presentation on obesity

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Obesity is a complex disease involving having too much body fat. Obesity isn't just a cosmetic concern. It's a medical problem that increases the risk of many other diseases and health problems. These can include heart disease, diabetes, high blood pressure, high cholesterol, liver disease, sleep apnea and certain cancers.

There are many reasons why some people have trouble losing weight. Often, obesity results from inherited, physiological and environmental factors, combined with diet, physical activity and exercise choices.

The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. A healthier diet, increased physical activity and behavior changes can help you lose weight. Prescription medicines and weight-loss procedures are other options for treating obesity.

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Body mass index, known as BMI, is often used to diagnose obesity. To calculate BMI , multiply weight in pounds by 703, divide by height in inches and then divide again by height in inches. Or divide weight in kilograms by height in meters squared. There are several online calculators available that help calculate BMI .

See BMI calculator

Asians with a BMI of 23 or higher may have an increased risk of health problems.

For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly measure body fat. Some people, such as muscular athletes, may have a BMI in the obesity category even though they don't have excess body fat.

Many health care professionals also measure around a person's waist to help guide treatment decisions. This measurement is called a waist circumference. Weight-related health problems are more common in men with a waist circumference over 40 inches (102 centimeters). They're more common in women with a waist measurement over 35 inches (89 centimeters). Body fat percentage is another measurement that may be used during a weight loss program to track progress.

When to see a doctor

If you're concerned about your weight or weight-related health problems, ask your health care professional about obesity management. You and your health care team can evaluate your health risks and discuss your weight-loss options.

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Although there are genetic, behavioral, metabolic and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through typical daily activities and exercise. Your body stores these excess calories as fat.

In the United States, most people's diets are too high in calories — often from fast food and high-calorie beverages. People with obesity might eat more calories before feeling full, feel hungry sooner, or eat more due to stress or anxiety.

Many people who live in Western countries now have jobs that are much less physically demanding, so they don't tend to burn as many calories at work. Even daily activities use fewer calories, courtesy of conveniences such as remote controls, escalators, online shopping, and drive-through restaurants and banks.

Risk factors

Obesity often results from a combination of causes and contributing factors:

Family inheritance and influences

The genes you inherit from your parents may affect the amount of body fat you store, and where that fat is distributed. Genetics also may play a role in how efficiently your body converts food into energy, how your body regulates your appetite and how your body burns calories during exercise.

Obesity tends to run in families. That's not just because of the genes they share. Family members also tend to share similar eating and activity habits.

Lifestyle choices

• Unhealthy diet. A diet that's high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain.
• Liquid calories. People can drink many calories without feeling full, especially calories from alcohol. Other high-calorie beverages, such as sugared soft drinks, can contribute to weight gain.
• Inactivity. If you have an inactive lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Looking at computer, tablet and phone screens is inactivity. The number of hours spent in front of a screen is highly associated with weight gain.

Certain diseases and medications

In some people, obesity can be traced to a medical cause, such as hypothyroidism, Cushing syndrome, Prader-Willi syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain.

Some medicines can lead to weight gain if you don't compensate through diet or activity. These medicines include steroids, some antidepressants, anti-seizure medicines, diabetes medicines, antipsychotic medicines and certain beta blockers.

Social and economic issues

Social and economic factors are linked to obesity. It's hard to avoid obesity if you don't have safe areas to walk or exercise. You may not have learned healthy ways of cooking. Or you may not have access to healthier foods. Also, the people you spend time with may influence your weight. You're more likely to develop obesity if you have friends or relatives with obesity.

Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. The amount of muscle in your body also tends to decrease with age. Lower muscle mass often leads to a decrease in metabolism. These changes also reduce calorie needs and can make it harder to keep off excess weight. If you don't consciously control what you eat and become more physically active as you age, you'll likely gain weight.

Other factors

• Pregnancy. Weight gain is common during pregnancy. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women.
• Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain to qualify as obesity. Often, this happens as people use food to cope with smoking withdrawal. But overall, quitting smoking is still a greater benefit to your health than is continuing to smoke. Your health care team can help you prevent weight gain after quitting smoking.
• Lack of sleep. Not getting enough sleep can cause changes in hormones that increase appetite. So can getting too much sleep. You also may crave foods high in calories and carbohydrates, which can contribute to weight gain.
• Stress. Many external factors that affect mood and well-being may contribute to obesity. People often seek more high-calorie food during stressful situations.
• Microbiome. The make-up of your gut bacteria is affected by what you eat and may contribute to weight gain or trouble losing weight.

Even if you have one or more of these risk factors, it doesn't mean that you're destined to develop obesity. You can counteract most risk factors through diet, physical activity and exercise. Behavior changes, medicines and procedures for obesity also can help.

Complications

People with obesity are more likely to develop a number of potentially serious health problems, including:

• Heart disease and strokes. Obesity makes you more likely to have high blood pressure and unhealthy cholesterol levels, which are risk factors for heart disease and strokes.
• Type 2 diabetes. Obesity can affect the way the body uses insulin to control blood sugar levels. This raises the risk of insulin resistance and diabetes.
• Certain cancers. Obesity may increase the risk of cancer of the uterus, cervix, endometrium, ovary, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate.
• Digestive problems. Obesity increases the likelihood of developing heartburn, gallbladder disease and liver problems.
• Sleep apnea. People with obesity are more likely to have sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts during sleep.
• Osteoarthritis. Obesity increases the stress placed on weight-bearing joints. It also promotes inflammation, which includes swelling, pain and a feeling of heat within the body. These factors may lead to complications such as osteoarthritis.
• Fatty liver disease. Obesity increases the risk of fatty liver disease, a condition that happens due to excessive fat deposit in the liver. In some cases, this can lead to serious liver damage, known as liver cirrhosis.
• Severe COVID-19 symptoms. Obesity increases the risk of developing severe symptoms if you become infected with the virus that causes coronavirus disease 2019, known as COVID-19. People who have severe cases of COVID-19 may need treatment in intensive care units or even mechanical assistance to breathe.

Related information

• Link between extra pounds, severe COVID-19 illness grows stronger - Related information Link between extra pounds, severe COVID-19 illness grows stronger

Quality of life

Obesity can diminish the overall quality of life. You may not be able to do physical activities that you used to enjoy. You may avoid public places. People with obesity may even encounter discrimination.

Other weight-related issues that may affect your quality of life include:

• Depression.
• Disability.
• Shame and guilt.
• Social isolation.
• Lower work achievement.
• Overweight and obesity. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity. Accessed Dec. 21, 2022.
• Goldman L, et al., eds. Obesity. In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 21. 2022.
• Kellerman RD, et al. Obesity in adults. In: Conn's Current Therapy 2023. Elsevier; 2023. https://www.clinicalkey.com. Accessed Dec. 21, 2022.
• Feldman M, et al., eds. Obesity. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Dec. 21, 2022.
• Perrault L. Obesity in adults: Prevalence, screening and evaluation. https://www.uptodate.com/contents/search. Accessed Dec. 21, 2022.
• Melmed S, et al. Obesity. In: Williams Textbook of Endocrinology. 14th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 21, 2022.
• COVID-19: People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed Dec. 21, 2022.
• Perrault L. Obesity in adults: Overview of management. https://www.uptodate.com/contents/search. Accessed Dec. 21, 2022.
• Healthy weight, nutrition and physical activity. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/index.html. Accessed Dec. 21, 2022.
• Ferri FF. Obesity. In: Ferri's Clinical Advisor 2023. Elsevier; 2023. https://www.clinicalkey.com. Accessed Jan. 20, 2023.
• Feldman M, et al., eds. Surgical and Endoscopic Treatment of Obesity. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Dec. 21, 2022.
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Clinical Guidelines: Evaluation and Treatment of Overweight and Obesity in Adults Slide Show

The National Heart, Lung, and Blood Institute, in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases, released in June 1998 the first Federal guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. About 108 million adults in the United States are overweight or obese. Obesity and overweight substantially increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality.

The Clinical Guidelines Evidence Report has been made into a slide show. This slide show consists of six sections: Clinical Guidelines Core Set, Evidence-Based Methodology, Background Data, Practical Tips, Special Considerations, and Future Research. Presenters will be able to focus their presentation accordingly.

The slide set consists of six parts including:

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• Background Data
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Last Updated February 2013

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Research for Healthy Living

Obesity and Nutrition

More than one-third of U.S. adults — and about 17 percent of U.S. children — are obese. Obesity puts people at risk for many health issues including heart disease, stroke, type 2 diabetes, arthritis, and certain types of cancer. Because these conditions are some of the top preventable causes of chronic illness and death, NIH has a considerable interest in addressing obesity.

The problem of obesity seems straightforward: When we eat more calories than we burn, our bodies store this extra energy as fat. Yet, we all know how hard it can be just to lose a few pounds. And solving this problem on  a population-sized scale has proven to be tremendously difficult. That is because so many factors play a role: where we live and work, how much time we spend sitting – and the availability of safe spaces for exercise – and the fact that many people cannot choose alternatives. Access to nutritious food can be a major barrier for many with low incomes or mobility limitations.

Heredity also has an impact. For example, NIH research shows that certain gene variations that occur in one  of six people of European descent translate into an extra 7 pounds, on average. Those discoveries are pointing to pathways involved in obesity that suggest potential ways to prevent undesirable weight gain. Research on the social factors contributing to obesity also offers ideas for intervention. When people are provided funds to buy food once a week, instead of monthly, they are more likely to buy fresh fruits and vegetables instead of pre-packaged (and often less-nutritious) goods. We also know that affordable housing programs lead to better nutrition, because people no longer must compromise on food  in order to pay rent. 

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Overweight and Obesity

Goal: reduce overweight and obesity by helping people eat healthy and get physical activity..

About 2 in 5 adults and 1 in 5 children and adolescents in the United States have obesity, 1 and many others are overweight. Healthy People 2030 focuses on helping people eat healthy and get enough physical activity to reach and maintain a healthy weight.

Obesity is linked to many serious health problems, including type 2 diabetes, heart disease, stroke, and some types of cancer. 2 Some racial/ethnic groups are more likely to have obesity, which increases their risk of chronic diseases. 3

Culturally appropriate programs and policies that help people eat nutritious foods within their calorie needs can reduce overweight and obesity. Public health interventions that make it easier for people to be more physically active can also help them maintain a healthy weight.

Objective Status

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Overweight and Obesity — General

• Nutrition and Healthy Eating
• Pregnancy and Childbirth

Other topics you may be interested in

• Physical Activity

Hales, C.M., Carroll, M.D., Fryar, C.D., & Ogden, C.L. (2017) Prevalence of Obesity Among Adults and Youth: United States, 2015-2016. National Center for Health Statistics Data Brief. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db288.pdf  [PDF - 603 KB]

Lauby-Secretan B., et al. (2016). Body Fatness and Cancer — Viewpoint of the IARC Working Group. New England Journal of Medicine, 375 (8), 794–798. DOI: 10.1056/NEJMsr1606602

U.S. Department of Health and Human Services. (2013). Managing Overweight and Obesity in Adults. Retrieved from https://www.nhlbi.nih.gov/health-topics/managing-overweight-obesity-in-adults  [PDF - 6 MB]

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Dr. SUPANTHA CHATTERJEE PGT DEPT. OF COMMUNITY MEDICINE BURDWAN MEDICAL COLLEGE. OBESITY. DEFINITION. IT IS THE ABNORMAL GROWTH OF THE ADIPOSE TISSUE DUE TO AN ENLARGEMENT OF FAT CELL SIZE OR AN INCREASE IN FAT CELL NUMBER OR A COMBINATION OF BOTH.

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• unexplained variations
• further weight gain
• physical inactivity
• metabolic complications
• brocca index

Presentation Transcript

Dr. SUPANTHA CHATTERJEE PGT DEPT. OF COMMUNITY MEDICINE BURDWAN MEDICAL COLLEGE OBESITY

DEFINITION • IT IS THE ABNORMAL GROWTH OF THE ADIPOSE TISSUE DUE TO AN ENLARGEMENT OF FAT CELL SIZE OR AN INCREASE IN FAT CELL NUMBER OR A COMBINATION OF BOTH. • ENLARGEMENT OF FAT CELL SIZE – HYPERTROPHIC • INCREASE IN FAT CELL NUMBER – HYPERPLASTIC

PREVALENCE • Perhaps the most prevalent form of malnutrition in present days, affecting children as well as adult. • Prevalent in both developed and developing countries. • It is estimated by the WHO that globally, over 1 billion (16%) adults are overweight and 300 million (5%) are obese. • In India the prevalence of obesity is 12.6% in women and 9.3% in men.

EPIDEMIOLOGICAL DETERMINANTS Non-modifiable • Age: • It can occur at any age • The vulnerability is maximum in the middle age • Infants with excessive weight gain have increased chance of obesity in later life. • Gender: • Females are more likely to be obese • Women gain weight most at menopausal period (45-49 yrs) • It is claimed that women’s BMI increases with successive pregnancies.

Genetic factors: • Twin studies show that there is a close correlation between the weights of identical twin. • Ethnicity: • There are large unexplained variations in the prevalence of obesity in the people from different ethnic groups.

Modifiable • Physical Inactivity: • Avital component that keeps accumulation of fat and obesity under check. • Sedentary lifestyle brings about obesity. • Amajor reduction in activity without the compensatory decrease in energy intake causes increased obesity. • Physical inactivity and obesity – a vicious cycle. • Socio-economic status: • There is a clear inverse relationship between socio-economic status and obesity.

Dietary habit: • A diet rich in fats, refined sugar and carbohydrates predisposes to obesity. • Consumption of as little as 100 extra calories per day would increase the weight of an individual by 5 kg in one year. • Psychological factor: • Overeating may be a symptom of depression, anxiety, frustration and loneliness in childhood.

Family tendency: • Obese parents frequently have obese children. • Metabolic factors: • Cushing’s syndrome, hypothyroidism, growth hormone deficiency. • Alcohol: • High calorific value (7kcal per gm.) in itself is a risk factor for obesity. • The snacks consumed along with an alcoholic drink add many more calories and predisposing the individual to obesity.

Education levels : • In the Indian setting, people with a higher education level, are more likely to be obese. • In the west, however, the educated are in a better state of health i.e. less obesity. • Smoking: • Smoking per se reduces the likelihood of obesity, by virtue of nicotine being an anorexic agent. • Drugs: • Use of certain drugs e.g. corticosteroid, oral contraceptives, insulin

TYPES OF OBESITY • Gynecoid / ‘Pear shaped’: • The fat is evenly distributed (globally distributed). • Android/‘Apple shaped’: • The fat is centrally distributed or deposited preferentially in the abdominal region. • This expresses the peritoneal (visceral) distribution of fat in the individual. • Commonly seen in men of the South East Asian region, including India. • Such a distribution is a higher risk factor for coronary artery disease. • Higherwaist circumference or higher WHR is a good indicator of visceral (peritoneal) deposition of fat.

CLASSIFICATION OF OBESITY

GRADES OF OBESITY FOR SOUTH-EAST ASIANS REGION

ASSESSMENT OF OBESITY • BODY WEIGHT : In epidemiological studies it is conventional to accept +2SD from the median weight for height as a cut off point of obesity.

SOME INDICATORS TO MEASURE OBESITY • BODY MASS INDEX (BMI) • PONDERAL INDEX • BROCCA INDEX • LORENTZ’S FORMULA • CORPULENCE INDEX

Body mass index (BMI): • Weight in kilograms divided by the square of the height in meters (kg/m²) Weight in kg • BMI = ---------------------------------------- Height in meter² Example : Weight = 74 kg Height = 1.75 meter 74 BMI = ------------ = 24.2 1.75²

Height (cm) • Ponderal index = ----------------------------------------------- Cube root of body weight (kg) • Brocca index = Height (cm) - 100 Ht (cm) - 150 • Lorentz’s formula = Ht (cm) – 100 - ------------------------------ 2(women) /4(men) Actual weight • Corpulence index = ------------------------------------- Desirable weight

SKINFOLD THICKNESS • Rapid and noninvasive method • Harpenden skin callipers are used • Measurement at four sites – mid-triceps, biceps, subscapular and suprailiac regions • Sum of the measurement should be – • <40 mm in boys • <50 mm in girls • Main drawback – Poor repeatability

WAIST CIRCUMFERENCE AND WAIST : HIP RATIO (WHR) • Unrelated to height • Approximate index for intra-abdominal fat mass and total body fat. • Reflects changes in risk factors for cardiovascular diseases and other chronic diseases. • Indicates increased risk for metabolic complications if the waist circumference – • ≥ 102 cm in men • ≥ 88 cm in women • Indicates abdominal fat accumulation if WHR – • > 1.0 in men • > 0.85 in women

METHODS USED IN DETERMINING OBESITY IN CHILDREN WEIGHT TO HEIGHT TABLES – • Indian Council of Medical Research gives general ranges for healthy weight for a child's height. • However, the child’s age and growth pattern also has to be considered. • Generally a child is considered obese if the weight is 20 percent or more what is recommended as healthy range for the height and body type.

BODY MASS INDEX – • This measure is used to assess weight relative to height. Most of the studies use BMI as a measure of obesity in children. The Centers of Disease Control and Prevention suggests two levels of concern for children based on the BMI-for-age charts. A child with a BMI of • ≥85th percentile for age and sex is considered at risk of being overweight • ≥95th percentile for age and sex is considered obese.

RELATIVE RISK OF HEALTH PROBLEMS ASSOCIATED WITH OBESITY

Prevention and control Indicated prevention • Individuals who are already overweight or showing biological markers associated with excessive fat stores but who are not yet obese. • Indicated prevention strategies usually involve working with patients on a one-to-one basis or, alternatively, through the establishment of special groups to provide guidance and support. • Primary objectives of this preventive strategy are restricted to preventing further weight gain and reducing the number of people who develop obesity-related comorbidities.

Selective prevention • Aimed at sub-groups of the population who are at a high risk for the development of obesity. • Selective prevention is concerned with improving the knowledge and skills of groups of people to allow them to deal more effectively with the factors which put them at a high risk of developing obesity.

High risk groups - • Genetically susceptible individuals, certain ethnic groups, socially or economically disadvantaged, Recent successful weight reducers, Recent past smokers, Patients who have been prescribed certain drugs that, promote weight gain Vulnerable period – • Adolescence, Early adulthood, Pregnancy, Menopause

Universal or public health prevention • Population or community as a whole regardless of their current level of risk. • Where the prevalence of the condition is already extremely high, universal approaches have the potential to be the most cost effective form of prevention, to reduce the incidence as well as the prevalence of obesity. • Other objectives of universal prevention include a reduction in weight-related ill health, improvements in general diet and exercise levels and a reduction in the level of population risk of obesity.

WAYS TO PREVENT OBESITY DIETARY THERAPY • Restrictions of calories represent the first line therapy in all cases • Low calorie diets (LCD), which provide 1000–1500 kcal/day, resulted in weight loss of 8% of baseline body weight over six months • Very low calories diets (VLCD), which provide 300–800 kcal/day, can be useful in severely obese patients . They are found to produce 13% weight loss over six months. • Meal replacement programmes and formula diets can be used as an effective tool in weight management. • Fat substitutes like Olestra (Olean), which is a non-digestible, non-caloric fat, can be used in food preparations taken by obese patients.

PHYSICAL ACTIVITY • Physical activity, which increases energy expenditure, has a positive role in reducing fat storage and adjusting energy balance in obese patients. • Various exercises preceded and followed by short warm up and cool down sessions help to decrease abdominal fat, prevent loss of muscle mass. • Patients who exercise regularly had increased cardio vascular fitness along with betterment in their mental and emotional status. • Aminimum of 30 minutes exercise is recommended for people of all ages as part of comprehensive weight loss therapy.

BEHAVIOUR THERAPY • Patients need to be trained in gaining self-control of their eating habits. • Behaviour modification programmes which seek to eliminate improper eating behaviour include individual or group counseling of patients. • Self-help groups (weight watchers) use a program of diet, education and self-monitoring like maintenance of logbook, keeping an account of food intake etc. are beneficial.

OTHER MEASURES • Appetite suppressing drugs can be used. • Surgical treatment for controlling obesity e.g. gastric bypass, gastroplasty, jaw wiring, liposuction etc. • Take appropriate measures to prevent childhood obesity • Health education

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Kiran K. Panuganti ; Minhthao Nguyen ; Ravi K. Kshirsagar .

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Last Update: August 8, 2023 .

• Continuing Education Activity

Obesity is the excessive or abnormal accumulation of fat or adipose tissue in the body that may impair health. Obesity has become an epidemic which has worsened for the last 50 years. In the United States, the economic burden is estimated to be about $100 billion annually. Obesity is a complex disease and has multifactorial etiology. It is the second most common cause of preventable death after smoking. This activity reviews the causes, pathophysiology, presentation, and complications of obesity and highlights the role of the interprofessional team in its management.

• Recall the epidemiology of obesity.
• Describe the pathophysiology of obesity.
• Summarize the treatment options for obesity.
• Explore modalities to improve care coordination among interprofessional team members in order to improve outcomes for patients affected by obesity.
• Introduction

Obesity is the excessive or abnormal accumulation of fat or adipose tissue in the body that impairs health via its association with the risk of development of diabetes mellitus, cardiovascular disease, hypertension, and hyperlipidemia. It is a significant public health epidemic which has progressively worsened over the past 50 years. Obesity is a complex disease and has a multifactorial etiology. It is the second most common cause of preventable death after smoking. Obesity needs multiprong treatment strategies and may require lifelong treatment. A 5% to 10% weight loss can significantly improve health, quality of life, and economic burden of an individual and a country as a whole. [1] [2] [3] [4] [5]

Obesity has enormous healthcare costs exceeding $700 billion each year. The economic burden is estimated to be about $100 billion annually in the United States alone. The body mass index (BMI) is used to define obesity, which is calculated as weight (kg)/height(m). While the BMI does correlate with body fat in a curvilinear fashion, it may not be as accurate in Asians and older people,  where a normal BMI may conceal underlying excess fat. Obesity can also be estimated by assessing skin thickness in the triceps, biceps, subscapular, and supra-iliac areas. Dural energy radiographic absorptiometry (DEXA)  scan may also be used to assess fat mass.

Obesity is the result of an imbalance between daily energy intake and energy expenditure, resulting in excessive weight gain. Obesity is a multifactorial disease caused by a myriad of genetic, cultural, and societal factors.  Various genetic studies have shown that obesity is extremely heritable, with numerous genes identified with adiposity and weight gain. Other causes of obesity include reduced physical activity, insomnia, endocrine disorders, medications, the accessibility and consumption of excess carbohydrates and high-sugar foods, and decreased energy metabolism. 

The most common syndromes associated with obesity include Prader-Willi syndrome and MC4R  syndromes, less commonly fragile X, Bardet-Beidl syndrome, Wilson Turner congenital leptin deficiency, and Alstrom syndrome.

• Epidemiology

Nearly one-third of adults and about 17% of adolescents in the United States are obese. According to the Centers for Disease Control and Prevention (CDC)'s 2011-2012 data, one out of five adolescents, one out of six elementary school-age children, and one out of 12 preschool-age children are obese. Obesity is more prevalent in African Americans, followed by Hispanics and Whites. Southern US states have the highest prevalence, followed by the Midwest, Northeast, and the West.

Obesity rates are increasing at a staggering rate worldwide, affecting over 500 million adults.  

• Pathophysiology

Obesity is associated with cardiovascular disease, dyslipidemia, and insulin resistance, causing diabetes, stroke, gallstones, fatty liver, obesity, hypoventilation syndrome, sleep apnea, and cancers.

The association between genetics and obesity is already well-established by multiple studies. The  FTO gene is associated with adiposity. This gene might harbor multiple variants that increase the risk of obesity.

Leptin is an adipocyte hormone that reduces food intake and body weight. Cellular leptin resistance is associated with obesity. Adipose tissue secretes adipokines and free fatty acids, causing systemic inflammation, which causes insulin resistance and increased triglyceride levels, subsequently contributing to obesity.

Obesity can cause increased fatty acid deposition in the myocardium, causing left ventricular dysfunction. It has also been shown to alter the renin-angiotensin system, causing increasing salt retention and elevated blood pressure.

Besides total body fat, the following also increase the morbidity of obesity:

• Waist circumference (abdominal fat carries a poor prognosis)
• Fat distribution (body fat heterogeneity)
• Intra-abdominal pressure
• Age of onset of obesity

The body fat distribution is important in assessing the risk for cardiometabolic health. The distribution of excess visceral fat is likely to increase the risk of cardiovascular disease. [6] [7] [8]  Ruderman et al [9]  introduced the concept of metabolic obese normal weight(MONW) subjects with normal BMI suffer from metabolic complications normally found in obese individuals.

Metabolically healthy obese (MHO) Individuals have a BMI over 30 kg/m 2 but do not have the characteristics of insulin resistance or dyslipidemia [10] [11]  

Adipocytes have been shown to have an inflammatory and prothrombotic activity, which can increase the risk of strokes. Adipokines are cytokines mainly produced by adipocytes and preadipocytes; in obesity, macrophages invading the tissue also produce adipokines.  [12] [13] . 

Altered adipokine secretion causes chronic low-grade inflammation, which may cause altered glucose and lipid metabolism and contribute to cardiometabolic risk in visceral obesity.  [12]

Adiponectin has insulin-sensitizing and anti-inflammatory properties, and the circulating levels are inversely proportional to visceral obesity.

• History and Physical

All children six years and older, adolescents, and all adults should be screened for obesity according to the United States Preventative Services Task Force (USPSTF) recommendations.

Physicians should carefully screen for underlying causes contributing to obesity. A complete history should include:

• Childhood weight history
• Prior weight loss efforts and results
• Complete nutrition history
• Sleep patterns
• Physical activity
• Associated past medical histories like cardiovascular, diabetes, thyroid, and depression
• Surgical history
• Medications that can promote weight gain
• Social histories of tobacco and alcohol use
• Family history

A complete physical examination Should be done and should include body mass index (BMI) measurement, weight circumference, body habitus, and vitals.

Obesity focus findings like acne, hirsutism, skin tags, acanthosis nigricans, striae, Mallampati scoring, buffalo hump, fat pad distribution, irregular rhythms, gynecomastia, abdominal pannus, hepatosplenomegaly, hernias, hypoventilation, pedal edema, varicoceles, stasis dermatitis, and gait abnormalities can be present.

A standard screening tool for obesity is the measurement of body mass index (BMI). BMI is calculated using weight in kilograms divided by the square of height in meters. [14] [15] [16] [17] [18]  Obesity can be classified according to BMI:

• Underweight: less than 18.5 kg/m 2
• Normal range: 18.5 kg/m2 to 24.9 kg/m 2
• Overweight: 25 kg/m2 to 29.9 kg/m 2
• Obese, Class I: 30 kg/m2 to 34.9 kg/m 2
• Obese, Class II: 35 kg/m2 to 39.9 kg/m 2
• Obese, Class III: more than 40 kg/m 2

The waist-to-hip ratio should be measured; in men, more than 1:1, and in women, more than 0:8 is considered significant.

Further evaluation studies like skinfold thickness, bioelectric impedance analysis, CT, MRI, DEXA, water displacement, and air densitometry studies can be done.

Laboratory studies include a complete blood picture, basic metabolic panel, renal function, liver function study, lipid profile, HbA1C, TSH, vitamin D levels, urinalysis, CRP, and other studies like ECG and sleep studies can be done for evaluating associated medical conditions. 

• Treatment / Management

Obesity causes multiple comorbid and chronic medical conditions, and physicians should have a multiprong approach to the management of obesity. Practitioners should individualize treatment, treat underlying secondary causes of obesity, and focus on managing or controlling associated comorbid conditions. Management should include dietary modification, behavior interventions, medications, and surgical intervention if needed.

The dietary modification should be individualized with close monitoring of regular weight loss. Low-calorie diets are recommended. Low calorie could be carbohydrate or fat restricted. A low-carbohydrate diet can produce greater weight loss in the first months compared to a low-fat diet. The patient's adherence to their diet should frequently be emphasized.

Behavior Interventions: The  USPSTF recommends obese patients be referred for intensive behavior interventions. Several psychotherapeutic interventions are available, which include motivational interviewing, cognitive behavior therapy, dialectical behavior therapy, and interpersonal psychotherapy. Behavior interventions are more effective when they are combined with diet and exercise.

Medications: Antiobesity medications can be used for BMI greater than or equal to 30 or BMI greater than or equal to 27 with comorbidities. Medications can be combined with diet, exercise, and behavior interventions. FDA-approved antiobesity medications include phentermine, orlistat, liraglutide, semaglutide, diethylpropion, phentermine/topiramate, naltrexone/bupropion, setmelanotide, and phendimetrazine. All the agents are used for long-term weight management. Orlistat is usually the first choice because of its lack of systemic effects due to limited absorption.

Surgery: Indications for surgery are a BMI greater or equal to 40 or a BMI of 35 or greater with severe comorbid conditions. The patient should be compliant with post-surgery lifestyle changes, office visits, and exercise programs. Patients should have an extensive preoperative evaluation of surgical risks. Commonly performed bariatric surgeries include adjustable gastric banding, Rou-en-Y gastric bypass, and sleeve gastrectomy. Rapid weight loss can be achieved with a gastric bypass, and it is the most commonly performed procedure. Early postoperative complications include leak, infection, postoperative bleeding, thrombosis, and cardiac events. Late complications include malabsorption, vitamin and mineral deficiency, refeeding syndrome, and dumping syndrome. [19] [20] [21]

Weight loss associated complications

When weight loss is rapid, it is also associated with complications that include:

• Electrolyte abnormalities (esp, hypokalemia)
• Cardiac arrhythmias
• Hyperuricemia
• Cholelithiasis
• Mood and behavior alterations

Complications associated with bariatric surgery

• Wound dehiscence
• Malabsorption
• Dumping syndrome
• Post-surgery diarrhea
• Vitamin and nutrient deficiency
• Anastomotic leaks
• Failed surgery
• Differential Diagnosis
• Adipose dolorosa 
• Cushing syndrome
• Hypothyroidism
• Iatrogenic Cushing syndrome
• Kallman syndrome and idiopathic hypogonadotropic hypogonadism 
• Generalized lipodystrophy 
• Polycystic ovarian disease

Obesity has enormous morbidity and mortality rates. Obese patients have a high risk of adverse cardiac events and stroke. In addition, the quality of life is poor. Factors that worsen morbidity include:

• Amount of central adiposity
• Severity of obesity
• Associated comorbidity
• Pearls and Other Issues

Management of obesity should also include prevention strategies with physical activity, exercise, nutrition, and weight maintenance.

• Enhancing Healthcare Team Outcomes

The obesity epidemic continues to worsen and has become a public health issue. The management and prevention of obesity is best done with an interprofessional team that includes a bariatric nurse, surgeon, internist, primary care provider, endocrinologist, and a pharmacist. There is no cure for obesity, and almost every treatment available has limitations and potential adverse effects.

The key is to educate the patient on the importance of changes in lifestyle. All clinicians who look after obese patients have the onus to educate patients on the harms of the disorders. No intervention works if the patient remains sedentary. Even after surgery, some type of exercise program is necessary to prevent weight gain. So far, there is no magic bullet to reverse obesity- all treatments have high failure rates, and some, like surgery, also have life-threatening complications. There is an important need for collaboration between the fast-food industry, schools, physical therapists, dietitians,  clinicians, and public health authorities to create better and safer eating habits.

Lifestyle changes alone can help obese people reverse the weight gain, but the problem is most people are not motivated to exercise. [21] [22]

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BMI chart with obesity classifications adopted from the WHO 1998 report. Contributed by the World Health Organization - "Report of a WHO consultation on obesity. Obesity Preventing and Managing a Global Epidemic."

Disclosure: Kiran Panuganti declares no relevant financial relationships with ineligible companies.

Disclosure: Minhthao Nguyen declares no relevant financial relationships with ineligible companies.

Disclosure: Ravi Kshirsagar declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Panuganti KK, Nguyen M, Kshirsagar RK. Obesity. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Obesity and Cancer

• Being overweight or having obesity increases your risk of getting cancer.
• The risk of cancer increases with the more excess weight a person gains and the longer a person is overweight.

You may be surprised to learn that being overweight or having obesity are linked with a higher risk of getting 13 types of cancer. These cancers make up 40% of all cancers diagnosed in the United States each year.

Many things are associated with cancer, but avoiding tobacco use and keeping a healthy weight are two of the most important steps you can take to lower your risk of getting cancer.

Being overweight or having obesity doesn’t mean that someone will definitely get cancer. But it does mean that they are more likely to get cancer than if they kept a healthy weight.

Which cancers are related to obesity?

Being overweight or having obesity is linked with a higher risk of getting 13 kinds of cancer:

• Adenocarcinoma of the esophagus.
• Breast (in women who have gone through menopause).
• Colon and rectum.
• Gallbladder.
• Upper stomach.
• Meningioma (a type of brain cancer).
• Multiple myeloma.

What is overweight and obesity?

Weight that is higher than what is considered a healthy weight for a given height is called overweight or obesity.

Body mass index (BMI) is used as a screening tool for overweight and obesity. For adults, a person with a BMI from 25.0 to 29.9 is considered overweight. A person with a BMI that is 30.0 or higher has obesity.

For children and teens, BMI is calculated the same way, but interpreted in a different way. BMI for children is often compared to the average BMI of other children in the same age range.

How can overweight and obesity lead to cancer?

Overweight and obesity can cause changes in the body including long-lasting inflammation and higher than normal levels of insulin, insulin-like growth factor, and sex hormones. These changes may lead to cancer. The risk of cancer increases with the more excess weight a person gains and the longer a person is overweight.

How can I lower my risk?

You can achieve a healthy weight by making healthy lifestyle choices. You can reduce your risk of obesity-related cancer by following a healthy eating plan and getting regular physical activity .

"Talk to Someone" Simulation

Talk to Someone: Physical Activity and Nutrition gives tips for cancer survivors to improve physical activity and healthy eating.

How can doctors help their patients keep a healthy weight?

Health care providers can help patients keep a healthy weight in several ways. For example, they can:

• Measure patients' weight, height, and BMI.
• Explain that keeping a healthy weight can lower a person's cancer risk.
• Connect patients and families with community services that provide healthy food and ways to be active.
• Encourage adult patients to participate in behavioral interventions recommended by the US Preventive Services Task Force. These interventions are designed to help patients lose 5% or more of their weight through dietary changes and increased physical activity.
• Screen for obesity in children and teens who are 6 years old or older. If needed, refer them to behavioral interventions to help them lose weight.

How many people have obesity or cancers linked to obesity?

Many people in the United States have obesity. Recent surveys have found that about 42% of adults and about 20% of children and adolescents have obesity. Adults with obesity have a higher risk of many serious diseases and health conditions, including cancer, than people with a healthy weight.

From 2005 to 2014, most cancers associated with overweight and obesity increased in the United States, while cancers associated with other factors decreased. During this time, the rate of new cancers associated with overweight and obesity (except colorectal cancer) increased 7%, while the rate of new cancers not associated with overweight and obesity dropped 13%. (The rate of new cases of colorectal cancer dropped 23% during this time. Screening tests can prevent this cancer.)

CDC's Data Visualizations tool provides data on the rates of new obesity-associated cancers among males and females in the United States. For example:

• More than 684,000 obesity-associated cancers occur in the United States each year, including more than 210,000 among men and 470,000 among women.
• Breast cancer after menopause is the most common obesity-associated cancer among women. Colorectal cancer is the most common obesity-associated cancer among men.
• More than 90% of new obesity-related cancers occur in men and women who are 50 or older.
• Obesity and Cancer (National Cancer Institute)
• Does Body Weight Affect Cancer Risk? (American Cancer Society)

Learn how to lower your cancer risk and what CDC is doing to prevent and control cancer.

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Soleno therapeutics announces oral presentation featuring dccr (diazoxide choline) extended-release tablets in prader-willi syndrome at endo 2024.

REDWOOD CITY, Calif., May 22, 2024 (GLOBE NEWSWIRE) -- Soleno Therapeutics, Inc. (“Soleno”) (NASDAQ: SLNO), a clinical-stage biopharmaceutical company developing novel therapeutics for the treatment of rare diseases, today announced that data from the randomized withdrawal period of Study C602 of DCCR (diazoxide choline) extended-release tablets in Prader-Willi Syndrome (PWS) will be featured in an oral presentation at the Annual Meeting of the Endocrine Society (ENDO 2024), being held June 1-4, 2024 in Boston, Massachusetts.

Details of the presentation are as follows:

About PWS The Prader-Willi Syndrome Association USA estimates that PWS occurs in one in every 15,000 live births. The hallmark symptom of this disorder is hyperphagia, a chronic and life-threatening feeling of intense, persistent hunger, food pre-occupation, extreme drive to food seek and consume food that severely diminish the quality of life for patients with PWS and their families. Additional characteristics of PWS include behavioral problems, cognitive disabilities, low muscle tone, short stature (when not treated with growth hormone), the accumulation of excess body fat, developmental delays, and incomplete sexual development. Hyperphagia can lead to significant morbidities (e.g., obesity, diabetes, cardiovascular disease) and mortality (e.g., stomach rupture, choking, accidental death due to food seeking behavior). In a global survey conducted by the Foundation for Prader-Willi Research, 96.5% of respondents (parent and caregivers) rated hyperphagia and 92.9% rated body composition as either the most important or a very important symptom to be relieved by a new medicine. There are currently no approved therapies to treat the hyperphagia/appetite, metabolic, cognitive function, or behavioral aspects of the disorder.

About DCCR (Diazoxide Choline) Extended-Release Tablets DCCR is a novel, proprietary extended-release dosage form containing the crystalline salt of diazoxide and is administered once-daily. The parent molecule, diazoxide, has been used for decades in thousands of patients in a few rare diseases in neonates, infants, children and adults, but has not been approved for use in PWS. Soleno conceived of and established extensive patent protection for the therapeutic use of diazoxide, diazoxide choline and DCCR in patients with PWS. The DCCR development program is supported by data from five completed Phase 1 clinical studies in healthy volunteers and three completed Phase 2 clinical studies, one of which was in patients with PWS. In the PWS Phase 3 clinical development program, DCCR showed promise in addressing hyperphagia, the hallmark symptom of PWS, as well as several other symptoms such as aggressive/destructive behaviors, fat mass and other metabolic parameters. Diazoxide choline has received Orphan Drug Designation for the treatment of PWS in the U.S. and E.U., and Fast Track and Breakthrough Designations in the U.S.

About Soleno Therapeutics, Inc. Soleno is focused on the development and commercialization of novel therapeutics for the treatment of rare diseases. The company’s lead candidate, DCCR (diazoxide choline) extended-release tablets, a once-daily oral tablet for the treatment of Prader-Willi syndrome (PWS), recently completed its Phase 3 development program to support a planned NDA submission. For more information, please visit www.soleno.life .

Corporate Contact: Brian Ritchie LifeSci Advisors, LLC 212-915-2578