It may be a sensitive topic for some but an important one, indeed!
Obesity is an epidemic…and, literally, growing rapidly. Over 36 percent of Americans are obese. Not just overweight, but obese. Guess how many people were obese is 1980?….15%…So obesity has more than doubled in the past three decades. What has happened? See link here
Introduction:
Before going into the complications of this disease, I want to note that this post is not about shaming overweight people. In fact, around 36 percent of people reading this on Steem are obese. As doctors and humans, we should never value judge someone for unhealthy life choices. There are many stressors in life, and some of the nicest patients I have had the opportunity to meet don’t have the best lifestyle choices. Some smoke cigarettes, don’t exercise enough, or eat too much. The point of this post is to make it clear to the Steem community what obesity actually does to one’s health. We are caught in a politically correct society where the fears of offending someone has taken precedence over bringing reality to the surface.
A cultural revolution is needed. Cigarettes used to be the “norm,” but a cultural revolution occurred. It was good that as a culture we were able to decrease the percentage of people who chose to smoke through public health education...but why hasn’t that happened with obesity? Many less physicians smoke nowadays, but physicians are just as overweight as the general population. It is the problem trapped in the closet. The problem will not be brought to the forefront without proper education—not just about how to eat better but how this disease truly affects an individual. Everyone has the freedom to live the lifestyle they choose (at least I believe that), but as a training fourth year medical student, it is my job to at least educate you about the dangers. I will not be like TLC that in some ways promotes obesity with their shows that show happiness in all sizes. Of course you can be happy and big, but you also don’t see them glorifying the life of smoking. Again, another double standard.
Before I bore you with a rant….LETS GET TO IT!
What is Obesity?
It can be defined as a body mass index (BMI) of over 30. BMI= Wt in kg/ square root of height in meters. Although it is not the greatest measurement for very strong individuals, the CDC points out a very strong correlation between high body fat and BMI. See link here
For its simplicity, it is a great way to screen for obesity. Almost everyone with a BMI of over 30 has some weight to lose. Being overweight, is a BMI of over 25-29. My personal belief is that this category has much more margin of error in determining the need for weight loss. As far as health concerns, there is clearly much more evidence for health effects when the BMI is over 30. However, the closer to 30 you are, the more likely it is time to lose weight! For the rest of this post, we will be discussing the more clear evidence of health concerns for people with a BMI of over 30.
The Health Effects:
—Obesity shortens the, overall, life expectancy:
57 prospective studies on over 800,000 European/North American people were analyzed over an 8-year follow up period. The collection of studies put together in a meta-analysis formed evidence that for every 5 point increase in BMI (over the obese range) was correlated with a 30 percent increase in overall mortality for those subjects in those 8 years! In other words, the more fat one has, the more chance of death. On the other hand, a BMI of 22.5-25 had the lowest risk of all-cause mortality.
Another meta-analysis of over 230 cohort studies (which included over 30 million subjects!!!) was published in the BMJ in 2016 and found that high BMI did correlate with more death. This study also had a much longer followup time, some for over 20 years. From this evidence, it is certainly suggestive and evidence based to form this conclusion.
—Metabolic Syndrome:
While some heavy individuals never develop this collection of symptoms, it is increased with more weight. We still have more to understand about the genetic influence of this syndrome, but it is clear that weight is a big player in the deleterious effects of metabolic syndrome. A syndrome is a collection of problems that are correlated with a condition. Metabolic syndrome includes/linked with Type II diabetes, HTN, abdominal obesity, dyslipidemia (bad cholesterol profile), polycystic ovarian disease, and more. The bad profile of metabolic syndrome increases the risk of Type II diabetes, heart disease, atrial fib, peripheral vascular disease, heart failure, sleep apnea, kidney disease, stroke, deep vein thrombosis (DVT), and much more. Type II diabetes is one of the most significant when it comes to weight. UPTODATE specifies that over 80 percent of Type II diabetics are obese. I have seen other sources say as much as 90 percent. Regardless, diabetes leads to terrible complications including blindness and limb amputations. I will consider writing a post just on the complications of this disease.
—Osteoarthritis:
You have heard of OA. The “bone on bone” arthritis. While this analogy is not actually accurate, it helps demonstrate why it occurs. Extra weight puts more stress on cartilage that supports the body . If a heavy person is on his feet a lot, this puts lots of stress on his knees. Many of these patients will need to get knee replacements in the future. This is why I stress to patients the need to find different types of exercise. Swimming and riding bikes are great ways to help prevent OA in the process of losing weight. Even modest weight loss can help improve outcomes on the weight-bearing joints.
—Gall Bladder Disease:
A study released in 2015 which encompassed more than 55,000 subjects found that there was a high link between abdominal obesity and gallstones. The increase in gallstones can trap bile within the cystic duct of the gallbladder and lead to infections.
—Cancer:
Now this one... I bet many people do not consider this when thinking about obesity, but it is significant! A study published in a Oncologist journal in 2010 suggested that 20 percent of diagnosed cancers were caused by obesity/weight gain! WOW!….makes you wonder if this is truly why cancer seems to be increasing in modern society (besides the fact that we also live longer and have more time to get cancer). With obesity there is an increase risk of endometrial cancer (up to 41 percent caused by obesity!), gallbladder, kidney, liver, colon, cervical, thyroid, ovarian, postmenopausal breast cancer, and leukemia.
Link to entire health effect section can be found here. **Note that this source requires a membership and you would have to pay to look through a majority of this source.
Why would obesity lead to cancer??
I remember asking myself this same question in medical school. With an increase in fat, there is an increase peripheral conversion to estrogen (fat converts other hormones into estrogen). Unopposed estrogen, has been shown to be a carcinogen. So cancers like endometrial and postmenopausal breast cancer are probably linked to this peripheral conversion.
These are the major health effects of obesity-- and by no means-- is this list exhaustive. Hopefully with more education such as this, we can reverse this epidemic. It will take willpower, a cultural revolution, and proper education.
As a senior medical student, I hope to really focus on ways to decrease obesity. I especially have a deep passion for working hard to decrease the Type II diabetes epidemic.
If you have any questions, I would be happy to answer if at all possible.
I hope everyone had a wonderful Christmas/Hanukkah...and everyone get ready for a new year!
Feel free to follow if you enjoyed this informative post.
Picture of me!
Thanks!
Sources:
All links provided for written content above, which included UPTODATE, Medscape, and the CDC website. All pictures were from pixabay.com, and links are provided.