Obesity

What is obesity?

Obesity is a modern world problem and it is a morbid disease that often requires medical treatment or life-saving surgery

Obesity is undoubtedly a global civilization disease – the newest data show that about 200 billion people worldwide are overweight and over 700 million are obese. What is even more frightening, the obesity statistics show that about 38 million children aged 0-5 were diagnosed as overweight or obese solely in 2019. Regarding the obesity definition, it is a disease that involves accumulation of the excessive fat to such an extent that it poses danger to general health and gives rise to other medical conditions and diseases. Some people may think that obesity is a cosmetic problem, but it is a morbid disease that often requires medical treatment or life-saving surgery. 

The simplest way to determine whether a person is obese, and if yes, which of the types of obesity class he or she belongs to is calculating the BMI. There are many BMI calculators available on the Internet where it is enough to give the weight and height to get the immediate results.

The BMI ranges are as follows:

• BMI lower than 18.5: Underweight
• BMI between 18,5 and 25: Normal weight
• BMI between 25 and 30: Overweight
• BMI between 30 and 35: Obesity Class 1
• BMI between 35 and 40: Obesity Class 2
• BMI higher than 40: Obesity Class 3 (called extreme obesity).

Of course, BMI is not the ideal device to determine obesity, however, people whose BMI exceeds 30 should double-check the fat percentage and visit the GP or dietician for the instructions on how to get back to a healthy weight.

Is obesity a disease?

Obesity can lead to other health problems including hypertension, coronary heart disease, type 2 diabetes, or sleep apnea

There have been many debates about obesity disease or disorder categorizing, however, the final worldwide statement (including the American Medical Association) is that obesity is a chronic disease belonging to the same category as heart disease, cancer, or joint disease. 

Chronic disease is defined by the CDC (the Centres for Disease Control and Prevention) as a medical condition that prevails for over a year and requires continuing medical care and treatment. The problems with obesity are reflected in other health problems, including hypertension, coronary heart disease, type 2 diabetes, or sleep apnea. What is even more frightening, obesity may lead to some types of cancer, strokes, or even death, so it should never be underestimated or tolerated. Obesity is a life-threatening disease, not a cosmetic problem, and should never be tolerated or accepted by society, not because of the additional kilograms, but because of its deadly character.

What is childhood obesity?

Childhood obesity concerns children and adolescents. It is a very serious condition determined when weight is higher than the healthy weight range suggested for children at a certain age and height. Childhood obesity statistics show that over 40 million children in the world aged 0-5 weigh too much – it is a starting point for future health problems, such as high cholesterol, type 2 diabetes, and high blood pressure. Also, child obesity often deteriorates into adult obesity. Regarding the psychological aspect, overweight and obese children are proved to have low confidence, lack of self-esteem, eating disorders, and depression. Undoubtedly, children obesity may and should be tackled – just by teaching kids healthy eating habits and encouraging them to practice any sport they like. It is extremely important that adults set a good example of a healthy lifestyle for kids and adolescents, then it is much easier, even entertaining and joyful, for them to eat healthily and be active.

The tips for parents wanting to prevent obesity in their children include:

• encouraging children to eat a variety of vegetables and fruits
• eat meals together as often as possible
• control (and limit) the consumption of sweets and beverages with sugar
• adjust the meal size to a child, do not force children to eat once they are full
• limit eating outside, especially at places serving unhealthy fast food
• do not allow children to spend too much time watching TV or in front of the computer, but make an effort to spend active time with them or encourage them to go outside
• make sure that children get enough sleep
• visit a doctor regularly (at least once a year for an annual checkup where the doctor checks a child’s weight, height, and general health).

Obesity in the world

Obesity in the world has been spreading especially in the 21st century and nowadays it is very difficult to find a country where obesity does not pose a problem. The world obesity rates (showing the problem of obesity by country) are more than worrying.

Below, we present a table showing obesity rates by country for the selected states. 

*The data are taken from CIA World Factbook (edition 2017)

The table above presents only a part of countries struggling with obesity. It does not show the country with the highest obesity rate, which is Nauru (with over 60% of obese people). Also, the main Asian countries are not included here. There the percentage of obese people is lower than average – the obesity in China is 6,2% and obesity in Japan is 4,3%. Generally, Asian culture and tradition are based on care for the health and body, so there, the obesity problem is not as serious as in Europe or America.

Obesity in Europe

There are almost 50% obese adults and 20% overweight and obese children in Europe

Since the 90s, the number of obese adults in Europe has tripled and the number of obese children is ten times higher – nowadays, there are almost 50% obese adults and 20% overweight and obese children in Europe. The European Union attributes about 6% of its healthcare expenditures to obesity in Europe and diseases related to it. 

Obesity in UK is a growing problem. Almost 6 in 10 women and 7 in 10 men in the UK are overweight or obese. The number of overweight children is also growing constantly. Many children struggle with excessive weight even before they are 6 years old, as shown by NHS obesity statistics. Childhood UK obesity was acclaimed a national emergency by the government in 2016. The adult obesity rates UK are higher than in all other Western European countries (except Malta and Iceland), as provided in the Global Burden Disease Study. No wonder, the British put a great emphasis on promoting a healthy lifestyle, especially a balanced diet and regular physical activity. More and more people become aware of the scale of the obesity epidemic UK and decide to fight against it, and the most important aspect of this battle is children’s education about the physical, social and psychological advantages of a healthy lifestyle.

Obesity in America

The obesity rate in America is one of the highest in the whole world

Obesity rate in America is even higher than in Europe. The studies from 2020 show that in the United States 75% of the population is overweight or obese. Harvard T.H. Chan School of Public Health published a note in 2019 saying that over 40% of Americans are obese and 18% are severely obese, and these numbers are growing, unfortunately. Obesity in America is one of the most severe problems among adults and children, and the bad news is that all the predictions for the future show the growing number of obese Americans.

To illustrate the problem, we present a table showing the obesity rate in the US states, the European countries are shown in the table above.

Causes of obesity

Basically, weight is determined by the balance of calories intake and energy expending. If people consume more calories than are metabolized, they gain weight. If more calories are burnt than eaten, they lose weight. Hence, one of the main causes of obesity is overeating.

Yet, we present the ideas of what causes obesity below:

• overeating, especially diet rich in sugar and fat where tiny amount of products contain much empty calories
• lack of physical activity and sedentary lifestyle
• genetics (the studies show that people whose parents are obese have a tendency to weigh too much, also the hormones responsible for fat regulation can also be affected by genetics)
• a diet poor in proteins and rich in simple carbohydrates
• not knowing how to eat (people who eat too rare, e.g. only 2 meals a day, tend to eat too big portions and overeat in the evening, it is also important to chew thoroughly and separate the times of drinking and eating)
• medications – there are some medications that cause weight gain, e.g. antidepressants, anticonvulsants (e.g. Tegretol, Carbatrol, Equetro), valproate (Depakene, Depacon), certain diabetes medications, oral contraceptives, corticosteroids, and medications lowering blood pressure
• psychological reasons, where eating is a way to cope with such emotions as stress, boredom, anger, happiness or sadness
• some diseases, e.g. hypothyroidism, polycystic ovary syndrome, insulin resistance, Cushing syndrome, Prader-Willi syndrome
• social reasons (e.g. loneliness, poverty, lack of education or knowledge).

As shown, it is very hard to determine explicitly how is obesity caused as there are many types of cause of obesity and overeating, however, the main one is not the only reason for this condition. Also, it is very important to find the reason or reasons for obesity for every individual just because it would make the treatment much easier. 

Is obesity genetic

Genetics may cause obesity to some extent but it should never be an excuse or justification for people to start a healthy life

There is some evidence proving that obesity genetics may cause obesity to some extent. Generally, genes are instructing the body on how to respond to changes in the surrounding environment. There have been studies analyzing the differences and resemblances among relatives, twins, family members, and adoptees, which proved that the genetic factors matter in obesity development in family members. The other studies analyzed non-obese and obese people’s reactions, behaviors, and metabolism and it turned out that there are several genes that have different variants for obese and non-obese people which may influence the tendency to be obese. Anyway, whether genetics is partly responsible for obesity or not, it should never be an excuse or justification for people. Obesity can be treated and those who claim that they are obese because of genetics are totally wrong and uneducated. 

Obesity symptoms

One of the most frequently listed signs of obesity is a physical appearance. People with much excessive weight are big and inevitably it is the fat that causes such a physical appearance. So, whether a person is obese (especially severely obese) or not may be determined by just looking at a person.

Regarding the daily health problems which are obesity symptoms, they include:

• hyperhidrosis
• snoring
• breathlessness
• feeling tired all the time
• joint and back pain
• difficulties in doing any physical activity (including walking)
• the feeling of isolation.

Regarding obesity – symptoms are only a part of the equation. The most serious problem is that obesity causes many other obesity-related diseases and conditions. They include high blood pressure, type 2 diabetes, high cholesterol, coronary heart disease, stroke, asthma, chronic kidney disease, gallbladder disease, dementia, osteoarthritis, gout, even cancers. Additionally, signs and symptoms of obesity involve a psychological aspect – obese people tend to suffer from persistent depression, refrain from the social life, have more problems with work, relationships, emotions than people with a normal weight. They have difficulties with self-acceptance and confidence, which influences all other spheres of their lives. The psychological problems are sometimes so rooted that people need 2 parallel treatments – for obesity and for their mental health.  

Obesity health risks

The health risks of obesity are very serious and in fact, all the obesity problems come down to the diseases and disorders being obesity effects. The health problems associated with obesity being in fact consequences of obesity. The effects of obesity on the body and health are described in detail below.

Obesity related diseases

Obesity itself as well as obesity-related diseases are health hazards. What can obesity cause eventually is death – people with BMI over 35 are at two times higher risk of premature death than people with a healthy weight. The most frequent health problems caused by obesity include high blood pressure, stroke, heart diseases, type 2 diabetes, gallstones (and gallbladder disease), cancer, gout, osteoarthritis, asthma, or sleep apnea.

What also enhances the effects of obesity on health is:

• medical history of family members (people whose parents or other relatives are obese or suffer from diabetes or heart disease are more likely to have the same problems)
• the existence of health problems other than those related to obesity, e.g. Hypothyroidism
• “apple” type of body shape.

It needs to be emphasized that losing even 5-10 kilograms may significantly improve health conditions, so any lost kilogram should be appreciated and motivating.

Obesity and diabetes

Obesity and type 2 diabetes are strongly related because obesity is proved to be one of the main causes of type 2 diabetes

Type 2 diabetes is a serious medical condition where the level of blood sugar is higher than normal. It may result in kidney disease, heart disease, stroke, blindness, or amputation. Obesity and type 2 diabetes are strongly related because obesity is proved to be one of the main causes of type 2 diabetes. The fact is that over 88% of people suffering from diabetes are overweight or obese. There have been numerous studies indicating how does obesity causes diabetes and the thing is that being obese makes cells become resistant to insulin, which causes high blood sugar. Losing weight (even 5-7% of the excessive weight)  and becoming active (for minimum 2,5 hours a week) is proved to delay or even prevent diabetes and restore the normal blood sugar level.

Obesity and cancer

Obesity may influence the following types of cancers: kidney, breast, uterine, colorectal, head and neck, pancreatic, esophageal, endometrium, thyroid, prostate, and gallbladder.

The aspects of obesity that have an influence on cancer diseases are:

• Increased level of insulin hormone and IGF-1 (insulin growth factor-1)
• low-level inflammation, which is a chronic condition for obese people
• very high levels of estrogen which is produced by fat tissue
• fat cells might affect processes regulating cancer cells development

Additionally, such factors as high birth weight, gaining much weight in adult life, or repeated losing and gaining weight may influence cancer development.

Obesity and depression

Depression may cause obesity and obesity may cause depression

Without any doubt, obesity and mental health are related to each other and to some extent dependent on each other. The relation between depression and obesity is twofold – depression may cause obesity and obesity may cause depression.

Regarding obesity as a cause of depression, it is claimed that obese people suffer from depression about 25% more often than people with a normal weight. Obesity makes people have very low self-esteem and self-image and refrain from social life. Also, obese people often have to deal with ostracism, stereotyping, or discrimination. Apart from that, difficulties and limitations at work, poor family life, inability to perform many daily activities often result from obesity and can lead to a deep depression. 

On the other hand, depression may be the cause of obesity, especially among teenagers. Adolescents with depression are much more likely to be gaining weight. It is also proved that overweight teenagers struggling with depression are prone to become severely obese in the future. The main problem is usually that people suffering from depression tend to overeat and food becomes their only source of happiness, entertainment, and the way to deal with emotions. 

People dealing with depression and obesity should undergo parallel treatments (psychotherapy or antidepressant treatment for depression as well as diet and exercises or bariatric surgery for obesity).

Obesity and heart disease

Heart disease is the cause of 1 in 4 deaths in the United States according to Centres for Disease Control and Prevention.

Obesity is proven to contribute to the development of heart diseases by:

• changing the level of cholesterol (obesity is lowering good high-density lipoproteins cholesterol, which increases the risk for heart diseases)
• rising the blood pressure (its main danger is the high risk of a heart attack)
• developing type 2 diabetes (the risk of heart disease is even 4 times higher for people with diabetes than for healthy people).

Obesity and high blood pressure

High blood pressure may become very dangerous when it is not under medical control. It may result in a heart attack, stroke, or cause death. Generally, the common causes of hypertension are genetics, stress, high cholesterol, type 2 diabetes, physical inactivity, unhealthy diet, and obesity. 

Obesity increases the pressure on the heart and the force that it uses to pump blood, which causes high blood pressure. The studies show that 3 in 4 cases of hypertension are caused by obesity. Sometimes, especially when people are over 50 or with genetic conditioning, high blood pressure does not stem from obesity, but the medications lowering the blood pressure may result in weight gain, so it is always recommended to follow a healthy diet and stay physically active to prevent or tackle hypertension.

Obesity and pregnancy

Dealing with obesity in pregnancy may have serious consequences for a woman as well as a baby, so it is much safer for a woman to have a weight loss surgery before pregnancy than experience obese pregnancy.

Having BMI over 30 may have the following consequences for a woman:

• the high risk of miscarriage or stillbirth
• gestational diabetes
• problems with kidney and liver
• sleep apnea
• cardiac dysfunction
• high possibility of having a C-section

Obese women, of course, may get pregnant and give birth to a healthy child, however, they need to follow a healthy balanced diet and stay active. Pregnancy should never serve as an excuse to overeat

Babies are at risk of such health conditions as birth defects, childhood obesity, asthma, impaired growth, fetal macrosomia.

Women with a BMI over 30 expecting one baby should gain no more than 9 kilograms during pregnancy and women with BMI over 30 expecting more than one baby should not gain more than 19 kilograms. The higher BMI, the less weight should be gained. overweight and obese women who gain more kilograms, usually tend to overeat during pregnancy, which is completely unhealthy for them and a baby. Obese women, of course, may get pregnant and give birth to a healthy child, however, they need to follow a healthy balanced diet and stay active. Pregnancy should never serve as an excuse to overeat. 

How to prevent obesity?

Obesity prevention is extremely important, especially that the obesity rates are constantly growing. The instructions are slightly different for kids and adults, we present the solutions dedicated to both groups.

How to prevent obesity for children:

• breastfeed babies (children who were breastfed are less likely to gain weight)
• adjust the meal and portion sizes to the age of a child (do not expect that a child will eat the same meal portion as adults)
• show children healthy food choices and encourage them to try all the foods
• eat meals together as often as possible
• teach children how to eat (slow and thorough chewing is important) and when to eat (eating only when a child is hungry)
• do not buy or eat unhealthy food at home (children follow parents’ example also with regard to food choices)
•  stay active and incorporate shared physical activities with children
• limit the time that a child spends watching TV and separate eating and watching TV
• make sure that a child sleeps well and has enough sleep
• control what a child eats outside (at school or with friends).

How to prevent obesity for adults:

• eat meals with “good” fat and avoid “bad” fat
• eliminate sugary and processed food
• add vegetables to each meal
• eat fruit instead of sweets
• consume much dietary fiber 
• choose products with a low glycemic index
• get the support of family and friends (if others know that you try to lose weight or keep the weight you have, your motivation will be greater)
• stay physically active – the recommendations are 150 minutes of a moderate activity or 80 minutes of a tiring activity per week (of course we recommend a physical activity every day)
• engage in weight training (building the muscles boost metabolism and change fat and muscle proportions)
• try to avoid stress and do not treat eating as a way to deal with any types of emotions
• always make a shopping list and plan meals in advance.

Generally, both for adults and children, preventing obesity boils down to a healthy diet and physical activity. Once these are followed, people may enjoy their healthy life!

Obesity treatment

Any form of obesity treatment aims at achieving a healthy weight, which entails decreasing BMI so that it fits the range between 18 and 25. Treatments for obesity reduce the risk of many diseases related to excessive weight and improve mental health also. It is very important to set short-term goals, e.g. to lose 5-10 kilograms instead of 50 kilograms – achieving the results boosts motivation and makes people believe they can achieve more weight loss. 

The most common obesity-treatment is a diet. Just a balanced diet is not enough here, there is a need to introduce a calorie reduction which would enable losing weight. So, the combination of healthy meals with many vegetables and low-calorie intake is an ideal solution for obese people. Needless to say, any fast food, sweets, sugary beverages, or snacks should be totally eliminated. Any drastic diets promising unrealistic effects would never work.

The main rules of the obesity diet are:

• limit calories intake (the typical amount of calories for obese women is 1200 or 1500 and for obese men it is 1500 or 1800)
• avoid empty calories (e.g. desserts, fats, processed food) – people should choose the products that contain few calories and may be eaten in larger portions
• make healthy food choices (the diet should be based on vegetables, fruit, whole-grain carbohydrates, fish, lean meats, beans, olive, nut oils)
• resign from high-carbohydrate food, full-fat food, sugary drinks, and any other meals containing empty calories.

The diet should be mixed with exercises and physical activity. The minimum time of exercising to stay healthy is 150 minutes a week. Those who want to lose weight with the help of physical activity should exercise for minimum 300 minutes a week. Also, this time should be extended week by week because the form and muscles are being built, which allows for more strenuous and frequent training. Apart from the aerobic and obesity exercises, people should stay as active as possible throughout the day (e.g. choose stairs instead of a lift, take walks, park a car further from a destination place). It is also recommended by WHO to reach 10 000 steps a day (when people take walks to work, with children or dogs, go shopping on foot, etc. it is rather easy to achieve such a foot number). 

The other important factor of obesity solutions is a change of behavior. Here, it is highly recommended to use the help of experts and specialists (including psychologists, psychiatrists, and support groups). The main role of such counseling is re-building the connection between emotions and eating, restoring self-confidence, and gaining self-acceptance. Also, if a person struggles with any eating disorders, e.g. compulsive eating, it is the best way to get rid of it. There are many solutions available for people, they can attend individual meetings or group sessions, they can meet with psychologists, sociologists, psychiatrists, and dieticians. Regardless of the type and character of the meeting, it is of utmost importance to regain mental health with the help of specialists.

Once a diet and exercise do not bring the results, the doctor may prescribe weight-loss medications. Of course, meds are not a substitute for a healthy lifestyle, but rather work together with a diet and activity. The main advantage of such medications is stopping the hunger feeling. Any weight loss medication must be individually picked by a doctor. The FDA (Food and Drug Administration) accepts the following meds for treating obesity: Orlistat (Alli, Xenical), Bupropion and naltrexone (Contrave), Phentermine and topiramate (Qsymia), and Liraglutide (Saxenda, Victoza). The medication treatment of obesity requires constant medical care and regular visits to the doctor.

If a diet, exercise, and medication do not bring any effects, the last resort is a weight loss surgery or endoscopic weight loss procedure.

The procedures include:

• gastric balloon
• gastric sleeve
• gastric band
• gastric bypass
• gastric plication
• duodenal switch
• mini-gastric bypass. 

Weight loss procedures limit the stomach capacity, as a result of which only tiny amounts of food can be eaten. Patients need to follow a strict special diet after the surgery and totally change their lifestyle to avoid any complications or weight gain. Bariatric surgeries require several consultations (with a bariatric surgeon, psychologist, dietician, cardiologists) and undergoing many medical tests, however afterward bariatric patients are able to lose even up to 70% of their weight.

Obesity summary

Obesity is a civilization disease in the modern world. The physical sign of it is the body look and dozens of additional kilograms, however, the more serious symptoms are many life-threatening diseases that obesity causes. Apart from heart diseases, diabetes, hypertension, cancer, strokes, and other serious conditions, obesity may cause death, which is the most frightening. Both children and adults are in group risk and worldwide, the number of obese people is growing. To prevent or treat obesity, regular physical activity, and a healthy diet is recommended. For the most part, it helps lose weight. However, those who are severely obese might be in need of medical treatment and weight loss surgery. Anyway, obesity can and must be treated and if a person is very motivated to restore health, we can guarantee that obesity can be overcome. 

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