Obesity

Symptoms Of Obesity

The symptoms of obesity can vary from person to person. Some of the most common symptoms include:

• A history of weight gain

• Excess body fat, particularly around the waistline

• Shortness of breath or chest pain

• Snoring while sleeping

• Insomina or trouble sleeping

• Sleep apnea (breathing is irregular and periodically stops during sleep)

• Excessive sweating

• Tiredness or fatigue ranging from mild to severe

• Inability to perform simple physical tasks that one could easily perform before weight gain

• Osteoarthritis in weight-bearing joints, especially the knees

• Pain in joints, especially in the back and knees

• Swelling and varicose veins in legs

• Skin infections from moisture accumulating in the folds of skin

• Stretch marks

• Psychological issues such as low self-esteem, depression, and social isolation

Causes Of Obesity

The root cause of obesity is not restricted to a single cause but many different factors. The leading factors that contribute to obesity are lack of exercise, excessive calorie intake, genetics, emotional stress, and sedentary lifestyle. 

Obesity is also caused by energy imbalance (between energy intake and expenditure). This means that there is more food energy coming in than going out. If this continues, the person will gain weight until they are obese or overweight. 

Many factors may contribute to obesity such as:

1. Genetic factors

Obesity tends to run in families. A child with a single obese parent has a 3-fold risk to become obese while a child with obese parents has a 10-times higher risk of obesity in future.

Genes can affect appetite and thus, how much food you consume. They also control how quickly the body burns calories at rest and during exercise. Genes also influence fat regulation and places of body fat accumulation, particularly fat in the abdomen and around the waist. 

Very rarely, mutations in the following genes can cause obesity:

• The ob gene: This gene controls the production of leptin, a hormone made by fat cells and placenta. Leptin controls weight by signaling the brain to eat less when body fat stores are very high. A mutation in the ob gene prevents leptin production and results in severe obesity in a very small number of children.

• The gene for the melanocortin 4 receptor: Melanocortin 4 receptors are located mainly in the brain and play a key role in the regulation of energy. A mutation in this gene may account for obesity in 1 to 4% of children.

However, it should be noted that families not only share genes but also environment, and separating the two factors is quite difficult. In other words, you could be genetically predisposed to being overweight, but your genes may not get activated if you have the right environment and lifestyle. 

2. Aging

Obesity can occur at any age, even in children and teenagers. However, obesity becomes more common with age as the amount of muscle tissue decreases as you age. The result is a higher percentage of body fat and a lower basal metabolic rate (because muscle burns more calories). These changes also reduce the need for calories. So, if you don't consciously control what you eat and become more physically inactive as you age, you are most likely to gain weight.

3. Physical inactivity

A major factor that contributes to obesity is inactivity or lack of physical activity. Technological advances such as elevators, cars, remote controls, and online shopping have reduced the amount of calories burnt. More time is spent doing sedentary activities such as watching television, using the computer, smartphones, and playing video games.

Also, many people have desk jobs where they sit for hours without any breaks. This can lead to obesity in some people because their bodies are not burning enough calories when they are sitting at stretch for hours. 

4. Unhealthy diet 

Modern day diet has significantly shifted to energy-dense foods, which have a large number of calories in a relatively small amount. Most of these foods contain more processed carbohydrates, and trans fat, and less fiber. 

Fats, by nature, are energy dense. Carbohydrates increase blood glucose levels, which in turn stimulate the pancreas to release insulin. Insulin promotes the growth of fat tissue and can cause weight gain.

More food advertisements promote high-fat, high-sugar, junk foods like biscuits, namkeen, candy, fizzy drinks, soda, and packaged foods than healthier options like whole grains, vegetables, and fruits. Advertised products are designed to be cheap, have a long shelf-life and are specifically engineered to be addictive and irresistible. These convenience foods significantly contribute to obesity. 

5. Frequency of eating

It has been observed that people who eat small meals four or five times daily, have lower cholesterol levels and lower weight and/or more stable blood sugar levels than people who eat big two or three large meals daily. Hence, large and fewer meals can predispose you to gain weight.

6. Eating disorders

The following eating disorders are associated with obesity:

• Binge eating disorder is characterized by binging i.e.; eating large amounts of food during a short amount of time and usually by feeling guilty or out of control. 

• Night-eating syndrome involves not eating enough during the day and consuming a lot of food or calories in the evening. It also involves awakening in the middle of the night to eat. 

7. Medical conditions

Certain medical conditions can lead to weight gain and eventually might lead to obesity. These include:

• Cushing syndrome is caused by excessive levels of cortisol in the body. It mostly causes fat to accumulate in the face (called moon face), and behind the neck (called a buffalo hump).

• Polycystic ovary syndrome (PCOS) causes obesity in affected women. Levels of testosterone and other male hormones are increased, which causes fat to accumulate in the waist and abdomen.

• Hypothyroidism makes the body use less of the energy that one eats as food. The extra energy is more likely to be stored in the body as fat leading to obesity.

• Insulin resistance is a condition which acts as a precursor for developing type 2 diabetes and can also predispose to obesity.

• Osteoarthritis causes joint pain that may lead to reduced physical activity and thereby cause obesity.

• Prader-Willi syndrome, a rare condition, present at birth that causes uncontrolled hunger.

8. Certain drugs

Many drugs used to treat certain diseases increase the risk of weight gain. These include:

• Antidepressants

• Antiseizure drugs, such as carbamazepine

• Antihypertensives such as beta-blockers

• Corticosteroids

• Some anti-diabetics

• Oral contraceptives

If this issue concerns you, you should discuss your medications with your doctor rather than discontinuing them, as this could have serious side-effects.

9. Pregnancy and menopause

Gaining weight during pregnancy is normal and necessary. However, some women find this weight difficult to lose after the baby is born. This weight gain may predispose to the development of obesity. Having several children close together may compound the problem. 

If a pregnant woman is obese or smokes, weight regulation in the child can be disturbed, leading to weight gain during childhood and later.

Many women tend to gain weight after menopause. This weight gain may result from reduced activity and hormonal changes may cause fat to be redistributed and accumulated around the waist. 

10. Gut microbiota

Normally, the gut bacteria or gut flora help in digestion of food among other functions. However, an altered gut microenvironment such as long term use of antibiotics, may increase the risk of obesity. Changes in the number and types of bacteria in the digestive system may change how the body processes food.

11. Exposure to chemicals

Obesogens are chemicals that disrupt normal development and metabolism. Being exposed to obesogens early in life can increase the risk of developing obesity. These include cigarette smoke, bisphenol A, air pollution, flame retardants, phthalates, and polychlorinated biphenyls.

12. Psychological factors

Many people eat excessively in response to emotions such as boredom, sadness, stress, anxiety or anger. Adverse childhood events or a childhood history of verbal, physical, or sexual abuse are also associated with a higher risk of obesity. 

13. Lifestyle factors

Sleep deprivation or lack of the right amount of sleep can result in weight gain. Sleeplessness results in hormonal changes that increase appetite and cravings for energy-dense foods.

Cessation of smoking usually results in weight gain. When nicotine is stopped, people tend to eat more food, and their metabolic rate decreases, so that fewer calories are burned. As a result, body weight may increase, sometimes leading to obesity.

14. Socioeconomic factors

Obesity and socioeconomic issues are also related. Lack of money to buy healthy foods or familiarity with healthy ways of cooking can increase the risk of obesity. So does lack of safe places to walk or exercise.

Diagnosis Of Obesity

Obesity is a disease that is diagnosed by a physician who will measure the patient's height, weight, and body mass index. The physician may also do a physical examination, a laboratory test for thyroid function, and other tests to diagnose the cause of obesity.

There are different methods for diagnosing obesity. 

Body mass index (BMI)

The most common way to diagnose obesity is body mass index (BMI). It is calculated by dividing weight in kilograms by height in meters squared. If your BMI is greater than 30 kg/m2, you are considered obese. Being overweight or obese increases the chance of various diseases and chronic conditions. 

The BMI categorizes people as underweight, normal weight, overweight, and obese.

• Underweight: < 18.5 kg/m2

• Normal weight: 18.5-24.9 kg/m2

• Overweight: 25-29.9 kg/m2

• Obese: 30-34.9 kg/m2

• Morbidly obese: 35-39.9 kg/m2

But, BMI is considered as an old way of diagnosing obesity because this doesn’t give accurate results for tall people or individuals with a lot of muscle mass.

Waist circumference

The new way to diagnose obesity is by measuring waist size (waist circumference) instead of BMI. This method is more accurate than BMI because it doesn’t rely on height or muscle mass. Waist circumference greater than 40 inches (102 centimeters) in men and 35 inches (89 centimeters) in women is diagnosed as being obese. People with a larger waistline are at higher risk for cardiovascular disease, diabetes, stroke, and cancer. 

Obesity is not the same as being overweight. If someone has a body mass index (BMI) of 30 or more they are classified as obese, whereas someone with a BMI of 27-29.9 will be classified as overweight.

Read more about overweight, obese, morbidly obese: know the difference.
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Lab tests

Many lab tests can be done to diagnose obesity. In most cases, you will need to go through an examination from your doctor or have blood work done. You may also have to take some steps before going through the testing process so that you are prepared for the results of the test.

Some of these tests for obesity are:

• Fasting lipid tests: These are done to understand the build-up of fats in your body.

• Liver function tests: This test is done to determine whether the liver is functioning properly and to know that obesity is not caused due to liver disease.

• Thyroid function tests: These tests are done to check whether the person has hyperthyroidism or not.

Prevention Of Obesity

 
In the past few years, there has been a rise in obesity rates all around the world. That's why it's so important to be educated on how we can prevent this from happening and lower the rates of obesity. The question of how to prevent obesity is a difficult one in this modern day. Many factors contribute to the onset and progression of obesity. It’s not an easy problem to solve, but there are ways we can prevent or at least lessen it. 

1. Dietary changes

Healthier food choices

• Safe and practical long-term weight reduction and maintenance diet needs to include balanced, nutritious foods to avoid vitamin deficiencies and other diseases of malnutrition. 

• Eat the rainbow diet which is rich in fruits, vegetables, whole grains, nuts, seeds, lean proteins like fish, chicken breast or vegetable protein like soy. Low-fat or fat-free dairy, which is rich in Vitamin D, should also be included in the diet.

• Eat ‘low energy density' foods which contain relatively few calories per unit weight. For example, you can consume a large amount of cucumbers or carrots without taking in many calories. These foods reduce hunger pangs and make you full on less.

• Eat foods with a low glycemic index to keep insulin spikes in check.

• Switch to healthy fats such as monounsaturated fats (olive and canola oil) and polyunsaturated fats (deep-sea fish and vegetable oil)

Cutting down calories

• The first step is to review and record how many calories you normally consume. Usually 1,200 to 1,500 calories for women and 1,500 to 1,800 for men are recommended for every day. 

• Your doctor/dietician/nutritionist can help you in guiding your daily calorie intake. It is also important to educate yourself in reading food labels and estimating calories and serving sizes.

Restricting certain foods

• Avoid or limit sugar intake. Sugar in any form like table sugar, sweets, cookies, pastries, doughnuts, cakes, muffins, sugar sweetened beverages like fizzy drinks, packaged juices, and packaged flavored milk is detrimental for health. 

• Limit ‘energy dense foods'. These food items generally have a high calorie value in a small amount. They are high in saturated or trans fats and simple sugars.  Examples include red meat, deep fried foods, packaged foods, sweets, cookies, cakes, pastries, butter, and high-fat salad dressings. 

• Avoid empty calories which are foods that provide calories but almost no nutrition such as alcohol, soft drinks, soda and many packaged high-calorie snack foods like biscuits and namkeen.

• Avoid food items containing harmful fats such as saturated and trans fats.

Healthier lifestyle habits

• Eat small, regular meals and limit or carefully choose snacks.

• Never skip breakfast as it can lead to consuming too many calories later in the day.

• Be wary of quick fixes. Do not get tempted by crash, fad or popular diets that promise fast and easy weight loss. They might help in the short term, but you're likely to regain the lost weight when you stop the diet.

• Consistency is the key. To lose weight and keep it off, one must adopt healthier habits that can be maintained for a long term.

2. Increased physical activity

Exercising can help people lose weight in a healthy way and keep it off. People who do not exercise while dieting are more likely to regain the weight they lose. Compared to those who are inactive, physically active people have stronger muscles and better cardiovascular fitness. They also usually have lower body fat and stronger bones. A few exercise recommendations are as follows:

• Indulge in 20 to 30 minutes of moderate exercise five to seven days a week, and if possible, daily. These include stationary bicycling, walking briskly, jogging, swimming, biking, tennis, skating, and skiing. 

• Exercise can be phased out over small sessions of 10 minutes.

• Start slowly and progress gradually to avoid any injury or excessive fatigue. Over time, build up to 30-60 minutes of moderate to vigorous exercise every day.

• Daily activitie such as taking the stairs instead of the elevator and walking instead of driving can burn a considerable number of calories. 

• It is never too late to start exercising. Even elderly individuals can improve their strength and balance by exercising regularly. However, it is always wise to consult your healthcare provider for evaluation of any risks associated with exercising.

• Parents should also get their children involved in low-intensity physical exercise that will last 20 to 30 minutes per day. This might help children to maintain a healthy weight throughout childhood and adulthood.

3. Get enough sleep

You need to make sure that you are getting enough sleep each night because if you’re not sleeping enough, it can affect your metabolism and appetite control, which can lead to weight gain or obesity over time.

4. Reduce screen time

Adults and children spend over 7 hours a day on screen time. This includes sitting or laying down with a smartphone, tablet, watching TV, playing video games and even doing office work on the laptops.

Too much screen time is a strong obesity risk factor. It's associated with low physical activity and poor sleep which predisposes to weight gain. Television also exposes one to incessant marketing of unhealthy packaged foods and sugary drinks.

PARENTS!

Here are a few valuable tips to manage your children’s dietary habits and avoid common traps:

• Don't reward your children for good behavior or try to stop bad behavior with candies, chocolates or treats. Junk food used as positive or negative reinforcer can make the child value it more than healthier options.

• Don't talk about ‘bad foods’ or completely ban all sweets and junk food. Children might rebel and overeat forbidden foods outside the home or sneak them in on their own. Idea is to serve healthy foods most of the time and offer treats once in a while.

• Don't have an empty-plate policy. If children feel full, don't force them to keep eating. Reinforce the idea that they should eat only when they're hungry and stop when they're full.

To know more about simple tips for prevention of obesity in kids.
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Specialist To Visit 

Most patients will visit their primary care physician first. The primary care physician will rule out any underlying health conditions and provide a diagnosis or refer you to a specialist depending on the severity of your obesity.

• If you're overweight and want to get back to a healthy weight, you must talk to a physician. He/she can diagnose the cause of your obesity and help you develop a customized treatment plan.

• If your weight gain is due to an underlying hormonal issue, then you must visit an endocrinologist.

• If you suffer from excessive weight due to overeating or eating unhealthy food, then the doctor that will be most helpful for you is a psychiatrist or a health coach.

• If it is that your body does not properly use the calories from food, then the doctor who will be most helpful for you is a dietitian.

• Some doctors may only treat severe or mild forms of obesity. For example, bariatric surgeons will only perform surgeries for people with extreme obesity. 

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Treatment Of Obesity

Obesity is a chronic and complex disease with significant health consequences. In case, lifestyle changes don't work, then consult your healthcare provider to evaluate the need of the next level of treatment -- medications and surgery.

Medications

The drugs that are used to treat obesity are called anti-obesity drugs. These drugs work by decreasing appetite, increasing the rate at which the person burns calories, or decreasing how much food is absorbed from one’s diet. The following drugs are prescribed for obesity:

1) Orlistat 

Orlistat works by reducing the absorption of fats from food in the gut. It also reduces appetite and promotes feeling of fullness leading to weight loss. It is a prescription medication that can be taken for a long time.

2) Rimonabant

Rimonabant is a cannabinoid receptor agonist. It has been found to reduce appetite and body weight and to cause a reduction in the body mass index (BMI).

3) Phentermine

Phentermine is a drug that slows down the activity of your brain to reduce your appetite. It also increases the amount of energy that you expend during physical activity, which means that you will burn more calories than you usually would.

4) Lorcaserin

Lorcaserin, on the other hand, helps suppress appetite and increase weight loss through serotonin activity in the brain.

These drugs are used in combination with behavioral therapy and other lifestyle changes to reduce weight gain or improve weight loss. One problem with these drugs is that they may lead to side effects like nausea, vomiting, dizziness, dry mouth, etc.

Recent Advances

1. Semaglutide: It is a GLP-1 receptor agonist approved for obesity management. It reduces appetite and promotes significant weight loss when combined with diet and exercise​

2. Tirzepatide: It is a dual GIP and GLP-1 receptor agonist. It aids in weight loss by making you feel fuller for longer and balancing energy intake, while also effectively controlling blood sugar levels.

Tirezeptide V/s Semaglutide

Tirzepatide showed an additional 5% weight loss and a greater reduction in type 2 diabetes risk compared to semaglutide, emphasizing its promise for effective weight management and diabetes prevention strategies.

These drugs are used in combination with behavioral therapy and other lifestyle changes to reduce weight gain or improve weight loss. One problem with these drugs is that they may lead to side effects like nausea, vomiting, dizziness, dry mouth, etc.

Bariatric surgery

This surgery reduces the size of the stomach so that it can’t hold as much food as before. Surgery for obesity may be suggested in the following obese patients:

• Patients with a BMI more than 40 

• Patients with a BMI more than 35 who have serious medical conditions like sleep apnea that would improve with weight loss

Currently, the following types of bariatric surgeries are advised:

• Restrictive surgeries: These surgeries restrict the size of the stomach and slow down digestion.

• Malabsorptive/restrictive surgeries: These surgeries restrict the size of the stomach and also bypass or remove some part of the digestive system to reduce absorption of food.

Home-care For Obesity

Here are some tips that can help you take care of obese people at home:

• Monitor their diet and exercise habits by maintaining a diet journal.

• Educate them on the risks posed by obesity.

• Take steps to promote healthy living.

• Improve their self-esteem.

• Encourage them to eat healthily.

• Plan the meals together.

• Exercise together by going on a walk or doing some other physical activity you both enjoy.

• Give them enough time to rest and sleep every day.

• Stop their unhealthy habits like smoking or drinking alcohol.

• Keep them hydrated by drinking plenty of water throughout the day.

Complications Of Obesity

The complications of obesity are many and varied. The risks range from several serious medical conditions to a poor quality of life. It also has negative effects on the person’s social, physical, mental, and emotional health.

There are many complications of being obese. These include: 

• Hypertension (high blood pressure)

• Abnormal levels of cholesterol and other fats (lipids), called dyslipidemia

• Coronary artery disease

• Heart failure

• Diabetes or prediabetes

• Metabolic syndrome, which includes insulin resistance, abnormal levels of cholesterol and other fats in the blood, and high blood pressure

• Cancer of the breast, uterus, ovaries, colon, prostate, kidneys, or pancreas

• Gallstones and other gallbladder disorders

• Gastroesophageal reflux (GERD)

• Obstructive sleep apnea

• Skin infections

• Varicose veins

• Fatty liver and liver cirrhosis

• Blood clots (deep vein thrombosis and pulmonary embolism)

• Osteoarthritis, gout, low back pain, and other joint disorders

• Low testosterone levels, erectile dysfunction, and reduced fertility in men

• Menstrual disorders, infertility, and increased risk of miscarriage in women

• Depression and anxiety

Obesity predisposes the body to a wide range of diseases. Read about 6 health risks of obesity.
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Alternative Therapies For Obesity

Ayurvedic treatment for obesity

Many medicinal plants that aid in weight loss include triphala, brahmi, and Garcinia cambogia. Fresh curry leaves, turmeric, mint, and spices like ginger, cinnamon, and black pepper (kalimirch) are all readily available and healthful.

Guggul, a gum resin derived from the Commiphora mukul tree, is a well-known natural ingredient that, once refined and processed properly, can be used to treat fat metabolic issues. It has been demonstrated in studies to break down fat cells.

Other well-known herbs used in Ayurvedic weight loss treatments include kalonji (black cumin) and vijaysar (Kino tree).

Homeopathic treatment for obesity

Homeopathic remedies for the treatment of overweight and obesity can be divided into two categories: those that can be used in both adults and children, and those that are only for children.

Ammonium bromatum, calcarea arsenicosa, fucus vesiculosus, phytolacca decandra, and thyroidinum are some of the treatments used to treat overweight and obesity in adults, whereas baryta carbonica, calcarea carbonica, and kalium bichchromicum are useful in youngsters.

Before prescribing a treatment, a homeopathic doctor evaluates a patient's physical and mental features, as well as his or her symptoms and miasms (tendency to suffer from an illness).

Yoga for obesity

Because every asana in yoga aims to work deeply on the core and the entire body, the positions listed below are some of the easier ones, especially for beginners. These will aid in the elimination of stomach-related ailments such as constipation, indigestion, and bloating, as well as strengthen the abdomen in order to minimize fat.

Some of the yoga asanas to help reduce fat in the body are:

• Bhujangasana (Cobra pose)
• Dhanurasana (Bow pose)
• Kumbhakasana (Plank pose)
• Naukasana (Boat pose)
• Ustrasana (Camel pose)
• Adho mukha svanasana (Downward-facing dog pose)

The word ‘Yoga’ is derived from Sanskrit and means to unite, symbolizing the union of body and mind. Read about 6 benefits of yoga even doctors swear by.
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Living With Obesity

Weight is frequently a very personal and sensitive subject because of our attitudes around body image. As a result, dealing with the issue of weight might be difficult. Overweight people typically have low self-esteem, so telling them they need to lose weight is the last thing they need. Instead, you may encourage them to join you in making healthier lifestyle choices.

Obesity, especially in women, can have a major impact on sexual quality of life. Obesity management that can improve self-esteem, sexuality, and overall quality of life includes:

• Lifestyle modifications

• Nutrition

• Medicines

• Behavioral therapy

• Weight loss surgery

The key to managing obesity is being committed to making lifestyle changes. These changes can be difficult at first but they will eventually become second nature. It's important not to let the difficulties get in the way of your success because you are worth it!

Regular exercise can help people lose weight, as well as maintain a healthy weight. Exercise releases endorphins which make us feel good and eat less. Find an exercise that you enjoy doing or that you don’t mind doing. Some forms of exercise that are effective in reducing weight include aerobic exercises, strength training exercises, and high-intensity interval training (HIIT).

Here is a quick look at some key aspects of obesity that every person should be aware of and why ending the weight stigma is the key to fight obesity.
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