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Health Risks of Obesity
Mortality
Research shows that excessive body weight is linked to overall health and susceptibility to chronic ailments. It has been proven that a BMI beyond 20 kg/m2, increases the risk of cardiovascular death, heart attack and diabetes, even after adjusting for age, smoking, social class, alcohol consumption and physical activity. Studies show that non smoking overweight men and women lose 3.1 and 3.3 years of life respectively compared to normal weight non smokers. These studies have also established that weight fluctuations increase the risk of death.
Coronary heart disease is the major cause of weight-related death followed by diabetes mellitus, digestive diseases and cancer. Evidence suggests that women can reduce mortality rate by 25% in diabetic, cardiovascular and cancer conditions by achieving a weight loss of 9 kgs. However if an obese person has already developed an associated co-morbidity, then planned weight loss of any amount has been reported to reduce mortality by 20%. It has also been established the risk of mortality is greater in younger patients suffering from obesity as compared to older ones.
MorbidityObesity is associated with chronic diseases such as heart disease, Type 2 diabetes, hypertension, stroke, gallbladder disease, sleep apnea, certain cancers and osteoarthritis. These chronic ailments tend to worsen with increasing degree of obesity. Nonalcoholic fatty liver disease which may progress to end-stage liver disease is now also being recognized as a consequence of obesity. Obesity may also lead to poor wound healing and poor antibody response to hepatitis B vaccine.
The multiplicity of problems associated with obesity and benefits of 10% weight loss can be outlined as –
Benefits to the obese of a 10% weight-loss |
|
| Mortality | 20-25% fall in total mortality |
| Blood Pressure | Fall of 10mmHg systolic pressure |
| Angina | Reduces symptoms by 90% |
| Lipids | Fall by 10% in total cholesterol |
| Diabetes | Reduces risk of developing diabetes by > 50% |
| Rheology | Decreases blood viscosity by 20-27% |
Regional Distribution of fat and Health Risk
There are basically two types of obesity; Android or apple-shape obesity where the excess fat is primarily subcutaneous abdominal/truncal fat or gynoid or pear-shape obesity where excess fat is gluteofemoral fat. This fat distribution is determined genetically and varies among men and women. Android obesity is more common among males whereas females are more susceptible to gynoid obesity. While incase of gynoid obesity it is more difficult to shed weight, the android obesity is linked to chronic ailments such as glucose intolerance, insulin resistance, hyperlipidemia and hypertension. Aging is also an important factor in the development of central obesity. This type of obesity is also closely associated with the development of metabolic syndrome (a complex of unified conditions like glucose intolerance, high blood pressure and alterations in serum lipids).
Psychological EffectsObesity and dieting are strongly related to an individual’s psyche. Studies show that many obese people suffer from low self esteem which frequently manifests itself as anxiety and depression. A study done on severely obese subjects showed poor mental well-being. Most of them were also found to be suffering from anxiety and depression. A further study done on siblings, one being severely obese and other normal weight, showed that functional and emotional wellbeing was significantly lower in severely obese siblings.
Effect of obesity on pregnancyThe risk of obstetric complication is higher in obese women. Significantly obese women with an IBW of > 135% have a 6.6-fold higher risk for the development of gestational diabetes, 1.9-fold risk for pregnancy-induced hypertension, 1.4-fold risk for urinary tract infections as well as other complications like pre-eclampsia, thrombophlebitis, post-partum haemorrhage and wound or episiotomy infections. Factors such as fetal size, especially macrosomia, an increase in maternal pelvic soft tissue narrowing the birth canal, late deceleration of the fetal heart rate, intrapartum meconium staining, prolonged labor, malpresentations and cord incidents raise the risk of caesarean delivery. This higher prevalence of a Caesarean delivery occurs with or without antenatal complications. Fetal weight appears to be a direct function of maternal size, with more than 50% of obese women having babies who weigh greater than 3600g. An increased risk of neural tube defects, especially spina bifida has also been reported in women with BMI greater than 29. Further, the protective effects of dietary folic acid as seen in leaner women are not seen in women weighing over 70 kg. Studies have also shown that prenatal deaths were 3 times more common in obese women than their counterparts.
Obesity and incidence of maternal complications during pregnancy as summarized as follows –
Obesity and Incidence of Maternal Complications during Pregnancy |
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Normal |
Overweight | Obese | Massively Obese | |
| Number of Subjects | 54 |
48 | 34 | 30 |
| Hypertension (%) | 9.3 |
33.3 a | 54.6 a | 79.3 a |
| Toxemia (%) | 3.7 |
17.8 | 30.3 a | 42.9 a |
| Gestational Diabetes (%) | 1.9 |
12.3 | 39.4 a | 44.8 a |
| Insulin (% patients) | 0 |
2.1 | 12.1 a | 20.7 a |
| Insulin (% diabetics) | 0 | 16.8 | 30.7 a | 46.2 a |
| Urinary infection (%) | 16.7 | 8.7 | 29.0 | 37.5 |
| Preterm Labor (%) | 14.8 | 13.0 | 22.6 | 28.0 |
| Caesarean section (%) | 9.3 | 16.7 | 15.1 | 42.9 a |
Hospitalization Outpatients (%) |
7.4 9.3 |
33.3 a 33.3 a |
45.5 a 36.4 a |
61.5 a 66.6 a |
| Overall cost | ||||
| Normal = BMI of 18-24.9; Overweight = BMI of 25-29.9; Obese = BMI of 30-34.9; Massively obese = BMI > 35. a = Significantly different from normal weight group, b = cost assessed as equivalent outpatient hospitalization. | ||||