What is Obesity?
What is Obesity? Is Obesity a Disease?
Obesity is a disease defined by the World Health Organization as “abnormal or excessive accumulation of fat in adipose tissues to the extent that it impairs health”.
If the energy taken daily is more than the energy spent, the energy that cannot be spent is stored as fat in the body and causes obesity. It also causes an increase in weight gain by affecting the hormonal system of the body.
Adipose tissue constitutes 15-18% of body weight in adult men and 20-25% in women. If this rate is over 25% in men and over 30% in women, obesity occurs.
Obesity is a complex and multi-factorial disease that manifests itself with behavioral, endocrine and metabolic changes along with an increase in body fat.
Although "excessive weight" and "excessive fatness” are used interchangeably, they are medically different concepts.
Obesity, which significantly reduces the quality of life and shortens its duration, is a very important health problem that is growing and becoming widespread. Almost 1.6 billion people in the world are overweight and 400 million of them are in the obese category.
According to the preliminary study report of the “Nutrition and Health Survey in Turkey-2010” conducted by the Ministry of Health, the prevalence of obesity in Turkey is as follows;
- 20.5% in men
- 41.0% in women
- 30.3% in total
Obesity is currently considered not as a cosmetic problem, but as a complex metabolic disease with long-term negative effects on more than one organ system. Due to its complex metabolic structure, the application of different diets can be ineffective and/or harmful to the patient.
For this reason, all individuals who want to maintain their health should keep having their ideal weight, and patients with obesity problems should reach their ideal weight with the control of a physician, dietitian and, if necessary, psychologist and physiotherapist.
Obesity ranks second in the world among preventable health problems after smoking addiction.
Obesity Diagnosis
Body Mass Index Calculation
Although many methods are used in clinical studies for obesity, the most valid method that is frequently used is the measurement of the body mass index (BMI) along with waist and hip circumference, since they are practical.
Body Mass Index (BMI) is calculated by dividing body weight (kg) by the square of our height in meters (kg/m²).
As a result of these values, patients are diagnosed with underweight, normal weight, overweight, obese or morbidly obese.
In general, those with a body mass index of 25 to 30 and above are considered to have obesity, and those of 40 and above are considered to have morbid obesity.
What is Morbid Obese?
Morbid obesity is the name given to obesity at a level that can cause fatal problems and shorten life expectancy due to the risks it faces. At this stage, the disease has become chronic and dangerous. Patients with overweight at this level have a 2% probability of losing weight by using diet, lifestyle changes, psychological support and medication. Therefore, 98% of these patients are unlikely to lose weight outside of surgery.
Types of Obesity by Appearance
(According to the Region of Excessive Fat)
Type I Obesity: Excessive fat is evenly distributed throughout the body.
Type II Obesity (Gynoid, Female, Pear-Shaped): Excessive fat is mostly in the hips and haunches. It is the most uncomforting type in terms of appearance but poses the least risk to health.
Type III Obesity (Visceral Obesity, Involving Organs): Fattening is high in the abdominal organs and tissues. It may not be obvious from the outside. It is the most dangerous type of obesity.
Type IV Obesity (Android, Male, Apple-Shaped, Central): Excessive fat is located in body, especially around the waist. It is the most dangerous type of obesity after Type III.
What Are the Symptoms of Obesity?
The most basic symptom of obesity disease is excessive accumulation of adipose tissue in the body. The disease can bring along some health problems as well as aesthetically undesired appearance. Problems and symptoms associated with obesity include:
- Excessive sweating
- Getting tired easily
- Shortness of breath
- Snoring and sleep apnea
- Skin problems
- Back and joint pain
- Swelling in the feet
- Increase in appetite
- Psychological problems
Causes of Obesity
Although the factors that cause obesity cannot be fully explained, excessive and wrong nutrition and lack of physical activity, that is, the energy taken over a long period of time is more than the energy spent is considered to be the most important causes of obesity.
In addition to these factors, many genetic, environmental, neurological, physiological, biochemical, socio-cultural and psychological factors cause obesity. Genetic predisposition is a very important factor. Body mass index is 66% genetic, that is, parental weight is 66% likely to be passed on to children. Obesity can be seen in every person from infancy, and its prevalence generally increases in adolescence and old age.
It is accepted that the role of environmental factors in the development of obesity is in the forefront, especially since the increase in childhood obesity is so high that it cannot be explained only by changes in genetic structure.
Risk Factors Causing Obesity
Although there are many causes of obesity, the biggest factor in the development of the disease is a sedentary lifestyle and unhealthy diet. The main risk factors causing obesity can be listed as follows:
- Excessive and wrong eating habits
- Insufficient physical activity
- Age
- Gender
- Education level
- Socio-cultural factors
- Financial status
- Hormonal and metabolic factors
- Genetic factors
- Psychological problems
- Having very low-energy diets at frequent intervals
- Smoking-alcohol habits
- Some medications (antidepressants, etc.)
- Number of births and birth interval
- Being breastfed insufficiently
What Are the Mistakes Causing Obesity?
Wrong feeding habit is among the primary causes of the disease. Misdiet habits can be listed as follows:
- Calorie intake over daily energy need
- Excessive fast-food consumption
- Unbalanced and irregular diet, particularly seen in employees
- Snacks eaten before and after dinner
- Rapid eating and insufficient chewing
- Skipping meals or continuous consumption of high-calorie food between meals
- Excessive eating when stressed
- Sitting down at the table more than adequate
- Eating at night, particularly between sleep intervals
- Drinking less than 2 liters of water or no water consumption
Treatment of Obesity
It is of great importance to prevent the obesity before it occurs for its treatment. Prevention from obesity should begin in childhood. The obesity developing in childhood and adolescent paves the way for obesity in adulthood.
Obesity treatment is a long and continuous process that requires the determination and active participation of the individual. The fact that many factors take place in development of obesity, which makes the prevention and treatment of this disease extremely difficult and complex. For this reason, it is necessary to get medical support from a team consisting generally of physicians, dietitians, psychologists and physiotherapists in the treatment of obesity.
Each patient undergoes a detailed examination for the factors underlying the obesity problem, eating habits, psychological problems and health status. Then, as a result of these examinations, the appropriate treatment program is planned for the patients. These treatment programs may include options such as medical treatment and surgical treatment in addition to medical nutrition therapy and exercise, depending on the medical characteristics of the patient.
The aim in treatment of obesity is to reduce the morbidity and mortality risks associated with the obesity, provide the individual with adequate and balanced nutrition habits as well as increase the quality of life based on a realistic weight loss target. A 10% decrease in body weight in a 6-month period provides significant benefits in prevention of health problems caused by obesity.
Methods practiced for treatment of obesity are classified under 5 groups listed below:
1. Medical Nutrition Therapy
Medical nutrition therapy plays a key role in the treatment of obesity. The obesity is a disease that can be prevented and treated with weight loss diets and some practices that support the diet.
It should be planned individually, from which food sources and how often the calories will be taken during the diet. The goal in diets is not to strictly follow a program. On the contrary, it is aimed to ensure that the person receives a diet training that s/he can be flexible with, maintain it and most importantly, make it a lifestyle.
In medical nutrition therapy of obesity:
- Reducing body weight to the appropriate body mass index level should be aimed. Diet (medical nutrition) therapy should be personalized.
- Weight loss diets should be consistent with adequate and balanced nutritional principles. The aim is to provide a favorable nutritional habit with individuals and ensure them to maintain this habit.
- When the body weight reaches the required level for height, possible weight gain should be prevented.
2. Exercise Therapy
Although the effect of exercise therapy on weight loss is still controversial, it is certainly accepted that physical activity reduces fat tissue and abdominal fat and prevents muscle loss that can occur when dieting.
Individuals lose weight by supporting nutrition therapy and prevent from gaining weight again thanks to exercise therapy.
Adults are recommended to do moderate-intensity exercise for 30 minutes on average each day. An activity at this level provides a daily energy expenditure of 840 kJ (200 kcal). It is aimed for patients with obesity to be physically active every day. Energy expenditure varies according to the person's body weight and activity level.
One of the most important issues to be considered while following the exercise program is to keep the risk of injury at the lowest level while increasing the energy expenditure. The recommended exercise program should be specific to the individual, fun, doable and consistent with the daily life habits of the individual.
3. Behavioral Change Treatment (Psychological Treatment)
Behavioral change treatment aims to positively change or reduce the negative behaviors related to overeating and sedentariness that cause excessive weight gain. Also, another goal is to reinforce positive behaviors and make them a lifestyle. The steps of behavioral change treatment are listed as follows:
- Self-observation
- Stimulus control
- Developing alternative behavior
- Reinforcement, self-awarding
- Cognitive restructuring
- Social support
4. Pharmacological Treatment (Medication Treatment)
The medications to be taken in treatment of obesity are not suitable for patients with mild or moderate obesity. The medications must accord with the following criteria:
- confirmed credibility in terms of health
- having an appropriate effect on factors causing obesity
- absence of important short/long-term side effects
- being non-addicting
- usage upon recommendation and under supervision of a physician.
The patients should continue medical nutrition therapy and exercise therapy in addition to the medication treatment and visit for regular follow-up examination in order for the obesity treatment to be successful.
5. Surgical Treatment
In patients with severe obesity, treatment can also be provided by means of bariatric surgeries in line with the physician's recommendations, especially when the risk of developing serious complications is high.
Bariatric surgery is basically grouped under two categories:
Bariatric Surgery
The aim of bariatric surgery is to reduce the absorption of nutrients in the gastrointestinal tract in order to decrease the energy taken with food.
For this purpose:
- Sleeve Gastrectomy
- Gastric Balloon Procedure
- Gastric Bypass Surgery
are performed.
Sleeve Gastrectomy
Being the most current surgical treatment method, in this surgery, the stomach that is left after the removal of a certain part of the stomach takes the shape of a tube. Due to decreased gastric volume, patients quickly feel satiety with low food consumption. Most importantly, some changes occur in the hormones that control hunger and satiety. It is an effective method for both weight loss and correction of accompanying metabolic disorders such as diabetes. It allows about 60% of excessive weight to be lost in a short time. Since there is no change in the gastrointestinal passage, it also influences the improvement of physiological and metabolic disorders.
Gastric Balloon Procedure
In this method, a balloon is placed in the stomach, which functions as a volume reducer. If the balloon remains in the stomach for more than 6 months, it will deflate. As a result, complications such as infection and gastric erosion occur. Therefore, it is not highly recommended. Rather than long-term treatment, it can be preferred as an initial treatment for weight loss in superobese patients before the bariatric surgery. Also, it can be performed for patients with serious co-morbidities before the surgery.
Gastric Bypass Surgery
In this method, the gastric volume is reduced, and the small intestines are connected to this new small stomach from a certain distance. Since this method allows the stomach to be reduced, the feeling of satiety with less food consumption and changes in the hormones that control hunger and satiety occur. In addition to these, weight loss can be achieved with the malabsorption mechanism as the intestinal transition is changed. Therefore, it helps both weight loss and improvement of metabolic disorders. Approximately 60-80% of excessive weight can be lost thanks to gastric bypass surgery. However, since it is a more complex surgery, complication rates are higher than sleeve gastrectomy and require longer hospitalization period.
Reconstructive Surgery
Reconstructive surgery aims to remove the existing fat tissues localized in various parts of the body. This treatment method is mainly based on aesthetics, and if the patient does not fulfill the requirements of obesity treatment, fat accumulation occurs again.
What Does Weight Loss Change in Our Body?
Having your ideal weight is very important for a healthy and quality life. The changes that occur in your body when you lose weight can be listed as follows:
- Depression is prevented, self-confidence increases.
- Gastrointestinal system functions better.
- Disorders such as joint pains, heel spur, lower back pain improve.
- Physical performance increases.
- It becomes easy to manage blood glucose.
- Risk of developing diabetes decreases.
- Risk of cardiac diseases and paralysis reduces.
- A decrease occurs in blood pressure level.
- Cholesterol and triglyceride levels decrease.
- Hepatosteatosis regresses.
- Shortness of breath disappears.
- Improvement is seen in sleep apnea.
- Irregular menstruation decreases.
- Risk of getting cancer reduces.
- Quality of life improves.
- Health expenses and medication intake decrease.
Why Is Obesity Important?
The quality of life decreases and risk of death increases in patients with obesity, because hypertension, elevated blood fats (cholesterol and triglycerides), type II diabetes, coronary artery disease, heart attack, gallstones, osteoarthritis (calcification), sleep and respiratory problems, some cancers (endometrium, breast, colon), hepatosteatosis (fatty liver), cirrhosis and risk of infertility increase in patients with obesity.
Link Between Obesity and Diabetes
Obesity is a disease whose link with many diseases, especially diabetes, has been scientifically determined. The risk of having type 2 diabetes increases 20 times in patients with obesity with a body mass index (BMI) above 30 kg/m2. 90% of people with type 2 diabetes are diagnosed with obesity. Obesity and diabetes are so intertwined due to both their causes and treatment methods that the term “diabesity” including both clinical conditions is used in the literature.
Does Obesity Cause Cancer?
The obesity increases the risk of cancer. The underlying mechanism is as follows:
Adipose tissue produces high amounts of estrogen, which is responsible for breast and uterine cancers as well as some others. Patients with obesity often have high levels of insulin or insulin resistance. This may trigger the formation of some tumors. Adipose cells produce hormones called adipokines that can accelerate the formation of malignant cells. Patients with obesity often have infections (low-grade, chronic or sub-acute) that increase risk of cancer. Other possible mechanisms leading to cancer can be listed as altered immune system responses and oxidative stress.
What Are the Diseases Caused By Obesity?
- Metabolic syndromes
- Insulin resistance - Hyperinsulinemia
- Type II diabetes
- High cholesterol
- Hypertension (high blood pressure)
- Coronary artery disease
- Heart failure
- Respiratory disorders
- Elevated blood lipids and cholesterol
- Hepatosteatosis
- Cardiovascular diseases such as atherosclerosis
- Joint disorders
- Gallbladder diseases
- Gastoesophageal reflux acid
- Paralysis (stroke)
- Sleep apnea
- Asthma
- Ovarian cysts and secondary irregular menstruation in women
- Hirsutism
- Concealed penis and hormonal disorders in boys
- Depression
- Osteoarthritis
- Varicose veins
- Some cancers
- Urinary incontinence
- Loss of libido
- Migraine attacks