Why obesity doesn’t give your body a fat chance

Obesity is no longer a condition but a metabolic and lifestyle disease prevalent globally. Evidence suggests that obesity is indirectly responsible for an array of life-threatening and chronic conditions including type-2 diabetes and cardiovascular, kidney and liver complications. According to the  Global Burden of Disease study 2019,  obesity and related complications claimed at least 5.2 million lives globally in 2019.

Most people ‘acquire’ obesity due to their sedentary lifestyle and unhealthy eating habits. Genetic factors leading to hormonal imbalances, side effects of medications and certain health conditions are the major factors inducing obesity. However, obesity is mostly preventable and reversible through lifestyle modifications and dietary alterations.

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“When someone becomes overweight and then obese, it leads to insulin resistance in the body leading to type-2 diabetes. This is followed by an increase in cholesterol levels which raises the risk of heart disease and hypertension. This cluster of disorders is collectively known as metabolic syndrome,” says Dr Banshi Saboo, Ahmedabad-based endocrinologist and Chair-Elect (2023-24) for the International Diabetes Federation (IDF).

These are some health conditions linked to obesity:

1. Type-2 diabetes

Type-2 diabetes has emerged as a global epidemic in recent decades mainly due to ‘obesity-friendly’ eating habits and a sedentary lifestyle. Obesity and vascular complications trigger many internal comorbidities leading to insulin resistance. As a result, the insulin produced by the pancreas is not properly utilised for glucose metabolism. Dr Saboo points out that people with type-2 diabetes should focus on their diet and lifestyle. Remission may be achieved in type-2 diabetes through weight loss. People with obesity have higher chances of remission after shedding at least 15 kg of their weight through diet and exercise.

2. Heart disease and hypertension

People with obesity are at a greater risk of cardiovascular complications including heart attacks, hypertension and strokes.

“Obesity leads to an increase in cholesterol levels which, in turn, leads to arterial blockages and coronary artery disease, thereby increasing the risk of heart attacks,” says Dr Vivek Jawali, chairman of the Cardiac Sciences & the Executive Council of Fortis Hospitals, Bengaluru.  He points out that obese people are also at risk of blood pressure variations, hypertension-induced strokes and cardiac disorders.

3. Depression and mental health

“Obesity and depression have a bidirectional relationship,” says Sucheta Baidya, counselling psychologist, Faridabad.

Social stigma, fat shaming, etc. can cause depression. But obesity leads to other health conditions like diabetes which increase the risk of depression. According to a Harvard University article, obesity is directly linked to mood regulation. So, people who are depressed are found to be averse to physical activity, preferring a sedentary lifestyle.

4. Cancer

“Some cancers like colorectal cancer, breast cancer and esophageal cancer are linked to obesity.  It is also associated with Gastroesophageal reflux disease (GID). The bile goes to the lower part of the oesophagus leading to adenocarcinoma of the esophagus,” says Dr Supratim Bhattacharya, consultant surgical oncologist and robotic surgeon, Apollo Multispecialty Hospital, Kolkata.  He also added that obese people have excess inflammatory mediators, chemicals that produce inflammation like cytokines. These mediators could severely damage tissues and cells and even lead to cancerous formations..

5. Hormonal disorders

Obesity affects the regular functioning of the hypothalamus-pituitary axes (the neural link between the brain and pituitary gland responsible for secreting hormones at optimum levels in our body. Dr Saboo points out that obesity could lead to the lowering of testosterone. It is also a major cause of Polycystic Ovarian Disease (PCOD) in women.

“Every alternate month, the ovary releases the ovum. This gets dysregulated in a person with obesity and causes PCOD,” he adds.

6. Renal hypertension

“Obesity causes hypertension, high blood sugar and flawed lipid metabolism, which first causes protein leak from the kidney, resulting in insulin resistance, and leads to chronic kidney failure,” says Dr Sujeeth Reddy Bande, MD, Consultant Nephrologist, Asian Institute of Nephrology and Neurology, Hyderabad. Obesity-induced diabetes could severely damage the kidneys leading to diabetic kidney disease (DKD). It may also lead to an increase in blood pressure in the kidney, a condition called renal hypertension.

7. Fatty liver

Obesity and type-2 Diabetes could deal a severe blow to the liver and its nearby organs.  Visceral fat deposits on the liver and pancreas in obese people lead to non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD).

“A few patients may also develop NASH [Non-Alcoholic Steatohepatitis], the next stage of the disease, which can progress to cirrhosis,” says Dr Chethan G, a gastroenterologist at Narayana Multispecialty hospital, Bengaluru.

8. Shortness of breath

Obesity reduces lung volume. “It becomes more challenging for the heart to carry a heavier weight. The more the weight, the more the cardiorespiratory system is required to sustain,” says Dr Ravindra Mehta, a pulmonologist at Apollo Hospital, Bengaluru. The heart needs to pump more and faster, leading to shortness of breath.

“The base of the lungs also tends to collapse in obese people. It is called atelectasis and leads to a lesser lung volume and shortness of breath,” adds Dr Mehta.

9. Pressure on spine and joints

“Obesity adds unnecessary weight in the abdomen and starts pulling the spine forward, giving rise to back pain. The extra weight can also lead to disc prolapse. This disc can apply stress on the nerve roots of the spinal cord, producing shooting pain from the back to the legs,” says Dr (Prof) Gokul Raj D, senior orthopedic consultant at Fortis Hospital, Chennai.

He also explains a link between obesity and spondylolisthesis (A developmental or congenital problem in the bone where the bone moves out from its original position). A person with obesity can also get osteoarthritis of the hip and the knee. If the person is obese, the joints need to bear the load, causing wear and tear and leading to osteoarthritis. Obese people are also likely to have an early onset of osteoporosis.

10. Sleep apnea

“Obesity is one of the major risk factors of sleep apnea. Fat accumulates everywhere, including the narrow area of the oropharynx, the mouth, nose, and throat, which leads to the narrowing of the airway. It also makes the muscles floppier, which increases the risk of sleep apnea,” says Dr Ravindra Mehta, a pulmonologist at Apollo Hospital, Bengaluru.

Takeaways

Obesity is linked with multiple serious and chronic health conditions including diabetes and cardiovascular complications. Experts point out that obesity control is integral for maintaining good health and preventing these conditions. It has also been pointed out that maintaining body weight could also ensure not only the prevention of but also the remission from serious health conditions like type-2 diabetes.