World Obesity Day 2022 – “Everybody Needs to Act”
Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes
Obesity is a global problem, and it affects us all. 800 million of us are living with the disease, with millions more being at risk. In adults, obesity is defined as having a Body Mass Index (BMI) of 30.0 or more, according to the Centers for Disease Control and Prevention (CDC).
Obesity is associated with a higher risk of contracting serious diseases, such as type 2 diabetes, heart disease, and cancer.
According to the CDC: “Factors such as age, sex, ethnicity and muscle mass can influence the relationship between BMI and body fat. Also, BMI doesn’t distinguish between excess fat, muscle, or bone mass, nor does it provide any indication of the distribution of fat among individuals.”
RISK FACTORS
A complex mix of factors can increase a person’s risk for obesity.
* Genetics
* Environment and community
The environment at home, at school, and in the community can all influence how and what persons eat, and how active they are.
They may be at a higher risk for obesity if they:
* Live in a neighbourhood with limited healthy food options or with many high-calorie food options, like fast-food restaurants
* Haven’t yet learned to cook healthy meals
* Don’t think they can afford healthier foods
* Haven’t found a good place to play, walk, or exercise in the neighbourhood
* Psychological and other factors
Depression can sometimes lead to weight gain, as some people may turn to food for emotional comfort. Certain antidepressants can also increase the risk of weight gain. Quitting smoking is always a good thing, but quitting may lead to weight gain too. In some people, it may lead to excessive weight gain. For that reason, it’s important to focus on diet and exercise while quitting, at least after the initial withdrawal period.
* Medications such as steroids or birth control pills can also raise the risk for weight gain.
CAUSES
Eating more calories than the amount burned in daily activities and exercise — on a long-term basis — can lead to obesity. Over time, these extra calories add up and cause weight gain.
Common specific causes of obesity include:
* Genetics, which can affect how the body processes food into energy and how fat is stored.
* Growing older can lead to less muscle mass and a slower metabolic rate, making it easier to gain weight.
* Not sleeping enough, which can lead to hormonal changes that make persons feel hungrier and crave certain high-calorie foods.
* Pregnancy, as weight gain during pregnancy may be difficult to lose, and might eventually lead to obesity.
Certain health conditions can also lead to weight gain, which may lead to obesity. These include:
* Polycystic ovary syndrome (PCOS), a condition that causes an imbalance of female reproductive hormones.
* Prader-Willi syndrome, a rare condition present at birth that causes excessive hunger.
* Cushing syndrome, a condition caused by having high cortisol levels (the stress hormone) in the system.
* Hypothyroidism (underactive thyroid), a condition in which the thyroid gland doesn’t produce enough of certain important hormones.
* Osteoarthritis (OA) and other conditions that cause pain, which may lead to reduced activity.
DIAGNOSIS
BMI is a rough calculation of a person’s weight in relation to their height. Other more accurate measures of body fat and body fat distribution include:
* Skinfold thickness tests.
* Waist-to-hip comparisons.
* Screening tests, such as ultrasounds, CT scans, and MRI scans.
COMPLICATIONS
Obesity can lead to more than simple weight gain. Having a high ratio of body fat to muscle puts strain on the bones as well as the internal organs. It also increases inflammation in the body, which is thought to be a risk factor for cancer. Obesity is also a major risk factor for type 2 diabetes.
Obesity has been linked to a number of health complications, some of which can be life threatening if not treated:
* Type 2 diabetes
* Heart disease
* High blood pressure
* Certain cancers (breast, colon, and endometrial)
* Stroke
* Gallbladder disease
* Fatty liver disease
* High cholesterol
* Sleep apnea and other breathing problems
* Arthritis
* Infertility
TREATMENT
* Lifestyle changes.
The healthcare team can educate persons on food choices, and help develop a healthy eating plan that works.
A structured exercise programme and increased daily activity — up to 300 minutes a week — would help build up strength, endurance, and metabolism.
Counselling or support groups may also identify unhealthy triggers, and help you cope with any anxiety, depression, or emotional eating issues.
Lifestyle and behavioural changes are the preferred weight loss methods for children, unless they’re extremely overweight.
* Medication
The doctor may also prescribe certain prescription weight loss medications in addition to eating and exercise plans.
Medications are usually prescribed only if other methods of weight loss haven’t worked, and if persons have a BMI of 27.0 or more in addition to obesity-related health issues.
Prescription weight loss medications either prevent the absorption of fat or suppress appetite. The following are approved for long-term use (at least 12 weeks) by the Food and Drug Administration (FDA):
*Phentermine/topiramate (Qsymia)
*Naltrexone/bupropion (Contraceptive)
* Liraglutide (Saxenda)
* Orlistat (Alli, Xenical), the only one that’s FDA-approved for use in children 12 years old and older.
These drugs can have unpleasant side effects.
* Surgery
Weight loss surgery is commonly called bariatric surgery. This type of surgery works by limiting how much food persons can comfortably eat, or by preventing the body from absorbing food and calories. Sometimes it can do both.
Weight loss surgery isn’t a quick-fix. It’s major surgery, and can have serious risks. Afterwards, people who undergo surgery would need to change how they eat and how much they eat, or they risk getting sick.
However, non-surgical options aren’t always effective at helping people with obesity lose weight and reduce their risk for comorbidities.
* Candidates for surgery
For decades, experts recommended that adult candidates for weight loss surgery have a BMI of at least 35.0 (classes 2 and 3).
However, in 2018 guidelines, the American Society for Metabolic and Bariatric Surgery (ASMBS) endorsed weight loss surgery for adults with BMIs of 30.0 up to 35.0 (class 1) who:
* Have related comorbidities, especially type 2 diabetes.
* Haven’t seen sustained results from nonsurgical treatments, such as eating and lifestyle modifications.
For individuals with class 1 obesity, surgery is most effective for those between the ages of 18 and 65 years old.
People will often have to lose some weight before undergoing surgery. Additionally, they’ll normally undergo counselling to ensure that they’re both emotionally prepared for the surgery and willing to make the necessary lifestyle changes that it’ll require.
PREVENTION
There’s been a dramatic increase in obesity and obesity-related diseases in the last couple of decades. This is the reason why communities, states, and the federal government are putting an emphasis on healthier food choices and activities to help turn the tide on obesity.
On a personal level, persons can help prevent weight gain and obesity by making healthier lifestyle choices:
* Aim for moderate exercise like walking,
swimming, or biking for 20 to 30 minutes every day.
* Eat well by choosing nutritious foods like fruits, vegetables, whole grains and lean protein.
* Eat high-fat, high-calorie foods in moderation.
