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Obesity


What is obesity?

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A condition associated with the presence of excess body fat mostly defined by lifestyle and genetic factors is obesity. Obesity is uncontrolled even with dieting. It is a health crisis in many industrialized nations that are experiencing its prevalence among common people.

Obesity is measured by the Quetelet index, more popularly known as BMI – Body Mass Index. It is calculated as weight/height, where the individual’s weight is in kilograms or by using the Deurenberg equation, which is:

body fat% = 1.2(BMI) + 0.23(age) – 10.8(gender) – 5.4. Gender is 0 for females and 1 for the males.

In men a body fat % > 25% denotes obesity, while in women a body fat % > 33% defines obesity. A person diagnosed with obesity will undergo a DXA scan to measure the body composition accurately.



Causes

One of the primary causes of obesity is the evident imbalance between food intake and equal energy output. An individual may eat too much or just exercise too little. A few possible factors instrumental in the development of obesity are:

  • Genetic – hereditary existence of obesity increases the individual’s susceptibility to the disease
  • Metabolic
  • Age-related factors
  • Endocrine
  • Low activity levels
  • Cessation of smoking
  • Racial
  • Culture and ethnicity
  • Imbalance in diet
  • Gestational diabetes
  • Menopause
  • Psychological

Co-morbidities

There are several comorbidities linked to obesity. Obesity leads to regional fat distribution at the abdomen and increased waist circumference leading to cardiovascular risk.

Some of the primarily associated comorbidities are:

  • Psychological – an obese individual is socially ostracized and stigmatized leading to depression
  • Obstructive sleep apnea – a respiratory disease with a predisposition to respiratory infection with a heightened incidence of bronchial asthma
  • Malignant cancer – endometrial, colon, prostate, lung, breast and gallbladder cancer
  • CNS – the breakdown of the central nervous system leading to stroke, meralgia paresthetica, idiopathic intracranial hypertension
  • Cardiovascular – CAD (coronary artery disease), cor pulmonate, left ventricular hypertrophy, artherosclerosis
  • Gastrointestinal – GI related cholecystitis, cholelithiasis, fatty liver infiltration, reflux esophagitis
  • Gynaecological – Pregnancy-related hypertension, pelvic dystocia, foetal macrosomia
  • Orthopaedic – osteoarthritis, chronic lumbago, Legg-Calve-Perthes disease

Secondary and related causes of obesity are:

  • Eating disorder – bulimia nervosa, binge eating and night eating
  • Pseudohypoparathyroidism
  • Cushing’s syndrome
  • Insulinoma
  • Polycystic ovarian syndrome
  • Growth hormone deficiency

Treatment and Medication

Physical examination is rather straightforward where a patient may have failed repeatedly to achieve weight loss. Questions may include the history of binging, food-seeking, night-eating etc. Family history may also be examined for the presence of weight problems.

Lab studies may include liver function studies, fasting lipid panel, fasting glucose, haemoglobin A1c and thyroid function tests.

Other studies for the examination of obesity may include:

  • DEXA – Dual energy radiographic absorptiometry
  • Calliper measurements to assess the skin-fold thickness
  • Ultrasonography for fat thickness
  • Bioelectrical impedance analysis
  • MRI and CT scan for measuring visceral fat

Treatment involves stimulus control methods, monitoring of physical activity, monitoring caloric intake and relapse prevention.

Medical management can be achieved with the intake of orlistat and lorcaserin and topiramate for long-term administration.

Approach us today for the effective treatment and management of obesity and its related conditions before they pose a high risk to the patient.

Authored By DR. DEEPAK S

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