to describe the global epidemic of overweight and obesity.

Stages

Obesity is classified on the basis of BMI, such as;

• Stage 1: BMI of 25-29.9 Kg/m2 = Overweight
• Stage 2: BMI of 30-34.9 Kg/m2 = Obesity I
• Stage 3: BMI of 35-39.9 Kg/m2 = Obesity II
• Stage 4: BMI of ≥40 = Obesity III

How to Calculate Your BMI:

Body Mass Index (BMI) is a widely used method to assess whether a person has a healthy weight for their height. It's a simple calculation based on your weight and height, and it can provide valuable insights into your overall health status. Here's how you can calculate your BMI:

Step 1: Gather Your Measurements

To calculate your BMI, you'll need to know your weight in kilograms (kg) and your height in meters (m). If you only know your weight in pounds (lbs) and height in inches (in), you'll need to convert them to the metric system using the following conversions:

1 pound = 0.453592 kilograms

1 inch = 0.0254 meters

Step 2: Calculate Your BMI

Once you have your weight and height in the metric system, you can use the following formula to calculate your BMI:

BMI = weight (kg) / height^2 (m^2)

Step 3: Interpret Your BMI

After calculating your BMI, you can interpret the results using the following categories:

• Underweight: BMI less than 18.5
• Normal weight: BMI between 18.5 and 24.9
• Overweight: BMI between 25 and 29.9
• Obesity: BMI 30 or greater

Step 4: Example Calculation

For example, if you weigh 70 kilograms and are 1.75 meters tall, your BMI would be calculated as follows:

BMI = 70 kg / (1.75 m)^2

BMI ≈ 22.86

Sign and Symptoms

• Body Mass Index (BMI) greater than 30 kg/m2
• Waist circumference greater than 94 cm in men and 88 cm in women
• Swelling and varicose veins in the lower limbs
• High blood pressure level > 140/90 mmHg
• Acanthosis nigricans
• Stretch marks (due to distension and rupture of the elastic fibers of the skin)
• Difficulty in sleeping
• Sleep apnea/daytime drowsiness
• Back/join pains
• Excessive sweating
• Increased intolerance to heat
• Dyspnea/feeling of shortness of breath

Causes

• Excessive caloric intake
• Poor eating such as; Eating large amounts of processed or fast food, Alcohol consumption, Consumption of too many sugary drink
• Lack of physical activity
• Genetics (Family history of obesity)
• Genetical disorders such as Prader-Willi syndrome and Bardet-Biedl syndrome
• Hypothyroidism
• Cushing’s syndrome
• Hormonal imbalance including insulin, leptin, neuropeptide Y, cortisol, ghrelin, norepinephrine, serotonin, orexin, inteleukin-6 TNF (tumor necrosis factor) and other peptides
• Use of corticosteroids, medications for epilepsy and diabetes, and some medications used to treat mental illness, including antidepressants and medicines for schizophrenia

Diagnostic Test

• Calculating BMI, waist circumference, MUAC, BP level
• Blood analysis (fasting blood glucose, cholesterol, LFT, RFT, t3 & t4, etc.)
• Electrocardiogram
• Liver ultrasound

Complications

• Cardiovascular: Congestive heart failure, enlarged heart & associated arrhythmias, dizziness, varicose veins, pulmonary embolism
• Hypertension: Lipidemic imbalance, the increase in triglycerides and total cholesterol
• Type-II diabetes & cancers: Breast (postmenopausal), colon, endometrial, ovary, cervical and gall bladder cancer in women and colon, rectum and prostate cancers in men
• Musculoskeletal: Osteoarthritis and rheumatoid arthritis
• Hyperuricemia: Predisposes to gout, immobility, osteoarthritis, and lower back pain
• Gastrointestinal: Gastroesophageal reflux disease (GERD) fatty liver disease, non-alcoholic fatty liver disease (NAFLD), cholelithiasis (gallstones), hernia, and colorectal cancer
• Endocrine disease: polycystic ovarian syndrome (PCOS), menstrual disorders, and infertility
• Renal and genitourinary problems: Erectile dysfunction, urinary incontinence, chronic renal failure, hypogonadism (male), breast cancer (female), uterine cancer (female), breast cancer (female), uterine cancer (female), and stillbirth
• Neurologic: Stroke, meralgia paresthetica, headache, carpal tunnel syndrome, dementia, and idiopathic intracranial hypertension
• Respiratory disorders: Obstructive sleep apnea, obesity hypoventilation syndrome, and asthma

Treatment

Obesity is a multidimensional problem and it cannot be treated by a single solution. Therefore diet, physical activity, medications, and surgical procedures are used.

Diet

The first step to treat obesity is managing dietary intake. Reducing portion size, selecting from the right food group, minimizing the consumption of oils and processed foods, consuming a balanced diet: low carbohydrate, high protein and low-fat diet helps to manage obesity. However, it is important to consult a dietician.

Physical activity

It is the most common misconception to manage obesity without adequate physical activity. Research shows brisk walk can help manage obesity more than going to gym. Daily physical activity increase fat metabolism and reduces weight.

Medications

In certain cases, physician might recommend oral medications or injectable medications, such as: Orlistat and Saxenda.

• Orlistat is a medication used in the management of obesity. Orlistat acts by reversibly inhibiting gastric and pancreatic lipases. The inactivation of lipases prevents the hydrolysis of triglycerides, and thus free fatty acids are not absorbed. The maximum benefit of orlistat occurs when used in conjunction with diet and exercise.
• Saxenda (liraglutide), is GLP-I medication. Saxenda (liraglutide) injection 3 mg is an injectable prescription medicine used for adults with excess weight (BMI ≥27) who also have weight-related medical problems or obesity (BMI ≥30), and children aged 12-17 years with a body weight above 132 pounds (60 kg) and obesity to help them lose weight and keep the weight off. Saxenda should be used with a reduced calorie diet and increased physical activity

Note: It is important to consult a healthcare professional before taking any medications or adjusting the dosage.

Surgical Intervention

In extreme cases of obesity where diet, physical therapy and medications does not yield any benefit, physician will recommend you surgical intervention. There three most common surgical interventions

Bariatric Surgery (Sleeve Gastrectomy)

Sleeve gastrectomy is a laparoscopic surgical procedure, which involves inserting small instruments through multiple small incisions in the upper abdomen. During sleeve gastrectomy, about 80% of the stomach is removed, leaving a tube-shaped stomach about the size and shape of a banana. Limiting the size of stomach restricts the amount of food, patient is able to consume. In addition, the procedure prompts hormonal changes that assist with weight loss. These same hormonal changes also help relieve conditions associated with being overweight, such as high blood pressure or heart disease.

Gastric Bypass

It is also known as Roux-en-Y (roo-en-wy) gastric bypass, is a type of weight-loss surgery that involves creating a small pouch from the stomach and connecting the newly created pouch directly to the small intestine. After gastric bypass, swallowed food will go into this small pouch of stomach and then directly into the small intestine, thereby bypassing most of the stomach and the first section of small intestine.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

A biliopancreatic diversion with duodenal switch (BPD/DS) is a less-common weight-loss procedure that entails two major steps.

1. The first step is sleeve gastrectomy in which about 80 percent of the stomach is removed, leaving a smaller tube-shaped stomach, similar to a banana. However, the valve that releases food to the small intestine (the pyloric valve) remains, along with a limited portion of the small intestine that normally connects to the stomach (duodenum).
2. The second step bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach. A BPD/DS both limits how much a person can eat and reduces the absorption of nutrients, including proteins and fats.

BPD/DS is generally performed as a single procedure; however, in select circumstances, the procedure may be performed as two separate operations — sleeve gastrectomy followed by intestinal bypass once weight loss has begun.

While a BPD/DS is very effective, it has more risks, including malnutrition and vitamin deficiencies. This procedure is generally recommended for people with a body mass index (BMI) greater than 50.

Balloon Angioplasty

It is a minimally invasive procedure. A specially designed catheter with a tiny balloon is carefully guided through the artery to the blockage, then inflated to widen the opening and increase blood flow to the heart. A stent is often placed during the procedure, to keep the artery open after the balloon is deflated and removed.

Liposuction

Liposuction is a type of surgery. It uses suction to remove fat from specific areas of the body, such as the stomach, hips, thighs, buttocks, arms or neck. Liposuction also shapes these areas. That process is called contouring. Other names for liposuction include lipoplasty and body contouring.

Liposuction isn’t considered an overall weight-loss method or a weight-loss alternative. People who are overweight can lose more weight through diet and exercise or through other kinds of surgery than with liposuction.

Prevention

• Reduce calorie intake
• Limit the consumption of high calorie foods
• Choose nutrient-dense healthier foods
• Slow eating
• Be mindful of amount and frequency of meals
• Plan your meals
• Plan your physical activity (at least 30 min. of moderate to a little intense exercise/day)
• Reduce sedentarism

Conclusion

Obesity poses a significant threat to both physical and mental health, as well as overall quality of life. It is characterized by an elevated BMI (body mass index), which serves as a precise indicator of excessive weight relative to height. The condition manifests through a variety of symptoms, but BMI remains the most accurate diagnostic measure.

Obesity is linked to a plethora of medical complications, including cardiovascular diseases, diabetes, atherosclerosis, non-alcoholic fatty liver disease, and neurological disorders. Fortunately, recent advancements have introduced various treatment options, including pharmaceutical interventions like Saxenda and Orlistat, as well as surgical procedures such as sleeve gastrectomy, gastric bypass, biliopancreatic diversion, balloon angioplasty, and liposuction.

However, it's essential to recognize that in less severe cases of obesity, the most effective approach involves dietary adjustments and increased physical activity. These lifestyle modifications often yield the most favorable outcomes in managing the condition.