Obesity is a chronic disease

Cheryl Sarmiento, MD • June 9, 2020

Discover the science behind the causes, effects, and management

Obesity is defined by the World Health Organization as abnormal or excessive fat accumulation and BMI (body mass index) provides a convenient measure of obesity. The best predictor for health if you want to know your chances of developing a chronic medical condition is to know percentage of body fat. Fat is considered highly inflammatory and contains hormones that have a negative impact on health.

Facts on Obesity:

It’s a chronic disease requiring long term management.

This is what most healthcare organization say about this dreadful disease

WHO - “Obesity is a chronic disease, prevalent in both developed and developing countries, and affecting children as well as adults.

” AMA - “Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans.

” AACE - “… obesity is a primary disease, and the full force of our medical knowledge should be brought to bear on the prevention and treatment of obesity as a primary disease entity.

” TOS - It is the official position of The Obesity Society that obesity should be declared a disease”.

It is a complex disease influence by multiple factors:

Genetics, Physiologic, Psychological and environmental

It is considered a global epidemic

The global prevalence of obesity has increased significantly over the last 30 years. In 2012, 35% or more than one-third of adults in the United States were obese. The prevalence varies by state and region and more than 30% is highest in the South and Midwest.

Associated with multiple comorbidities

Obesity are linked to Type 2 diabetes, Gallbladder Disease, Cancer (various), Osteoarthritis, Cardiovascular Disease, Sleep apnea, dyslipidemia...

Also “… obesity threatens to reduce a person’s health in the future even if no health impairment is observed in the present…”

Risk of mortality is significantly increased

Research showed a decreased life expectancy of up to 10 years

For every 5 kg/m2 BMI increment above the range of 22.5–25 kg/m2, there is a 30% increase in overall mortality

BMI 22.5-25 kg/m2= ~80% chance of reaching age 70 years

BMI 35-40 kg/m2= ~60% chance of reaching age 70 years

BMI 40-50 kg/m2= ~50% chance of reaching age 70 years

Patients with obesity can lose years off their life

Younger patients with obesity lose the most years off their life

At BMI >35% for 20-39 years old, years lost is 8.4 years for men; 6.1 years for women

At BMI 30 - <35% for 20-39 years old, years lost is 5.9 years for men; 5.6 years for women

Obesity is associated with impaired physical functioning

The higher the BMI, the greater the risk of impaired physical functioning, which may include limitations in mobility activities such as walking and dressing

People with obesity have higher health care costs

With increased medical spending, obesity can become an economic burden on both public and private payers:

27% on physician’s visit; 47% on Inpatient ; and 80% on prescription drugs

Maintaining weight loss is challenging

A review of 14 long-term studies showed that participants regained weight after weight loss achieved by diet

“… the high rate of relapse among obese people who have lost weight has a strong physiological basis and is not simply the result of the voluntary resumption of old habits.

Science has discovered that physiologic responses to weight loss trigger weight regain

The brain has a central role in regulating appetite and energy balance. Metabolic adaptations to weight loss include multiple hormones, such as ghrelin, GLP-1, and leptin. These hormones play an important role in regulating appetite such as decrease satiety and increase hunger. Weight loss in people with obesity causes changes in appetite hormones that increase hunger and the desire to eat for at least 1 year.

“… the high rate of relapse among obese people who have lost weight has a strong physiological basis and is not simply the result of the voluntary resumption of old habits.”

A 5% to 10% weight loss may improve obesity-related comorbidities

- Reduction in type 2 diabetes

- Reduction in cardiovascular risk factors

- Improvements in blood lipid profile

- Improvements in blood pressure Improvements in sleep apnea

Support from health care professionals can help patients achieve clinically significant and maintained weight loss

Patients are less likely to start the dialogue for many reasons, including:

a. Potential for hearing hurtful comments about their weight

b. Fear of being blamed for their weight problems

c. Shame and embarrassment about their weight

Physician-initiated discussions motivate patients to lose weight and change behavior. To achieve sustainable weight loss,

long-term intervention is often required, patients commitment to the program and regular follow up with the physician

Multiple treatment options are needed to help people with obesity lose weight and improve their health

Healthy eating and physical activity must be part of any weight-loss intervention, but are not always sufficient to maintain weight loss. Unhealthy behavior and habits can undermine or sabotage these efforts. Studies show a combined treatment of Nutrition, Exercise and Behavioral modification under doctor guidance have more success in long term weight maintenance.

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