Obesity/Adiposity-Based Chronic Diseases Treatment

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Causes

Symptoms

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What is obesity?

The United States has experienced a growing obesity epidemic during the past 30 years that has caused nearly 70% of adults to be overweight. More than a third of that group is obese, or extremely overweight. Just 20 years ago, only 56% of adults were overweight. The percentage of overweight and obese children has also increased dramatically. 

Obesity is a complex disease that means weighing more than what’s considered healthy for your height. It is a serious medical problem that increases your chances of developing other diseases and health problems -- heart disease, diabetes, high blood pressure and certain cancers.

Obesity is a complex disease involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It's a medical problem that increases the risk of other diseases and health problems, such as heart disease, diabetes, high blood pressure and certain cancers.

What is adiposity?

Adiposity is severe obesity, also called morbid obesity. According to the BMI, obesity is diagnosed at 30 or higher. Adiposity/severe obesity is diagnosed at a BMI of 40 or higher. Overweight is 25 to less than 30. In contrast, a healthy weight range is considered to be 18.5 to less than 25. 

What is a chronic disease?

Chronic disease includes any adverse condition or problem that lasts for a year or more, often for the rest of your life, and requires long-term medical attention. Chronic disease often limits normal daily activities, are the leading causes of death and disability, and are causing health care costs to soar. Chronic diseases can be caused by obesity or adiposity, having poor nutrition, lack of exercise, and excessive alcohol use. 

Why should I worry about my weight?

A healthy weight is crucial to reaching and maintaining good health. As BMI increases, the risk of serious disease increases. Obesity puts added stress on your bones, joints, and internal organs by making them work harder. It increases your risk of developing heart disease, stroke, and diabetes. Fat causes inflammation that damages cells. Your mobility, stamina, and ability to exercise are all decreased with weight gain. Obesity is associated with poorer mental health and reduced quality of life.

Causes

What causes obesity?

The reason some people gain weight and others do not is due to a complex combination of causes, individual behaviors, health issues, physiological factors (how the body functions), your environment, and genetics (family-inherited traits). These factors are different for each person, making weight reduction and treatment of weight-related chronic conditions even more complex.

  • Excess calories mean you are eating and drinking more calories than your body needs or can use up in physical activity. Extra calories are stored in your body as fat. But excess calories are only part of weight gain. 
  • Socio-economic factors related to food and exercise can be a strong determinant of obesity. Individual factors include education and income levels, knowledge about food preparation, and what’s included in a healthy diet. For example, people with low incomes may live in an area where healthy food is not readily available, or they cannot afford it; or they don’t have safe and accessible places to exercise.
  • Health status and the illnesses and chronic diseases you have may lead to weight gain. Certain medications can cause weight gain (beta-blockers, antidepressants and antipsychotics, anti-seizure and diabetes medications, and steroids). Certain diseases can also contribute to weight gain: Cushing’s disease, polycystic ovary syndrome, and exercise-limiting arthritis.
  • Your microbiome refers to the trillions of microbes that live in body fluids and the tissues of your mouth, gut, skin, and other places. Microbiome protects you from germs, breaks down food to release energy, produces vitamins, and keeps us alive. The microbiome in your gut is linked to obesity risk and obesity-related metabolic disorders. It is believed that a Western-style diet (high in fat and refined carbohydrates) promotes gut bacteria that are linked to obesity.

Can genetics cause obesity?

Genes don’t directly cause obesity, but they have an influence on weight. Genetic changes happen too slowly in humans to have caused the last 30 years obesity epidemic. Most obesity is a result of complex interactions among multiple genes coupled with environmental and community factors. This “causal” relationship is not well understood. 

Genes influence weight by giving directions to the body about how to respond to environmental changes. Genes can affect the amount of fat you store, how the fat is distributed in your body, how efficiently your body converts food into energy, and how your body burns calories during exercise. Some genes contribute to obesity by increasing hunger. The family you’re born into has a role in obesity because eating and activity habits are learned from your family. 

Who’s at risk for obesity?

The risk factors associated with being overweight include:

  • Genetics and the influence of family habits
  • Unhealthy eating
  • Unhealthy beverages, especially sugary soft drinks and alcohol
  • Inactivity, especially if you spend a lot of time in front of a TV or computer screen
  • Getting older (although obesity occurs at all ages) causes hormonal changes, and often muscle loss and a less active lifestyle
  • A slowing metabolism reduces calorie needs, making it harder to keep off excess pounds
  • The weight gain with pregnancy can contribute to long-term obesity in women
  • Changing a long-term habit, such as weight gain while quitting smoking
  • Lack of sleep can cause hormonal changes that increase appetite
  • Stress, which can cause high-calorie food cravings
  • Quitting smoking if you use food to “substitute” for tobacco
  • Yo-yo dieting - weight loss followed by regaining the weight -- can slow your metabolism
  • Family and friends who are gaining weight can influence you to gain weight

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Symptoms

Excess body fat is the chief symptom. Being overweight can increase the risk of developing other diseases, including:

  • Heart disease, including high blood pressure, coronary heart disease and stroke
  • High LDL and low HDL cholesterol
  • Type 2 diabetes
  • Many types of cancer
  • Gallbladder disease and digestive problems
  • Osteoarthritis
  • Sleep apnea and breathing problems
  • Mental health issues, including depression, anxiety, social isolation, and poor self image
  • Lower quality of life -- encountering discrimination or not being able to participate in activities
  • Body pain and issues with physical functioning
  • Poor stamina; easily tired with even mild exertion
  • Physical disability
  • Sexual problems, including infertility and irregular periods in women; erectile dysfunction in men
  • Severe COVID-19 symptoms
  • Death from all causes

Diagnosis

How is obesity diagnosed?

Your doctor will do a physical exam and ask about your diet and exercise habits. Obesity is often diagnosed using a screening tool called the Body Mass Index (BMI). You can use the Adult BMI Calculator or determine BMI by finding your height and weight in the BMI Index Chart. Fat distribution is another measure of obesity. Fat that’s carried around the belly and hips is especially unhealthy, regardless of your BMI. Women with waists greater than 35 inches, and men with waists greater than 40 inches, have too much belly fat. The waist size and waist-to-hip ratio measurements are increasingly used, with BMI, to diagnose obesity and the risk of chronic diseases.

Treatment

What are the treatment options for obesity?

The goal of treatment is to get to and maintain a healthy weight for life. In addition to your doctor, you may need to work with a dietitian, obesity specialist, and behavior counselor to understand and change eating and activity habits.  

  • Weight reduction. Focus on reaching and maintaining a healthy weight. It can reduce your risk of chronic diseases and other complications of obesity. 
  • Eat healthier. Learn about and adopt a healthier diet.
  • Get moving. Ask your doctor for a healthy exercise plan and start slowly to make it a habit for life. Exercise greatly improves your chances of keeping the weight off. 
  • Consider behavior modification, including counseling and support groups. Therapy can help you understand behavioral and emotional issues relating to being overweight.
  • Treat chronic diseases. Work with your doctor to get chronic diseases under control. Ask your doctor if weight-increasing meds can be switched to an alternative.  
  • Reduce your risks. Work with your doctor to analyze your personal risk factors. Develop a plan to reduce their influence on your weight.   
  • Weight-loss medication can help if it is used along with diet and exercise.
  • Endoscopic procedures or weight-loss (bariatric) surgery.
  • Vagal nerve blockage can signal the brain that the stomach feels full. 

The good news is that even modest weight loss can improve or prevent many of the health problems associated with obesity. A healthier diet, increased physical activity and behavior changes can help you lose weight. Consider supporting public efforts to expand access to healthy food and safe and accessible places to exercise.

References

Centers for Disease Control and Prevention. (June 2021) Defining Adult Overweight and Obesity. Retrieved 7-21-21, {https://www.cdc.gov/obesity/adult/defining.html}
Centers for Disease Control and Prevention. (March 2021) Adult Obesity Causes and Consequences. Retrieved 7-21-21{https://www.cdc.gov/obesity/adult/causes.html}
MacMillan, A. (Dec. 2014). What Is Obesity? WebMD. Retrieved 7-22-21, {https://www.webmd.com/diet/obesity/features/am-i-obese#1}
Mayo Clinic. (Sep. 2021). Obesity. Retrieved 11-1-21, {https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742}
Davis, C.D. (July 2016). The Gut Microbiome and Its Role in Obesity. Nutrition Today. Retrieved 7-22-21, {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082693/}

Medically reviewed by:

Stuart Seigel, MD

Dr. Seigel is a board certified Endocrinologist. He completed his residency in internal medicine and fellowship in endocrinology, diabetes and metabolism at the University Of Pittsburgh Medical Center in 2011 and 2013.

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