Obesity

What is Obesity?

Obesity, also known as Corpulence, is an ailment characterized by excessive storage of body fat and is assessed based on a higher than normal body fat percentage and by the presence of a higher than normal body mass index (BMI) which is the ratio of weight in kilograms to the square of the height of the individual in meters. Obesity is usually present along with a large number of other medical conditions such as cardiovascular disease, diabetes, etc., and contributes to their progress and a deleterious effect on the overall health of the individual.

Is Obesity condition a Medical emergency?

Obesity is not a medical emergency, but prompt and effective management is essential to prevent serious complications.

Types

Obesity may be classified as follows:

• Overweight: BMI is 25-29.9Kg/m²
• Severe Obesity: BMI is 30-39.9Kg/m²
• Morbid Obesity: BMI is 40-49.9Kg/m²
• Super Obesity: BMI is more than 50 Kg/m²

Obesity may also be classified as:

• Hypertrophic Obesity: In which the fat cells are larger in size; more commonly seen in Obesity that develops in adulthood.
• Hypercellular Obesity: In which there are more fat cells; it is more commonly seen in Obesity that begins in childhood or adolescence; it is less amenable to nonsurgical correction.

Causes

Obesity is a multifactorial ailment resulting from genetic, behavioural, hormonal, and environmental factors as well as an excessive intake of calories than required for normal body function, exercise, and activities of daily living.

Factors that play a role in the development of Obesity include:

• Genetics: Obesity is a heritable condition
• Diet and dietary habits: Especially due to excessive carbohydrate consumption, and fast food meals which are high in calories
• Sedentary lifestyle, lack of exercise, less physically demanding occupations
• Endocrine dysfunction:
  • Hypothyroidism
  • Cushing syndrome
  • Growth hormone deficiency
  • Insulinoma
  • Hypothalamic dysfunction
  • Hypogonadism
  • Pseudohypoparathyroidism
• Psychological conditions such as eating disorders, stress, and depression
• Medications: Such as antipsychotics, antidepressants, anticonvulsants, insulin, corticosteroids, and hormonal contraception
• Pregnancy and menopause
• Cessation of smoking
• High Socioeconomic status

Risk factors

Factors that increase the risk of Obesity include:

• Family history of Obesity
• Unhealthy lifestyle including diet, activity, and consumption of sweetened drinks
• History of treatment for medical conditions with medications that can cause Obesity
• Cessation of smoking
• Pregnancy and menopause
• Use of hormonal contraception
• Stress
• Abnormal gut bacteria
• Previous unsuccessful attempts at losing weight resulting in rebound weight gain

Symptoms & signs

The primary sign and symptom of Obesity is the presence of increased body weight with relation to height, and an inability to lose weight despite attempts to do so. Additionally, in a majority of individuals, there are symptoms of comorbidities that exist.

Investigations

Some investigations that are advised for the evaluation of Obesity include:

• Laboratory tests:
  • CBP & ESR
  • Lipid Profile
  • Liver and renal function tests
  • Thyroid profile
  • Fasting blood sugar and HbA1c
• Measurement of the degree of fat:
  • Calliper measured skinfold thickness
  • DEXA: Dual-energy radiographic absorptiometry
  • Bioelectrical impedance analysis
  • Weighing underwater
• Imaging tests:
  • Ultrasound to measure fat thickness
  • CT or MRI scan to measure visceral fat
• Assessment of BMI and Body Fat Percentage
  • *BMI is calculated as = weight in Kg/(height in meters)²
  • *Body fat percentage is calculated as = 1.2(BMI) + 0.23(Age) - 10.8(1 for males, or 0 for females) - 5.4

Diagnosis

A diagnosis of Obesity is established based on medical history, clinical evaluation, and results of the investigations done.

Treatment options

The aim of the treatment of Obesity is to help the individual reach and maintain ideal body weight. Treatment begins with lifestyle management which includes diet, behavioural modification, and physical activity, and is aided by medical management with pharmacotherapy for management of comorbidities, and surgical interventions as and when required. Obesity is managed in a phased manner and is divided into the screening phase, the weight loss phase and the maintenance phase.

Medical management

Medical management of Obesity is done along with dietary changes and physical activity in individuals with a higher risk of complications from existing comorbidities and may include:

• Anorexiants: Centrally acting agents to impair dietary intake
• Glucagon-like Peptide-1 Agonists - Centrally acting agents to impair dietary intake
• Gastrointestinal Agents: Induce weight loss by inhibiting the absorption of nutrients
• Melanocortin Agonists: Centrally acting agents to regulate hunger, satiety, and expenditure of energy

Interventional including surgery and indications for surgery

Surgical interventions are required for the management of morbid and super Obesity in the presence of comorbidities. Surgical interventions such as bariatric surgeries performed on carefully selected individuals help in resolving or improving several comorbidities that are present.

Some surgical procedures that are done for the management of Obesity include:

• Adjustable gastric banding
• Gastric sleeve surgery
• Vertical sleeve gastrectomy
• Roux-en-Y gastric bypass
• Horizontal gastroplasty
• Vertical banded gastroplasty
• Duodenal-switch procedures
• Biliopancreatic bypass
• Biliopancreatic diversion

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

Some measures that are indicated for the management of Obesity including post weight reduction maintenance include:

• Dietary changes: Which include:
  • Consumption of fewer calories
  • Eating larger portions of food with fewer calories:  Such as fruits and vegetables
  • Avoiding red meat
  • Avoiding sweetened beverages
  • Meal replacements with energy bars or shakes
• Exercise Programs and Physical activity to achieve a calorie deficit
• Behavioural therapy
• Getting adequate sleep
• Drinking about 500ml of water before each meal

Some measures that can be taken to prevent Obesity include:

• Getting regular exercise and avoiding a sedentary lifestyle
• Following a healthy diet plan and sticking to it
• Regular monitoring of weight

Complications

Some complications and comorbidities of Obesity include are as follows:

• Cardiovascular system:
  • Angina
  • Coronary artery disease
  • High blood pressure
  • Left ventricular hypertrophy
  • Congestive heart failure
• Central Nervous System:
  • Stroke
  • Psuedomotor cerebri
  • Meralgia paresthetica
• Respiratory system:
  • Obstructive sleep apnea
  • Recurrent respiratory infections
  • Bronchial asthma
  • Obesity hypoventilation syndrome
• Gastrointestinal tract:
  • Cholecystitis (gall bladder inflammation)
  • Cholelithiasis (gall stones)
  • Fatty liver
  • Nonalcoholic steatohepatitis
  • Reflux esophagitis
• Reproductive system:
  • Anovulation, Early puberty, menstrual disorders
  • Infertility
  • Polycystic ovarian disease
  • Pregnancy-related hypertension
  • Pelvic dystocia
  • Fetal macrosomia
  • Hypogonadism
• Metabolic:
  • Type 2 Diabetes
  • Insulin resistance
  • Abnormal lipid profile
• Orthopaedic:
  • Osteoarthritis
  • Chronic low back pain
• Genitourinary:
  • Erectile dysfunction
  • Buried penis
  • Urinary incontinence
  • Chronic renal failure
• Psychological:
  • Depression
  • Social stigmatization
• Skin:
  • Stretch marks
  • Acanthosis nigricans
  • Intertrigo (bacterial and fungal)
• Cancer:
  • Increased risk of gastrointestinal cancers
  • Increased risk of malignant melanoma
  • Increased risk of renal cancer
• Increased risk of COVID-19

Prognosis

The prognosis for Obesity depends on how well it is addressed and managed and more importantly on the compliance of the individual to medical advice. Untreated Obesity can lead to the development and worsening of comorbidities, reduced quality of life, and death.

When to contact the doctor or hospital? / How to identify the emergency or complications?

It is advisable to seek medical attention if there is an abnormal weight gain or persistence of weight gain in spite of efforts to reduce or maintain optimal weight.

Indications for hospitalization if required

Hospitalization for Obesity may be required for the management of complications or when surgical interventions are advised.

Suggested clinical specialist/ Departments to consult for this condition

Endocrinology.