Tjiang W, Ooi SL Amy, See KS Kris
Overview
· Worldwide obesity has nearly tripled since 1975.
· In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.
· 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.
· Obesity means having excess body fat. Having a BMI greater than 30 is considered obese.
· Obesity is a chronic medical disease that can lead to diabetes, high blood pressure, heart disease, gallstones, and also been linked to increased risk for a number of cancers.
· Dietary changes, increased physical activity and behavior changes can help you lose weight. Prescription medications and weight-loss surgery are additional options for treating obesity.
· Even a modest weight loss of 5%-10% of initial weight and the long-term maintenance of that weight loss can bring significant health benefits by lowering blood pressure and lowering the risks of diabetes and heart disease.
· Obesity is preventable.
What are overweight and obesity?
Overweight and obesity are defined as abnormal or excessive fat accumulation. The word comes from the Latin word "obesus," which roughly translates to "to eat.", but what exactly is the difference between them? The answer lies in their body mass index (BMI) classification.
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m2).
For adults, WHO defines overweight and obesity as follows:
overweight is a BMI greater than or equal to 25; and
obesity is a BMI greater than or equal to 30.
For children, overweight and obesity are defined based on WHO child growth standards and reference.
What causes obesity?
There are many factors that can cause obesity :
· Sedentary Lifestyle
If you don't get adequate exercise and you consume more calories than needed, the excess amount becomes stored as fat, leading to weight gain.
· Poor Dietary Choices
A diet high in processed and sugary foods can greatly increase your BMI. Alcoholic beverages contain lots of calories as well, you'll gain weight faster, if you are a heavy drinker. Many restaurant meals, especially fast foods, contain lots of calories, harmful fat and sugar that can make you gain weight
· Genetics
Your genes may affect the amount of body fat you store, and where that fat is distributed. Genetics may also play a role in how efficiently your body converts food into energy and how your body burns calories during exercise. Your chances of developing obesity are higher if one or both your parents are obese, not only due to genetic reasons, but due to your family's lifestyle choices as well.
· Medications
Certain types of medicines such as antipsychotics, antidepressants, antiepileptics, corticosteroids and antihyperglycemics can cause you to gain weight if used long-term.
· Psychological Reasons
Sadness and stress are just a few examples that can cause a person to eat more than they need to. It's estimated that 30 percent of those who seek treatment for obesity have psychological problems in controlling their binge eating.
· Environment and Economic Factors
Certain environmental or economic factors come into play regarding weight gain. For example, financial problems can cause you to purchase ready-to-eat, processed food more frequently than healthy, organic food. In addition, the people you spend time with may influence your weight, you're more likely to become obese if you have obese friends or relatives.
What are health consequences of obesity?
Below is a list of potential complications that can arise due to obesity, as well as their symptoms.
· Type 2 Diabetes
Most people who are obese develop type 2 diabetes, a condition wherein your body has higher levels of blood sugar (glucose) than the normal, due to insulin resistance.
· Breathing Disorders
Sleep apnea, a potentially serious sleep disorder in which breathing repeatedly stops and starts.
· Cardiovascular Disease
Obesity drastically increases your risk of developing coronary heart disease, which is the buildup of plaque in your arteries. If the plaque severely limits the flow of blood to your heart, a heart attack can happen. Symptoms of a heart attack include chest pain, shortness of breath and palpitations.
· Gallstones and Liver Problem
Gallstones are hard, crystal-like deposits created inside your gallbladder. In the case of obesity, the stones are usually made from cholesterol, and their sizes can vary. Nonalcoholic fatty liver disease, a condition in which fat builds up in the liver and can cause inflammation or scarring
· Cancer
The low-level inflammation caused by obesity can gradually damage your DNA over time, leading to cancer. The following types of cancer have been linked to obesity : Endometrial cancer, Esophageal adenocarcinoma, Breast cancer, Gastric cancer, Liver cancer, Kidney cancer, Pancreatic cancer, Colorectal cancer.
· Osteoarthritis
Pain in the knees, back and hips are usually common in obese people, because the heavy weight puts extra pressure on the joints. Depending on the symptoms, the pain may be mild, or it may be so severe that it can hamper your daily activities
How can obesity be reduced?
The goal of obesity treatment is to reach and stay at a healthy weight. You may need to work with a team of health professionals including a dietitian, behavior counselor or an obesity specialist.
The American Heart Association recommends obese patients participate in a medically supervised weight loss program two or three times a month for at least six months.
The initial treatment goal is usually a modest weight loss — 3 to 5 percent of your total weight. That means that if you weigh 200 pounds (91 kg) and are obese by BMI standards, you would need to lose only about 6 to 10 pounds (2.7 to 4.5 kg). However, the more weight you lose, the greater the benefits.
· Dietary changes
Reducing calories and practicing healthier eating habits are vital to overcoming obesity. Although you may lose weight quickly at first, slow and steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently.
For diet, recommendations for populations and individuals should include the following:
achieve energy balance and a healthy weight
limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats
increase consumption of fruits and vegetables, and legumes, whole grains and nuts
limit the intake of free sugars, salt (sodium) consumption from all sources
There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you.
· Exercise and activity
Increased physical activity or exercise is an essential part of obesity treatment. The concept of accumulation refers to meeting the goal of 60 minutes per day or 150 minutes per week by performing aerobic physical activity such as walking, dancing, gardening, swimming, cycling, in multiple shorter bouts spread throughout the day. For example, to meet the goal of 60 minutes of physically activity daily, children can do two bouts of 30 minutes in different times of the day. Adults can meet the 150 minutes weekly goal by doing 30 minutes of physical activity five times per week.
Inactive adults or adults with disease limitations will have added health benefits if moving from the category of “no activity” to “some levels” of activity.
· Behavior modification
Behavior modification, sometimes called behavior therapy, include: Counseling and Support groups
· Weight-loss medication
In certain situations, prescription weight-loss medication may help. Weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them.
Commonly prescribed weight-loss medications include orlistat, lorcaserin , phentermine and topiramate, buproprion and naltrexone, and liraglutide. You will need close medical monitoring while taking a prescription weight-loss medication.
· Weight-loss surgery
In some cases, weight-loss surgery, also called bariatric surgery, is an option. While weight-loss surgery offers the best chance of losing the most weight, it can pose serious risks.
Weight-loss surgery for obesity may be considered if you have tried other methods to lose weight that haven't worked and:
You have extreme obesity (BMI of 40 or higher)
Your BMI is 35 - 39.9, and you also have health problem, such as diabetes or high blood pressure
Common weight-loss surgeries include:
Gastric bypass surgery
Laparoscopic adjustable gastric banding (LAGB)
Biliopancreatic diversion with duodenal switch
Gastric sleeve
Prevention
Whether you're at risk of becoming obese, currently overweight or at a healthy weight, you can take steps to prevent unhealthy weight gain and related health problems. The steps to prevent weight gain are the same as the steps to lose weight: daily exercise, a healthy diet, and a long-term commitment to watch what you eat and drink, monitor your weight regularly, and be consistent.
References
1. AHA. “Obesity Information.”
2. Balentine JR. ”Obesity.” MedicineNet.com
3. Mayo Clinic. “Obesity.” 2015
4. Mercola.com. “What Happens to Your Body When You Are Obese? The Effects of Obesity You Can't Always See.”
5. Merriam-Webster. “Obese.” 2018.
6. WHO. “Global Strategy on Diet, Physical Activity and Health.” 2018.
7. WHO. “Obesity and overweight.” 2018.
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