Obesity has reached epidemic proportions in the U.S. and other parts of the industrialized world. Even in developing countries, obesity is escalating rapidly.
More than 60% of adults in the U.S. are now overweight or obese. What's even more alarming is the rapid increase in the prevalence of obesity among children and adolescents. The rate of overweight children and adolescents has more than doubled in the U.S. since the 1970s. Approximately 14% of U.S. children and adolescents are now seriously overweight.
Types of Obesity
There are two types of obesity:
1. Generalized obesity.
2. Abdominal obesity.
You have abdominal obesity if your waist-line is more than 35 inches for females or more than 38 inches for males. Slang words, such as “spare tire” or “love handles” are often used to describe abdominal obesity.
Most individuals with generalized obesity also have abdominal obesity. However, some individuals, especially Asians, may have abdominal obesity without generalized obesity. Therefore, the current WHO definition of obesity may underestimate obesity in the Asian population.
This issue was emphasized in a recently published study from Singapore, in which many Chinese, Malaysians and Indians, who were non-obese according to WHO definition, were found to have excess fat accumulation and increased risk factors for cardiovascular disease.
My clinical experience is in line with the findings in this study. At the Jamila Diabetes and Endocrine Center, most of our Asian Type 2 diabetics are non-obese, according to WHO criteria.
Health Consequences of Obesity
Obesity is now a well known risk factor for diabetes, high blood pressure, heart attacks, stroke, gall stones, degenerative arthritis and certain cancers such as breast, colon, uterus, ovary, kidney and prostate cancer.
Obesity, especially abdominal obesity puts you at high risk for Insulin Resistance Syndrome!
In normal individuals, one of the actions of insulin is to keep fat inside the fat cells.
In people with abdominal obesity, there is resistance to this action of insulin, which results in an accumulation of fat (free fatty acids) in the blood, which then leads to high triglycerides and low HDL cholesterol (the good cholesterol).
These cholesterol abnormalities lead to narrowing of the blood vessels. Narrowed blood vessels puts you at high risk for heart attack, stroke, dementia and amputation of legs.
People with abdominal obesity usually have low HDL cholesterol (good cholesterol), below 55mg/dl in females and less than 45 mg/dl in males, and a high triglycerides level (above 150 mg/dl).
Another action of insulin is to keep blood glucose in the normal range all the time. People with abdominal obesity develop resistance to this action of insulin. Consequently, the body produces more and more insulin in order to keep blood glucose in the normal range.
After a number of years, the body is unable to keep up with this mounting insulin resistance. At this point, blood glucose starts rising, initially in the post-meal state only and later on, even in the fasting state, giving rise to Pre-Diabetes and eventually Diabetes. An oral glucose tolerance test can diagnose these different stages of abnormal glucose metabolism.
A high level of insulin also increase your blood pressure and consequently you may develop hypertension.
Obesity and Cancer
In 2003, the American Cancer Society published its analysis of sixteen years of follow-up of 900,000 U.S. adults who were free of cancer at enrollment in the study in 1982. There were 57,145 deaths from cancer during this period.
Obesity was significantly associated with a higher rate of death due to cancer of the breast, uterus, cervix, ovary, esophagus, liver, gallbladder, pancreas, kidney, and prostate. This study was published in 2003 in the New England Journal of Medicine.
Other health risks associated with obesity include:
Low back pain
Pain in the knees and hips
Low vitamin D
Low testosterone in men
Polycystic Ovary Syndrome in women
What Causes Obesity?
1. Eating Habits
In the vast majority of people, overeating is the main reason for excessive weight gain. However, there are some medical disorders which can increase your weight gain, which are discussed below.
2. Under-active thyroid
Thyroid hormone controls the metabolism of the body. Therefore, if you are low in thyroid hormone, you can easily gain weight and you will have difficulty losing weight.
3. Insulin resistance
Insulin resistance itself causes a further increase in your weight, because high insulin level causes water retention, a growth of tissues and an increase in your craving for sugars. Thus a vicious cycle sets in: weight gain causing insulin resistance which leads to further weight gain.
Stress of daily living often causes "comfort eating," which causes a further increase in your weight which further frustrates you and thus a vicious cycle sets in. Stress causes an increase in cortisol production by the adrenal glands. An increase in cortisol hormone causes an increase in weight gain, increase in insulin resistance, an elevation in blood pressure and blood glucose and a deterioration of theimmune system.
A number of medications can cause weight gain. Some of these medications are: steroids, birth control pills, some anti-depression medications, some anti-epilepsy medications and some anti-diabetes medications.
Treatment of Obesity
Treatment of obesity is difficult and challenging.
The main reason why people have such a hard time losing weight is a psychological one. People are simply not willing to change their eating habits, even though they sincerely want to lose weight. Therefore, they seek out escapes, alternatives and short term quick fixes, all of which sooner or later fail.
At the Jamila Diabetes and Endocrine Medical Center, Dr. Zaidi has helped thousands of obese people. An overview of his approach to the management of obesity includes:
Medical evaluation, which includes proper evaluation of thyroid function, high blood pressure, waist-circumference, HDL cholesterol, triglycerides.
An in-depth review of current drug use and stopping unnecessary medications.
Proper treatment of under-active thyroid as the case may be.
Proper counseling about Insulin Resistance Syndrome and other health risks associated with obesity.
Psychological evaluation, which includes a person's eating habits, stress of daily living and personal psychological burden.
Proper counseling on how to change eating habits. Guidance about what foods to eat and what foods to avoid.
Exercise choices, according to age and life-style.
Proper vitamin supplementation.
Use of anti-obesity drugs in a few selected cases and only for the short term.
Counseling about lap band and bariatric surgery of the stomach as a last resort.
This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, Endocrinology and Metabolism.
Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.
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