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Obesity

Obese

In the United States, 36% of the population are clinically obese as of 2010. Obesity remains to be a looming major health crisis internationally where its prevalence rate is increasing rapidly especially in the first world countries worldwide [1].


Presentation

Obesity is technically defined as having a BMI of more than 30. BMI is an index that reflects the body weight in kilograms divided by the height of the individual in meters squared. Obese patients usually present with higher anthropometric measurements which include waist circumference, hip circumference, and thigh circumference. The neck circumference is also an effective parameter in determining the risk for sleep apnea in most obese patients [9]. Joint deformities may frequently be observed for it bears the weight of the unusually large body mass.

Weight Gain
  • The most common reason for significant weight gain is a high-calorie diet and decreased physical activity. However, apart from environmental factors, genetic predisposition plays a crucial role in the pathomechanism of obesity.[ncbi.nlm.nih.gov]
  • Antibiotics disrupt the intestinal flora (intestinal microbiota) and could be a factor in weight gain. Prescription of antibiotics for children should not be automatic but should be evaluated on a case-by-case basis.[english.prescrire.org]
  • Thus, the increased energy expenditure stimulated by starch in a whole-grain-like structural form is responsible for the reduced body weight gain of obese mice fed with a high fat-based diet.[ncbi.nlm.nih.gov]
  • We used longitudinal statistical models to examine whether weight gain in one person was associated with weight gain in his or her friends, siblings, spouse, and neighbors.[citeseerx.ist.psu.edu]
  • The aim of this study was to investigate the situation of prepregnant obesity in Shanghai and explore the impact of prepregnant obesity on gestational weight gain as well as other pregnancy outcomes.[ncbi.nlm.nih.gov]
Coronary Artery Disease
  • Secondary outcomes included coronary artery disease and cerebrovascular outcomes separately.[ncbi.nlm.nih.gov]
  • Overweight and obesity are often assumed to be risk factors for postprocedural mortality in patients with coronary artery disease (CAD).[ncbi.nlm.nih.gov]
  • Although obesity is a known risk factor for coronary artery disease, its impact on the presentation, treatment, and outcome of patients with acute coronary syndromes (ACS) has not been well studied.[ncbi.nlm.nih.gov]
  • Abstract Objective: Overweight and obesity are often assumed to be risk factors for postprocedural mortality in patients with coronary artery disease (CAD).[dx.doi.org]
Fatigue
  • Smith and Dorothy Williams , Obesity in Urban Women: Associations with Sleep and Sleepiness, Fatigue and Activity , Women's Health Issues , 24 , 4 , (e447) , (2014) .[doi.org]
  • Symptoms are widespread muscle pain and “tender points,” and can include fatigue, sleep problems, depression, bladder and bowel irritability and cognitive difficulties.[arthritis.org]
  • Differential reporting of sleeping time might have occurred by the obese if they tended to systematically underestimate the number of hours of sleep due to fatigue or sleepiness when awake.[doi.org]
Congestive Heart Failure
  • Finally, other clinical settings, for example, congestive heart failure, have their own obesity-survival paradox.[ncbi.nlm.nih.gov]
  • Finally, other clinical settings, for example, congestive heart failure, have their own obesity‐survival paradox.[dx.doi.org]
  • Heart Failure Elevated BMI predisposes to congestive heart failure (CHF) by promoting hypertension, diabetes, and CHD. 91,110–113 It is estimated that there is an increase in the risk of CHF of 5% for men and 7% for women for each increment of 1 U of[dx.doi.org]
Noncompliance
  • Noncompliance with behavioral recommendations following bariatric surgery. Obes Surg 2005 ;15: 546 - 551 Citing Articles (1423) Letters Article Figures/Media[dx.doi.org]
  • The populations in the studies reviewed were generally self‐ or researcher‐selected, and often noncompliant patients were excluded from analyses.[dx.doi.org]
  • Correcting for noncompliance and dependent censoring in an AIDS clinical trial with inverse probability of censoring weighted (IPCW) log-rank tests. Biometrics . 2000;56:779-78110985216 Google Scholar Crossref 36.[dx.doi.org]
Sleep Apnea
  • Sedentary lifestyles and increased pollution brought about by industrialization pose major challenges to the prevention of both obesity and chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), asthma, obstructive sleep apnea[ncbi.nlm.nih.gov]
  • Obesity is a well-recognized risk factor for obstructive sleep apnea.[dx.doi.org]
  • Obesity is becoming a global epidemic in both children and adults, and it is associated with numerous co-morbidities such as cardiovascular diseases (CVD), type 2 diabetes, hypertension, certain cancers, and sleep apnea/sleep-disordered breathing.[ncbi.nlm.nih.gov]
Snoring
  • It also causes heavy snoring. Respiratory problems associated with obesity occur when added weight of the chest wall squeezes the lungs and causes restricted breathing. Sleep apnea is also associated with high blood pressure.[stanfordhealthcare.org]
  • Barthel and Marshall Strome , SNORING, OBSTRUCTIVE SLEEP APNEA, AND SURGERY , Medical Clinics of North America , 83 , 1 , (85) , (1999) . Jeffrey R.[doi.org]
  • Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects. Int J Obes Relat Metab Disord 2001 ; 25 : 669 -75. 64. Valencia-Flores M, Orea A, Castano VA, et al.[dx.doi.org]
Dyspnea
  • Patients with obesity frequently report dyspnea and wheezing and are therefore often given therapy for asthma without objective diagnostic confirmation by pulmonary function testing. 16 An accurate diagnosis is important because dyspnea related to other[dx.doi.org]
  • Phrenic nerve paralysis from brachial plexus blocks can cause clinically significant dyspnea in obese patients. Brachial plexus catheters can be used effectively for these patients with some modification to routine management.[ncbi.nlm.nih.gov]
  • Additional reports from the SOS study report a small benefit of surgery in reducing sleep apnea and symptoms of dyspnea and chest pain and improving quality of life (31, 33) . Differences were related to the degree of weight loss.[annals.org]
Overeating
  • However, the prevalence of a (self-reported) BMI over 40 (about 100 pounds (45kg) overweight) increased by 50% and the prevalence of a BMI over 50 increased by 75%, two and three times faster, respectively.[ncbi.nlm.nih.gov]
  • RESULTS: Over 1991-2013 mean SBP and DBP (mmHg), and the prevalence of hypertension (%) increased in both sexes.[ncbi.nlm.nih.gov]
  • Treatment resulted in 1) reduction in body mass index (BMI) z score from 1.77 to 1.49 over 10 weeks during phase 1; 2) reduction in BMI z score from 1.49 to 0.82 over 38 weeks during phase 2; 3) reduced hyperphagia during phases 1 and 2; 4) continued[ncbi.nlm.nih.gov]
  • INTERVENTIONS: The patients received pharmacopuncture with WGC 5 times over 3 weeks on their abdomen without controlling diet and exercise.[ncbi.nlm.nih.gov]
  • Over the past decade there has been an increasing concern about the impact of chronic, noncommunicable diseases on the health of developing world populations.[ncbi.nlm.nih.gov]
Increased Appetite
  • They alter the function of your body and brain, reducing metabolic rate or increasing appetite ( 14 , 15 ). Summary Some medications may promote weight gain by reducing the number of calories burned or increasing appetite.[healthline.com]
  • Lack of sleep: The perennial habit of shortened sleeping time may alter one’s hormones that advertently increases appetite and cravings for high caloric meals and beverages.[symptoma.com]
  • But studies show that exercise increases appetite , causing people to consume more calories. Exercise also expends far fewer calories than most people think.[well.blogs.nytimes.com]
  • Endocannabinoids, through their effects on endocannabinoid receptors, increase appetite, enhance nutrient absorption, and stimulate lipogenesis. Melanocortin hormone, through its effects on various melanocortin receptors, modifies appetite.[emedicine.medscape.com]
Hypertension
  • Abstract Although obesity is clearly identified as a risk factor for hypertension, the association between its different metabolic phenotypes and hypertension remains unclear.[ncbi.nlm.nih.gov]
  • Hypertension was defined as SBP 140 mmHg and/or DBP 90 mmHg and/or on medication for hypertension. Obesity was measured by body mass index (BMI). Poisson, linear and meta-regression were used to assess period trends.[ncbi.nlm.nih.gov]
  • Plasma IGF-1 represents largely inactive IGF-1 and weakly associated with human obesity and hypertension. We evaluated the regulatory role for cGP in pregnancy-related obesity and hypertension, and in obesity status between pregnancy and postpartum.[ncbi.nlm.nih.gov]
  • Obesity is a major risk for hypertension. However, the associations between hypertension susceptibility loci and the risk of obesity as well as the effects of gene-gene interactions are unclear, especially in the Chinese children population.[ncbi.nlm.nih.gov]
  • Hypertension, diuretic use, and incident gout After we adjusted for potential confounders, including diuretic use, the RR of gout for men with hypertension as compared with men without hypertension was 2.31 (95% CI, 1.96-2.72) ( Table 4 ).[dx.doi.org]
Intertrigo
  • Obesity is a chronic disease that may lead to skin problems, including acanthosis nigricans, skin tags, hyperandrogenism, striae distensae, plantar hyperkeratosis, and candidal intertrigo.[ncbi.nlm.nih.gov]
  • Metabolic: Type 2 diabetes mellitus, prediabetes, metabolic syndrome, and dyslipidemia Reproductive (in women): Anovulation, early puberty, infertility, hyperandrogenism, and polycystic ovaries Reproductive (in men): Hypogonadotropic hypogonadism Cutaneous: Intertrigo[emedicine.medscape.com]
  • Siting of central venous catheters may be difficult, resulting in a higher incidence of catheter misplacement and local complications such as infection and thrombosis. 38 Femoral vein catheterization may be impossible owing to local intertrigo.[bja.oxfordjournals.org]
Striae Distensae
  • Obesity is a chronic disease that may lead to skin problems, including acanthosis nigricans, skin tags, hyperandrogenism, striae distensae, plantar hyperkeratosis, and candidal intertrigo.[ncbi.nlm.nih.gov]
  • Moreover, obesity is implicated in a wide spectrum of dermatologic diseases, including acanthosis nigricans, acrochordons, keratosis pilaris, hyperandrogenism and hirsutism, striae distensae, adiposis dolorosa, and fat redistribution, lymphedema, chronic[ncbi.nlm.nih.gov]
Arthritis
  • But if you like long odds, put your money on arthritis. It’s not as commonly known, but obesity in some cases raises the risk of getting a certain type of arthritis; in all cases, obesity makes arthritis worse.[arthritis.org]
  • .* Compared with metropolitan residents, nonmetropolitan residents have a higher prevalence of obesity-associated chronic diseases such as diabetes (1), coronary heart disease (1), and arthritis (2).[ncbi.nlm.nih.gov]
  • Being obese increases your risk of diabetes, heart disease, stroke, arthritis and some cancers.[icd9data.com]
  • If your elbows already have a tingling sensation or Best Hip Brace For 2019 No matter the reason – whether it’s old age, arthritis, healing after surgery, or a sports-related injury – hip pain sucks.[easoobesity.org]
Back Pain
  • Are you a back pain sufferer? Click here to check out our information about inversion therapy, inversion tables, and more! Looking for a unique way to kick your body into shape? Vibration machines are increasingly popular these days.[easoobesity.org]
  • Obesity is associated with low back pain in general 20 - 22 and with disability and health insurance claims for back pain on the job. 33 , 34 This association is confirmed in our data, with the back being a common body site of injury and with pain or[doi.org]
  • For instance, treatment costs of lower-back pain could depend on BMI status.[dx.doi.org]
Low Back Pain
  • Deyo RABass JE Lifestyle and low-back pain: the influence of smoking and obesity. Spine 1989;14501- 506 PubMed Google Scholar 23. Felson DTZhang YHannan MT et al.[doi.org]
  • Takaaki Ikeda, Kemmyo Sugiyama, Jun Aida, Toru Tsuboya, Nanae Watabiki, Katsunori Kondo and Ken Osaka , Socioeconomic inequalities in low back pain among older people: the JAGES cross-sectional study , International Journal for Equity in Health , 10.1186[dx.doi.org]
  • The effect of an ergometric training program on pregnants weight gain and low back pain. Gazzetta Medica Italiana Archivio per le Scienze Mediche 2007 ; 166 : 209 -13. Yeo S, Steele NM, Chang MC, Leclaire SM, Ronis DL, Hayashi R.[doi.org]
Knee Pain
  • Jinks , C , Jordan , K & Croft , P ( 2006 ) Disabling knee pain – another consequence of obesity: results from a prospective cohort study . BMC Public Health 6 , 258 . 27.[dx.doi.org]
  • Jing-Sheng Li, Tsung-Yuan Tsai, Margaret M Clancy, Guoan Li, Cara L Lewis and David T Felson , Weight Loss Changed Gait Kinematics in Individuals with Obesity and Knee Pain , Gait & Posture , 10.1016/j.gaitpost.2018.12.031 , (2018) . Jennifer N.[doi.org]
  • pain, skin rash); however, none of these were considered to be related to the study, and it was unclear if any of these were considered serious adverse events.[doi.org]
Ankle Arthritis
  • Conti , Posttraumatic Ankle Arthritis: An Update on Conservative and Surgical Management , Journal of Orthopaedic & Sports Physical Therapy , 10.2519/jospt.2007.2404 , 37 , 5 , (253-259) , (2007) .[doi.org]
Amenorrhea
  • CASE DESCRIPTION: We describe an unusual case of a young girl who presented with clinical triad of obesity, primary amenorrhea and central cord syndrome.[ncbi.nlm.nih.gov]
  • Irregular menses, amenorrhea, and infertility are associated with obesity ( 27 ). Women with a BMI greater than 30 kg/m 2 have abnormalities in secretion of hypothalamic GnRH, pituitary LH, and FSH, which results in anovulation ( 28 ). TABLE 2.[doi.org]
Asthenia
  • Extraintestinal symptoms or manifestations are quite frequent in adult CD, and may appear associated with other digestive symptoms such as asthenia, oral sores, osteoporosis or skin lesions.[dx.doi.org]

Workup

Patients that are seen to be obese with BMI of more than 30 are subjected to a more detailed clinical interview with emphasis on metabolic habits and genetic predispositions, and a meticulous physical examination inclusive of the standard anthropometric measurements for comparison. The following ancillary tests are done on an obese patient:

  • BMI measurement: The body mass index is an accurate measure of the relative risk of one on cardiovascular diseases. This can also be used as a monitoring index in weight reduction regimens. 
  • Vital signs: The blood pressure readings, pulse rate and respiratory rate may be adversely affected by the obese conditions.
  • Blood tests: Obese patients may be at risk with other concomitant medical illnesses. Blood cholesterol, blood sugar levels, thyroid function tests, and liver function test may be imperatively monitored for any abnormalities.
  • Electrocardiograph: This tool will involve electrodes placed on the chest to determine the condition of the heart impulses because cardiovascular risk is always higher in obesity.
Left Axis Deviation
  • ECG Changes That May Occur in Obese Individuals Heart rate PR interval QRS interval or QRS voltage QT c interval QT dispersion SAECG (late potentials) ST-T abnormalities ST depression Left axis deviation Flattening of the T wave (inferolateral leads)[dx.doi.org]
Hypertriglyceridemia
  • Obese women pregnancy runs on the background of hypertriglyceridemia and type IV hyperlipoproteinemia.[ncbi.nlm.nih.gov]
  • To diagnose the metabolic syndrome, the concomitant presence of at least three components, among them visceral obesity defined by the measurement of the waist circumference, elevated blood pressure, hyperglycemia, hypertriglyceridemia, or reduced high-density[dx.doi.org]
  • Contribution of abdominal obesity and hypertriglyceridemia to impaired fasting glucose and coronary artery disease. Am J Cardiol 2002 ;90: 15 - 18 Citing Articles (706) Letters Article Figures/Media[dx.doi.org]
  • Women generally lose weight more slowly and display differences in postprandial glucose and fat oxidation, which might influence the rate of fat loss. 21 The GL might also be more important in individuals with hypertriglyceridemia. 11 In this subgroup[dx.doi.org]

Treatment

The general goal in the treatment of obesity is to achieve the healthy weight level. Weight reduction regimens are dependent on the level of obesity [10]. The following treatment tools are usually implored on obese patients:

  • Dietary modification
  • Regular exercise 
  • Behavioral and attitude change
  • Weight loss medications
  • Weight reduction surgery (Bariatric surgery)

Prognosis

Recent researches in endocrinology and metabolic sciences have implicated obesity to increase the mortality and morbidity of patients with comorbid cardiovascular diseases [8]. Obesity is also associated with a significant increase of all-cause mortality and morbidity rating. Furthermore, obese patients with body mass index (BMI) of more than 28 are associated with an almost two fold risk of cardiac diseases and cerebral stroke.

Etiology

Obesity occurs as a combination of several contributing factors. The following factors are established to be contributory to the development of obesity among susceptible patients:

  • Genetics: Patients born from an obese family iare likely to be obese.
  • Hormonal influence: This includes intrinsic and exogenous hormones.
  • Inactivity: Prolonged inactivity or sedentary lifestyle burns lesser dietary calories than what is actually taken in leading to obesity.
  • Unhealthy eating habits: An exclusively carnivorous diet and by eating excessive portions in a meal may predispose one to weight development problems in the future.
  • Lack of sleep: The perennial habit of shortened sleeping time may alter one’s hormones that advertently increases appetite and cravings for high caloric meals and beverages.
  • Pregnancy: Hormonal induction during pregnancy leads to weight gain among expectant mothers. 
  • Medications: Some medications intrinsically increase the weight and boost the appetite. An example of these includes corticosteroids, anti-diabetics, anti-depressants, and beta blockers.
  • Medical issues: Some medical conditions predisposes one to be obese. These medical conditions includes Cushing syndrome, Prader-Willi syndrome, and hypothyroidism

Epidemiology

In the United States, more than 90 million of the population including men, women, and children are noted to be obese. Prevalence rate of obesity are even more pronounced in some minority groups like the Prima Indians, Afro-Americans, and the Latin Americans [3]. Obese and overweight individuals account for 1 out of 5 deaths in the United States today [4].

The worldwide prevalence of obesity has been steadily increasing especially in the northern hemisphere and Europe. Today, approximately 22% of the female and 15% of the male are obese in Europe [5]. Because women physiologically have a higher fat content than male, obesity has a greater predilection to women than in men. Conservatively, the currently global estimates suggests that 7% of the world population are obese. Obese children are most likely to obese when the reach adulthood.

Sex distribution
Age distribution

Pathophysiology

There are practically two types of obesity in relation to adipocyte (fat cells) development, the hypercellular obesity, and the hypertrophic obesity. Hypertorphic obesity is associated with the increasing size of adipocytes found in majority of cases like the android abdominal obesity. This is the type of obesity found in adulthood that is easily responsive to weight reduction treatments.

The hypercellular obesity type usually occurs among obese individual that starts out as an obese adolescent and may also occur among the severely obese adult patients. Recent researches are unearthing the possibilities that certain adipocytes in the body may functionally serve as an endocrine gland that regulates weight gain [6]. The involvement of insulin in the control the olfactory senses during the actual act of eating has been intensively investigated in the pathogenesis of obesity [7].

Prevention

The main goal in the prevention of obesity is practically very similar to the approach in weight reduction programs for the obese patient. One is regularly encourage to do exercises and monitor one’s weight and BMI. Dietary restriction of unhealthy foods should be practiced and an avid monitoring of the calories ingested daily should be in place.

Summary

Obesity is revered to be a complex medical condition involving excessive amounts of body and visceral fats. Obesity does not only distort the overall physique of the person, but it also increases the risk of one for diseases like diabetes, heart diseases, and hypertension [2]. Recent trends on weight reduction have shown dramatic decrease in the relative health risk associated with obesity. There are many options available today to address the obesity problem, these includes weight losing pills, exercises, dietary modifications, and bariatric surgery.

Patient Information

Definition

Obesity is a broad term that is used to describe a complex medical condition involving excessive amounts of body and visceral fats.

Cause

The cause of obesity can vary from genetic causes to hormonal influence, it can also be due to physical inactivity, as a side effect of excessive usage of few medications, secondary to few medical conditions, post pregnancy, and due to lack of proper sleep.

Symptoms

The symptoms of obesity can vary widely from breathlessness, muscle and joint pains, feeling tired often, irregular periods in females, varicose veins, and skin infections.

Diagnosis

Diagnosis includes detailed clinical history and physical examination, anthropometric measurements, blood tests to rule out secondary medical conditions, and ECG.

Treatment

Treatment includes treatment of secondary medical conditions, weight loss programs, dietary modifications, exercise, weight loss medications, and bariatric surgery.

References

Article

  1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. Feb 1 2012; 307(5):491-7.
  2. Nainggolan L. FDA Approves Bupropion/Naltrexone (Contrave) for Obesity. Medscape Medical News. Accessed November 15, 2014.
  3. Yaemsiri S, Slining MM, Agarwal SK. Perceived weight status, overweight diagnosis, and weight control among US adults: the NHANES 2003-2008 Study. Int J Obes (Lond). Aug 2011; 35(8):1063-70.
  4. Masters RK, Reither EN, Powers DA, Yang YC, Burger AE, Link BG. The Impact of Obesity on US Mortality Levels: The Importance of Age and Cohort Factors in Population Estimates. Am J Public Health. Aug 15 2013.
  5. Molarius A, Seidell JC, Sans S, Tuomilehto J, Kuulasmaa K. Waist and hip circumferences, and waist-hip ratio in 19 populations of the WHO MONICA Project. Int J Obes Relat Metab Disord. Feb 1999; 23(2):116-25.
  6. Martinelli CE, Keogh JM, Greenfield JR, Henning E, van der Klaauw AA, Blackwood A, et al. Obesity due to melanocortin 4 receptor (MC4R) deficiency is associated with increased linear growth and final height, fasting hyperinsulinemia, and incompletely suppressed growth hormone secretion. J Clin Endocrinol Metab. Jan 2011; 96(1):E181-8.
  7. Ketterer C, Heni M, Thamer C, Herzberg-Schäfer SA, Häring HU, Fritsche A. Acute, short-term hyperinsulinemia increases olfactory threshold in healthy subjects. Int J Obes (Lond). Aug 2011; 35(8):1135-8.
  8. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA. Oct 27 1999; 282(16):1530-8.
  9. Li C, Ford ES, Zhao G, Croft JB, Balluz LS, Mokdad AH. Prevalence of self-reported clinically diagnosed sleep apnea according to obesity status in men and women: National Health and Nutrition Examination Survey, 2005-2006. Prev Med. Jul 2010; 51(1):18-23.
  10. Jolly K, Lewis A, Beach J, et al. Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trial. BMJ. Nov 3 2011; 343:d6500.

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Last updated: 2017-08-09 18:14