Obesity

Obesity is defined as a condition in which a person has excess body fat storage that alters or impairs a person’s health. It is more than a cosmetic concern. It's a medical condition that raises your risk of developing other diseases and health issues like heart disease, diabetes, high blood pressure, and certain cancers.
World Health Organization uses body mass index, also known as BMI, to measure obesity. A person having a BMI of 30 or above is considered obese. 

While the exact cause of obesity is an increase in body fat stores, the levels of body fats in return are influenced by the following factors:

• Inactivity and lack of exercise
• Metabolic factors such as insulin resistance, type 2 diabetes, and dyslipidemia
• Genetic factors
• Endocrine factors
• Race, age, sex
• Socioeconomic status
• Dietary habits
• Pregnancy
• Psychological factors

Secondary causes of obesity include:

• Hypothyroidism
• Cushing’s syndrome
• Polycystic ovarian syndrome
• Insulinoma
• Pregnancy
• Smoking cessation
• Eating disorders such as bulimia and binge-eating
• Contraceptives
• Hypogonadism
• Growth hormone deficiency

Body mass index (the weight of a person in kilograms divided by height in meters) is frequently used to classify obesity. Following are the types of obesity:

• Grade 1: no obesity- BMI less than 30
• Grade 2: BMI ranging between 30-40
• Grade 3: BMI more than 40

Obesity is prevalent worldwide. There are certain races, such as North Americans and African Americans, and Hispanics, in which it is more prevalent.
Environmental factors seem to play an important role. People from rural areas are predisposed to obesity as they move to more affluent areas where their activity and dietary habits are affected.

It is more prevalent in children and adolescents. So, any prevention strategy should be targeted early to control obesity. Risk factors for obesity include:

• Sedentary lifestyle
• Comorbid conditions such as hypertension and diabetes that is uncontrolled
• Smoking
• Metabolic syndrome
• Fatty liver disease
• Osteoporosis
• Female gender

Following are the signs and symptoms of obesity:

• Bodyweight more than normal and BMI falling in the range of obesity
• Central fat distribution- excess fat over the abdomen and lumbar region
• Acanthosis nigricans- discoloration of skin folds due to insulin resistance caused by obesity
• Hirsutism- growth of facial hair in females
• Hepatic inflammation due to fatty liver disease caused by deposition of excess fat over the liver
• Pressure ulcers over extremities and dependent areas due to increased body weight
• Pedal edema
• Sleep apnea
• Shortness of breath upon mild exertion
• Anemia
• Associated diabetes, hypertension, and cardiovascular disease

Following tests, measurements, and investigations aid in the diagnosis of obesity and related disorders:

• BMI calculation
• Waist circumference
• Waist to hip ratio
• Caliper derived skinfold thickness measurement
• Ultrasonography to determine body fat thickness
• MRI and CT scans to measure visceral fat
• Fasting lipid profile
• Liver function tests
• Thyroid profile
• Fasting glucose and random blood glucose levels, acylated hemoglobin (HbA1c) levels
• Insulin levels
• Reproductive hormonal profile

Differential diagnoses of obesity include the following:

• Acromegaly
• PCOS
• Type 2 diabetes mellitus
• Depression
• Hypothyroidism
• Fatty liver
• Cushing syndrome
• Ascites
• Generalized lipodystrophy
• Hypercholesterolemia

• Treatment of obesity focuses on self-control and self-monitoring of daily caloric intake, daily exercise and switching to healthier life choices, goal setting for weight loss with non-food rewards, and relapse prevention.
• The most important aspect of training is lifestyle modifications that include diet, activity level, behavior, etc. this requires a motivated patient and a highly devoted team of healthcare professionals to achieve the goal as the process is slow and time-consuming. Dietitians, endocrinologists, surgeons, physicians, psychologists, and psychiatrists are all involved in the process.
• Drugs are the second line of treatment in patients in whom lifestyle changes and dietary modifications do not produce significant results over a long period.
• Bariatric surgery is the treatment of choice in patients with severe obesity and associated comorbidities. Candidates for bariatric surgery are people with BMI greater than 40 or people with BMI between 30 to 40 with at least one comorbid. The procedures include gastric banding and ligation, gastric bypass, liposuction, etc.

The major groups of medicines used for the treatment of obesity are:

• Drugs that decrease dietary uptake. These are lipase inhibitors such as orlistat, anorexiants, glucagon-like peptide agonists, anti-depressants, and melanocortin agonists. 
• Drugs that increase the uptake of fats in peripheral tissues

Obesity affects the quality of life and is associated with considerable morbidity and mortality. People with BMI greater than 40 years can have an average life expectancy reduced by as much as 20 years. It is the second most preventable cause of mortality after smoking.

• It poses a significant risk for cardiovascular diseases such as myocardial infarction that can be life-threatening at an early age.
• The chances of getting life-long conditions such as hypertension and diabetes are also multifold in the presence of obesity.
• Nevertheless, it is preventable, and if controlled earlier, the prognosis is good with a proper lifestyle and dietary modifications.

Obesity can be prevented by making healthy and considerate life choices and switching to behavior that promotes healthy living in the long term. A lot of it is behavioral therapy. Some prevention strategies include:

• Encourage eating all kinds of food with portion control.
• Inculcate raw and organic foods in the diet.
• Switch to good fats instead of bad fats.
• Cut excessive sugar, salt, and oil intake from the daily diet.
• Promote physical activities and exercise from a young age.
• Seek help for mental illnesses such as anxiety and depression that can cause obesity by promoting binge-eating habits.
• Seek medical care for associated illnesses. Compliance with medication in comorbidities such as hypertension, diabetes type 2, etc., is important to control obesity.