What Are the Medical Complications of Obesity?

How Can Obesity Lead to Medical Complications?

The obesity epidemic is one of the biggest health threats in the United States; as a result, it has garnered significant attention from physicians, politicians, and the public. The symptoms of overweight and obesity involve not only physical manifestations, but they also affect one’s behavior and psychological self. These additional components increase the complexity of the disease and its solutions. Unfortunately, rates of overweight and obesity in children and adults continue to climb despite recent interventions that involve increased community and governmental efforts in the prevention and management of these conditions (Obesity Rates & Trends, 2017; Strategies to Prevent Obesity, 2017). A serious concern linked with overweight and obesity is the wide range of associated medical complications. Thus, solutions for the management of overweight and obesity must consider a range of complications (e.g., hypertension, type 2 diabetes mellitus). This chapter aims to improve your knowledge of various medical complications associated with overweight and obesity.

Frequently, concern about developing a medical complication associated with obesity motivates behavioral change. As is true with many things regarding our health, knowledge is power; therefore, the idea behind this chapter is to educate you and your family about potential medical complications that are associated with obesity. As you read this chapter, don’t let it scare you! The more you know, the more you’ll be able to motivate yourself and your loved ones to make changes.

There are many causes of obesity; however, this chapter focuses on the complications of obesity itself. Our goal is to cover some of the common and significant obesity-related complications, in an easy-to-follow format.

Which Cardiovascular Conditions Are Worsened by Obesity?

Hypertension

Hypertension (high blood pressure) is a major consequence of overweight and obesity. Approximately one-third of Americans have hypertension, and in nearly one-third (30%) of them, that statistic can be directly attributed to overweight or obesity (Hypertension in the United States, 2015). Before discussing how high blood pressure is affected by obesity, let us first define the condition. In our circulatory system, blood travels through tube-like vessels (arteries) to deliver the oxygen and nutrients that our organs need. Blood pressure is the amount of force used to move blood through the walls of those arteries. The pressure originates from the rhythmic pumping of blood by the heart to the arteries. Because the heart is a muscle, it contracts and relaxes, producing two kinds of blood pressure: systolic and diastolic. When the heart contracts, it pumps blood into the arteries. The pressure in those arterial walls during contraction is the systolic pressure. When the heart relaxes, it receives blood from the body. This pressure, during relaxation, is the diastolic pressure, which is lower than the systolic pressure. Blood pressure is read as two values: systolic over diastolic blood pressure (Chronic Hypertension, 2017).

Table 6-1 displays the guidelines used by health-care providers to determine normal versus high blood pressure. High blood pressure (hypertension) is defined as the increase in resistance for the heart to pump blood through the walls of narrowing vessels. An increase in blood pressure can be caused by a variety of genetic and environmental factors. A study by Dua and colleagues (2014) found a link between high blood pressure and body mass index (BMI), which is the ratio of weight to height. BMI ratings between 25.0 and 29.9 are considered overweight, whereas having a BMI greater than or equal to 30.0 qualifies for obesity. High BMI values contribute to increased blood pressure readings. Additionally, high blood pressure can develop due to the increased workload that arteries must manage to deliver oxygen and nutrients to the excess fat tissue present in those who are overweight or obese (high BMI). Diets high in cholesterol and sodium can lead to the production of arterial plaques, which block blood flow in arteries and increase the blood pressure (Chronic Hypertension, 2017; Dua et al, 2014). 

Another explanation of how hypertension is caused by obesity involves the relationship between the elevated heart rates observed in patients with overweight and obesity. Raising the heart rate (the number of heart beats per minute) can make it more difficult for blood to travel through the arteries, leading to hypertension (Chronic Hypertension, 2017). Hypertension, linked to overweight and obesity, can give rise to further complications, such as heart disease and type 2 diabetes mellitus.

What is hypertension?.

Also known as high blood pressure, this condition occurs when the blood pressure in your arteries rises above what is considered normal.

How common is hypertension?

Among individuals with obesity, nearly half (42%) also have hypertension (Wang and Wang, 2004). Hypertension is quite common; one out of every three American adults carries a diagnosis of hypertension (Merai et al, 2016).

What are the signs and symptoms of hypertension?

Usually hypertension has no symptoms and is detected on a routine blood pressure check. When symptoms are present, they can include headaches, chest pain, vision changes, a general feeling of being unwell, dizziness or lightheadedness, anxiety, or nausea and vomiting. If you are having any serious symptoms, you should call emergency services (9-1-1 in the United States) or proceed to your nearest emergency room.

How is hypertension diagnosed?

Hypertension is diagnosed by elevated blood pressure readings at your doctor’s office. You can also check it at your local pharmacy or at home, and you should notify your doctor if you find that you have high blood pressure readings (over 130/80 mm Hg). Doctors use published guidelines to determine whether you have hypertension and how it should be treated. For those aged 60 years or less with no diabetes or chronic kidney disease, the blood pressure should be less than 130/80 mm Hg. For those older than 60 years without diabetes or chronic kidney disease, the goal is less than 130/80 mm Hg. For anyone with diabetes or chronic kidney disease, regardless of age, the blood pressure should be less than 130/80 mm Hg. If your blood pressure readings are higher than these numbers, you will be diagnosed with hypertension.

How is hypertension treated?

Treating hypertension will consist of you making changes at home and taking the medications that your doctor feels are necessary for you to achieve the goals for your blood pressure. Treatment also consists of scheduled visits to have your blood pressure checked. Some medications will require routine bloodwork to monitor your electrolytes and kidney function. The changes you can make at home include eating a low-salt diet, along with a diet that is heart-

and weight-healthy. Regular exercise, at least 30 minutes per day for 5 days per week, will also help to lower your blood pressure.

Should I learn anything else about hypertension?

It is important to know that hypertension is a risk factor for two other important diseases that we discuss later in this chapter, which are coronary artery disease and cerebrovascular disease. These terms include what is commonly referred to as heart attacks (myocardial infarction) and strokes. Preventing hypertension or keeping it well managed will reduce your risk of these complications.

Coronary Artery Disease

What is coronary artery disease (CAD)?

This is when there is a buildup of plaque, which contains cholesterol, in the arteries that supply blood to the heart (coronary arteries). When the buildup causes severe narrowing (stenosis) of an artery, a heart attack can occur due to decreased blood flow to the heart. When blood flow to the arteries that supply the heart becomes inadequate, it can cause a heart attack (myocardial infarction). During a heart attack, the heart muscle does not receive enough oxygen due to a lack of blood flow, and it can be damaged or stop functioning altogether. This damage to the heart can lead to heart failure, or possibly death if it is severe.

How common is CAD?

Heart disease is the leading cause of death among American men and women. CAD is the most common type of heart disease, and every year more than 735,000 Americans suffer a heart attack as a result. Roughly 370,000 people die each year due to CAD (CDC Heart Disease Facts, 2017). The importance of these numbers lies in the fact that most of these deaths are preventable. CAD develops over many years due to risk factors as well as genetics. We can prevent or control the risk factors for CAD, which include obesity, high blood pressure, diabetes, and high cholesterol.

What are the symptoms and signs of CAD?

Chest pain is an important symptom. The pain is usually on the left side or the center of the chest. It can be intermittent and mild to moderate, or sudden and severe. Sensations of heartburn, left-sided jaw pain, left-arm pain, and upper- abdominal pain are also possible. You might also notice shortness of breath, sweating, dizziness, or lightheadedness. Not everyone with CAD has chest pain; those with diabetes and women tend to present atypically. If you believe that you might have CAD, you should inform your primary-care physician immediately. If you experience symptoms concerning for a heart attack, call emergency services (9-1-1) right away.

How is CAD diagnosed?

Your doctor might order tests (such as an electrocardiogram [EKG or ECG], an echocardiogram [an ultrasound of your heart], a stress test, and/or a cardiac catheterization [a procedure in which dye is injected into your heart to see whether the arteries supplying your heart are clogged]) for diagnosis.

How is CAD treated?

What you can do at home to prevent CAD is to eat a heart-healthy diet, keep your weight within the recommended limits, and exercise regularly, as recommended. If you have already been diagnosed with CAD or any of the diseases that are risk factors for CAD, it is still important to focus on what you eat and on your exercise levels as well as on taking all of your medications as prescribed and following-up with you doctors as scheduled. You might be placed on medications such as aspirin, blood-thinners, cholesterol-lowering medications, and other heart medications.

Is there anything else I should know about CAD?

CAD can lead to congestive heart failure (CHF), a condition that follows damage to the heart leading to inefficient function. If you or a family member is interested in more information regarding CHF, you can visit https://www.cdc.gov/

Cerebrovascular Disease

What is cerebrovascular disease?

The most common manifestation of this disorder is a stroke (cerebrovascular accident [CVA]). It is like losing blood flow to the heart in a heart attack, but it occurs in the brain, leading to a stroke. Plaques containing cholesterol can build up in the arteries that supply the brain. The plaques can cause severe narrowing of the arteries and a decrease in blood flow to the brain. These plaques can also break off and travel into the smaller arteries and become lodged there, cutting off blood flow to the part of the brain that is supplied by these arteries. 

How common is cerebrovascular disease?

Each year, more than 795,000 Americans suffer a stroke, and it is a leading cause of long-term disability in the country (CDC Stroke Facts, 2017).

What are the symptoms and signs of cerebrovascular disease?

The symptoms of a stroke include difficulty speaking or understanding what someone is saying, difficulty moving your arms or legs, facial droop, confusion or decreased alertness, numbness or tingling in your limbs, dizziness, and sudden headache. A mnemonic to help remember the main symptoms and what to do when a stroke occurs is F-A-S-T:

F – Face drooping

A – Arm weakness

S – Speech difficulty T – Time to call 9-1-1

How are strokes diagnosed?

A stroke is diagnosed by assessing symptoms along with the use of imaging studies of the brain, which include a computerized tomography (CT) scan, a magnetic resonance imaging (MRI) scan, or both.

How are strokes treated?

If you suspect that you or someone you know might be having a stroke, time is of the essence because there is a small window of time in which treatment can be given before permanent damage develops. This treatment consists of medication that can dissolve the clot that is blocking blood flow to the brain. If you are a candidate for it, it can be given only within a few hours of the start of the symptoms. Therefore, as soon as a stroke is suspected, you should call emergency services (9-1-1) immediately to be taken by ambulance to the nearest emergency room.

Is there anything else I should know about strokes?

  • Following are some additional on-line resources: National Stroke Association: https://www.stroke.org/
  • American Stroke Association: https://www.strokeassociation.org/

Thromboembolic Disease

Given its high mortality rate, thromboembolic disease (blood clots in major blood vessels), or thromboembolism, is the third most common vascular disease in the United States. 

Thromboemboli can arise from the formation of blood clots in either arteries or veins. In response to blood vessel injuries, blood clots form as clusters of aggregated platelets and red blood cells that accumulate at the site of injury; they act as plugs to prevent leakage of the vessels. However, blood clots can negatively affect blood flow by disrupting the directional flow during circulation. These clusters of platelets and red blood cells can leave the injury site and enter a different part of the circulatory system; hence, a thromboembolism (What is Deep Vein Thrombosis? 2011). Thromboembolic disease can present in arteries as arterial thromboembolism, and in veins as venous thromboembolism.

This section focuses on venous thromboembolism (VTE) and its status as a medical complication of obesity. VTE is a chronic vascular disease that involves two clinical conditions: deep-vein thrombosis (DVT) and pulmonary embolism (PE). DVT is caused by the formation of a blood clot in the veins of the legs or the pelvis. Pulmonary emboli occurs when the blood clot leaves, travels to, and blocks the pulmonary arteries, which aid in the oxygenation of blood in the lungs (Yang, De Staercke, & Hooper, 2012; Stein, Beemath, & Olson, 2005). Symptoms of VTE can range from swelling and pain to cardiac and respiratory failure and death, especially if untreated. Although VTE is considered a dangerous yet preventable disease, recent findings from a 2015 survey highlighted a relative lack of global public awareness of VTE and its associations with stroke and heart disease (Wendelboe et al, 2015). With the rising rates of obesity, it is important to improve our understanding of VTE and its link to obesity as a moderate risk factor. Studies have shown that a high BMI correlates with an increased risk of VTE (Yang et al, 2012). Additionally, obesity interacts with risk factors associated with VTE. For example, excess fat tissue in those with obesity can cause hypoxia (a decrease in oxygenation) and indirectly increases the synthesis of coagulation factors (factors that cause the blood to clot) in the circulatory system (Yang et al, 2012). An increase in coagulation can lead to more blood clots in the system. These indirect interactions between obesity (high amounts of fat tissue) and VTE can lead to PE, which are primary contributors to higher mortality rates of VTE.

Heart Disease

As the leading cause of death in the United States, heart disease is common in many Americans. According to the CDC, 610,000 people die from heart disease each year, which is a fatality rate of 1 in 4 Americans (Heart Disease Facts, 2017). As shown in Table 6-2, heart disease is also the leading cause of death for Americans of most race/ethnic groups.

This section focuses on the various heart conditions that fall under the umbrella of heart disease that can complicate overweight or obesity. These conditions involve a narrowing or blocking of the blood vessels that surround the heart (Figure 6-1), in addition to defects in the muscle, valves, or rhythm of the heart. Although some forms of heart disease can be caused by family genetics, other forms, such as CAD, can be caused by a poor diet and by a lack of physical activity, both being risk factors for obesity. CAD is the most common form of heart disease; 16.5 million Americans aged 20 years or older have the disease, and more than 370,000 people die from CAD each year (Heart Disease Facts, 2017; Wilson & Douglas, 2016). It is described as having blockages in the coronary arteries. Blocking blood flow in coronary arteries affects the level of oxygen that the heart muscle receive. When not enough oxygenated blood is pumped throughout the heart muscle, a fatal heart attack can occur.

Because we now know that heart disease is caused by the narrowing or blockage of a coronary artery, let’s dive deeper in understanding how these blockages occur. According to the National Health and Nutrition Examination Survey (NHANES) and the CDC, approximately half of American adults have at least one of three major risk factors for CAD, including hypertension (high blood pressure), high cholesterol, or cigarette smoking (Heart Disease Facts, 2017; Fryar et al, 2012). As stated in the section “Hypertension” earlier in the chapter, diets high in salt and cholesterol can contribute to high blood pressure, which can lead to further blockages of blood vessels. In tandem with the plaque buildup from cigarette smoking, these three factors can lead to untoward physical changes in a person’s body weight. Other risk factors for heart disease include diabetes mellitus, alcoholism, a poor diet, and a sedentary lifestyle.

Because having these conditions intensifies their association with overweight or obesity, they simultaneously increase the risk of CAD or other forms of heart disease (narrowing arteries) as potential complications (Heart Disease Facts, 2017; Wilson & Douglas, 2016; Fryar et al, 2012).

The influence of overweight and obesity on heart disease has been further examined in studies that have verified the link between the BMI of people with overweight and obesity and the risk factors for heart failure and disease. Results from these studies have confirmed correlations between a higher BMI and an increase in the likelihood that one will develop heart failure. 

Specifically, obesity was linked to defects in the heart muscle, as the muscle tissue increased in size due to higher blood pressures needed by the heart to pump blood (Kenchaiah et al, 2002). As the BMI of people enters into classes of overweight and obesity (BMI: 25–29.9 [overweight]; 30–34.9 [Class I obesity: mild]; 35– 39.9 [Class II obesity: moderate]; ≥40 [Class III obesity: severe]), their risk of heart disease dramatically increases. Unfortunately, the risk of heart disease is associated with many conditions (e.g., hypertension, sleep apnea, type 2 diabetes mellitus), which we cover next.

Which Pulmonary Conditions Are Worsened by Obesity?

Sleep Apnea

Sleep apnea is a chronic sleep disorder marked by repeated awakenings during a person’s sleep. There are three types of sleep apnea: obstructive, central, and complex (Sleep Apnea, 2015). Obstructive sleep apnea (OSA) is caused by the relaxation of throat muscles, which obstruct the breathing pathway during sleep. Central sleep apnea is caused by the brain’s inability to send signals to the muscles that control breathing. Complex (or mixed) sleep apnea is a combination of obstructive and central sleep apnea (Sleep Apnea, 2015; Strohl, 2016). OSA is the most common type of sleep-related breathing disorder. It is considered a serious condition due to its complications, which include an increased risk of heart disease and hypertension. 

OSA can range from mild, moderate, to severe, based on the number of loss-of-breathing (apneic) episodes that a person experiences. Currently, nearly half (45%) of adults and children (46%) with obesity suffer from OSA (Romero-Corral et al, 2010). Like hypertension, obesity is a risk factor for OSA given that the prevalence of OSA increases with higher BMI values of obesity (Strohl, 2016; Romero-Corral et al, 2010).

The relationship between OSA and obesity is complex. The increased fat tissue that is present in those with obesity can surround and disrupt the breathing pathways, leading to OSA. 

However, complications of OSA, such as increased appetite and decreased energy levels, can be driving factors for developing obesity (Romero-Corral et al, 2010). Genetic factors are suggested to influence the interaction between both conditions. Further studies can provide more conclusive evidence on the cause-and-effect relationship between OSA and obesity. In terms of treating OSA, continuous positive airway pressure (CPAP) therapy is the most common treatment. CPAP therapy requires that those with OSA be attached to a ventilator (breathing machine) while they are asleep; this device applies air under pressure and keeps the breathing pathways open while the person is sleeping. Weight loss and bariatric surgery in those with obesity and OSA has also been effective in reducing the severity of OSA; this often leads to the reduction of other risk factors (Strohl, 2016; Romero-Corral et al, 2010).

OSA

What is OSA?

OSA is a breathing disorder that occurs during sleep, and it can cause you to stop breathing (apnea) episodically while you sleep. Obstruction in the back of your throat is the underlying cause, and this occurs more in people with obesity because they tend to have more tissue in the back of their throats. When the tissues in the throat relax during sleep, the airway becomes blocked. There can be other reasons for obstructions in the throat (such as enlarged tonsils and adenoids); however, obesity is the most common cause of sleep apnea in adults.

How common is OSA?

OSA is estimated to affect 3% to 7% of adults in the United States (Punjabi, 2008) and approximately 1% to 4% of children (Lumeng and Chervin, 2008).

What are the symptoms and signs of OSA?

OSA is suspected when you have a combination of the following symptoms or signs: snoring, insomnia, fatigue or daytime napping, high blood pressure or high blood counts (hemoglobin and hematocrit), a large neck size (shirt collar greater than 16 inches), a large tongue, or apnea (if someone has noticed that you stop breathing intermittently while sleeping). You might also experience waking up and choking, snorting, coughing, or gasping for air. When there is decreased oxygen to the lungs, the heart compensates by working harder to deliver more blood to the body. This in turn can lead to high blood pressure.

How is OSA diagnosed?

The diagnosis is made with a sleep study, called a polysomnogram, that can be ordered by your primary-care physician. During this test, you are monitored overnight for signs of OSA.

How is OSA treated?

If obesity is a cause of your OSA, weight loss will be part of your treatment plan, and it might be a solution, because OSA can be reversed. As long as you have OSA, you might need to use a sleep machine such as the aforementioned CPAP or a Bilevel Positive Airway Pressure (BiPAP) machine during sleep. This machine pushes air into and/or out of your lungs to help them expand fully. It is important to supply oxygen to, and remove carbon dioxide from, the blood. Addressing your weight as an underlying factor for OSA is key because this can reverse OSA.

Is there anything else I should know about OSA?

If OSA is left untreated, it can lead to high blood pressure and an elevated heart rate, which can place excess strain on the heart. Over time, the increased work load on the heart can lead to heart failure. OSA can also lead to a higher risk of CAD, stroke, diabetes, and premature death. The lungs can also be strained, leading to a condition called pulmonary hypertension (increased pressure in the pulmonary arteries), which can also lead to heart failure.

Obesity Hypoventilation Syndrome

What is obesity hypoventilation syndrome (OHS)?

Also known as Pickwickian syndrome, this is a disease in which the excess weight on the outside of the body restricts the lungs from expanding completely. When the lungs cannot expand completely, they cannot perform the function of exchanging oxygen and carbon dioxide effectively. This leads to an accumulation of carbon dioxide and a decrease in oxygen supply to the blood.

What are the symptoms and signs of OHS?

Fatigue, loss of energy, shortness of breath, daytime sleepiness, snoring while sleeping, or pauses in breathing can be present.

How is OHS diagnosed?

If you feel that you might have OHS, you should be evaluated by your doctor. Your doctor will likely want to know about your sleeping habits as well as the levels of oxygen and carbon dioxide in your blood. A polysomnogram might also be ordered.

How is OHS treated?

As is the case with OSA, weight loss is key. CPAP or BiPAP machines might also be used to ensure an adequate oxygen supply and carbon dioxide removal.

Is there anything else I should know about OHS?

Is it important to know if you have OSA or OHS because they can be risk factors for complications during procedures or surgeries that require anesthesia. You might need more assistance with breathing during or after surgical procedures.

Which Endocrine/Metabolic Conditions Are Worsened by Obesity?

Type 2 Diabetes Mellitus

What is type 2 diabetes mellitus? Type 2 diabetes mellitus occurs when the body becomes resistant to the effects of insulin. Insulin is the hormone that our body produces to reduce levels of glucose (sugar) in our blood. It usually works on the muscles and other tissues in the body to help them utilize the sugar circulating in the blood. Fat buildup in the blood causes resistance to the effects of insulin, and then the tissues cannot take sugar out of the blood like they are supposed to, which leads to high sugar levels in the blood. Over time, uncontrolled high sugar levels in the blood can damage the circulatory system, which can contribute to vision loss, heart attacks, strokes, limb loss, and damage to the kidneys and nerves. It also affects the immune system, leading to more frequent infections and impairments in healing after injuries.

How common is type 2 diabetes?

Type 2 diabetes is a disease of obesity, and as such, rates have increased along with obesity rates in the United States. Type 2 diabetes is very common, effecting more than 29 million people in the United States, and an estimated 422 million people globally! (National Center for Chronic Diseases, 2017; WHO, 2017).

What are the symptoms and signs of type 2 diabetes?

Symptoms of diabetes include increased thirst, increased urinary frequency, and increased amount of urine production.

How is type 2 diabetes diagnosed?

In your blood work, an HbA1C level greater than 6.5% or a fasting blood sugar level greater than 126 on two separate occasions is used to diagnose diabetes.

How is type 2 diabetes treated?

Depending on your blood sugar levels, your doctor might treat you with diet and exercise, or this combination along with (oral or injectable) medications and/or insulin. You will also be placed on a baby aspirin each day, as a preventive measure against cardiovascular disease. Your doctor will likely add an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) medication to your regimen. These are blood pressure medications, but they are also given to people with diabetes to help protect their kidneys. If your cholesterol is high, your doctor will start you on a medicine to help lower your cholesterol (generally a medication known as a statin). You might not receive some of these medications if you are not able to take them for specific reasons.

Is there anything else I should know about type 2 diabetes?

Keep in mind that it is the high blood sugar levels in diabetes that cause the damage. If you are already a diabetic, don’t worry! The key is to prevent the complications of diabetes. You can do this by keeping your blood sugar levels within the recommended levels. And, you can achieve this by taking your medicines as prescribed, following a diabetic diet, exercising regularly, and following up with your doctor to ensure that you are being monitored for any of the aforementioned complications.

Diabetes doesn’t develop overnight, Rather, it usually takes many years to develop. The good thing about this is that you can prevent it by tackling the issues that lead to obesity. If you already have diabetes, there are measures that you can take to improve or reverse it if you are in the early stages. If you think that you might have diabetes, make an appointment with your doctor and be sure to express your concerns.

Hyperlipidemia

What is hyperlipidemia?

This is when there is elevated cholesterol or triglycerides in the blood.

How common is hyperlipidemia?

It is very common; more than 73.5 million American adults have elevated low-

density lipoprotein (LDL, the “bad cholesterol”) levels. What are the symptoms and signs of hyperlipidemia?

Usually there are none. High cholesterol is usually found on routine blood work; however, if cholesterol levels are severely elevated, there can be physical manifestations due to fatty deposits in the body, especially when the cholesterol level is greatly elevated. These deposits or physical manifestations include xanthomas or xanthelasmas.

How is hyperlipidemia diagnosed?

It is diagnosed with blood work, specifically a lipid panel that is ordered by your doctor. The lipid panel will show the levels of different fats in your blood, including total cholesterol, high-density lipoprotein (HDL, or “good cholesterol”), LDL, and triglycerides. Adults who have not been diagnosed with hyperlipidemia should still have their levels checked at least once every 5 years.

How is hyperlipidemia treated?

Your doctor will determine the right treatment for you based on your risk factors. If you don’t have many risk factors, your doctor might try a trial of diet and exercise to bring your cholesterol levels down. If your doctor recommends a prescription medication, you should still continue a good diet and exercise regimen. The first-line medication for high cholesterol and triglycerides is a statin medication. If you are already on a statin medication, your doctor might be following your cholesterol closely to see whether you need adjustments in your dose. If you cannot tolerate a statin for any reason, there are alternative medications that your doctor can prescribe. If you have high triglycerides only, your doctor might also recommend fish-oil supplements. You should check with your doctor before starting any over-the- counter medications because they could interfere with your prescription medications.

Is there anything else I should know about hyperlipidemia?

The most important thing to know about hyperlipidemia is that it is a risk factor and contributor to several other conditions such as heart attacks and strokes. If you have a strong family history of hyperlipidemia, you should inform your doctor so that he or she can check your lipids and monitor you more closely.

Metabolic Syndrome

Metabolic syndrome is not an individual disease. Rather, it is a collection of the following diseases: hypertension, high blood glucose levels, elevated cholesterol levels, and obesity (specifically excess weight around the waist). This syndrome is important because having this collection of diseases significantly increases your risk of heart attacks and strokes.

Type 2 Diabetes Mellitus

Like heart disease, diabetes mellitus (usually shortened to diabetes) is a common and chronic condition that affects many Americans; it is often considered one of the most challenging complications of obesity. When the term “diabetes mellitus” is broken down, “diabetes” in Greek means “to pass through,” and “mellitus” in Latin means “sweet,” which accurately describes the “high sugar” levels in the blood associated with diabetes. Diabetes mellitus involves the dysfunctional interaction between our bodies and the insulin hormone during digestion. When we ingest and process food, our bodies break down the food into glucose (sugar) molecules, which are vital energy sources for our organs, tissues, and cells. An organ called the pancreas, which lies adjacent to the stomach, produces and releases insulin into the bloodstream in the presence of

glucose. Insulin signals cells in the body to absorb the glucose molecules produced by food breakdown, which is used for energy (Diabetes, 2017). People with diabetes have difficulty producing or releasing insulin, causing glucose to stay in the bloodstream, yielding high blood glucose (sugar) levels. The two most common types of diabetes are type 1 and type 2 diabetes mellitus. Type 1 diabetes involves the body’s immune system, which is responsible for protecting the body from foreign pathogens; in this condition, the body attacks its own pancreas cells that produce insulin. This results in the body’s inability to make insulin, leading to high blood sugar levels. Type 1 diabetes is usually diagnosed early in life, in children and adolescents, and requires insulin injections to maintain proper glucose levels (What is Diabetes? 2016).

Type 2 diabetes, the obesity complication we are focusing on here, accounts for most of the diagnosed diabetes cases in the United States. It can be acquired during childhood or adulthood. The cells in the person with type 2 diabetes resist the effects of insulin, leading to a failure to absorb or store glucose. This inability can cause increased glucose levels in the bloodstream, which increases the demand for more insulin to be produced by the pancreas. Eventually, insulin- producing cells become exhausted, leading to an overall decreased amount of insulin released (Diabetes, 2017; What is Diabetes? 2016). Figure 6-2 further depicts this interaction. Diagnoses for type 2 diabetes and pre-diabetes (the precursor stage of type 2 diabetes) are made through either a fasting or random blood glucose (sugar) test, which measures the glucose concentration from a drawn blood sample. A fasting glucose test is typically done in the morning on an empty stomach (that is, without having eaten), whereas a random glucose test can be done at any time during the day (Diabetes, 2017). Blood glucose (sugar) level readings are read in milligrams per deciliter (mg/dL) and can indicate type 2 diabetes (≥126 mg/dL in a fasting sample, or 200 mg/dL in a random sample), pre-diabetes (100–125 mg/dL on a fasting test or 140–200 mg/dL on a random test), or normal levels (<100 mg/dL on a fasting test or <140 mg/dL on a random test) (Managing Diabetes, 2017). Additionally, a hemoglobin A1C lab test is given to those with diabetes two to four times each year to determine how effectively people are managing their condition. The A1C test can measure your average blood glucose (sugar) levels for the past 2 to 3 months. Specifically, this test measures the amount of glucose that attaches to the hemoglobin molecules of red blood cells. The A1C levels can be associated with a diagnosis of type 2 diabetes (6.5% or higher) or pre-diabetes (5.7%–6.4%). Therefore, the higher the A1C levels, the higher the glucose levels are in both the bloodstream and in the hemoglobin (Managing Diabetes, 2017).

Pre-diabetes and type 2 diabetes are chronic conditions that affect more than 11% of Americans aged 20 years or older (Eckel et al, 2011). Non-variable factors (e.g., race, age, genetics) can affect the likelihood that a person will develop type 2 diabetes, but poor habits (e.g., an unhealthy diet, inadequate physical exercise) are major contributors, as well. Excess weight (with a high BMI) is an established risk factor for type 2 diabetes, given that an increase in fat tissue can result in the insulin resistance that is common in those with diabetes. Although there is currently no cure for this condition, researchers have been able to understand more fully the exact mechanisms involved in both type 2 diabetes and obesity. The excess adipose (fat) tissues in patients with overweight or obesity release certain hormones and proteins that directly induce their bodies’ cells to be resistant to insulin. This resistance can then contribute to the decreased uptake of glucose by those cells (Eckel et al, 2011; Kahn et al, 2006). Common symptoms associated with type 2 diabetes include frequent thirst and urination, fatigue, numbness in the hands and feet, blurry vision, and an inability to heal wounds properly (Managing Diabetes, 2017). These symptoms negatively affect a person’s quality of life.

Fortunately, lifestyle changes (e.g., healthy diet, increased exercise), insulin therapy, taking prescribed medications, and weight-loss surgery are proven to be effective in preventing, managing, and even reversing the insulin resistance/type 2 diabetes associated with obesity. Early detection and immediate management can greatly reduce the negative impact of these chronic conditions, in addition to preventing further development of health issues associated with obesity and type 2 diabetes (such as heart disease and strokes). For patients with refractory, or unmanageable, type 2 diabetes, weight-loss surgery is the best tactic for improved glucose control or for complete remission of the disease (Surgery for Diabetes, 2017).

Which Musculoskeletal Conditions Are Worsened by Obesity?

Arthritis

The progression of arthritis in patients with overweight and obesity is common. Although this major obesity comorbidity is prevalent, arthritis is not well understood by the public. There are multiple types of arthritic conditions, but arthritis is generally defined as inflammation (swelling) and pain in the joints (i.e., the spaces between bones). In this section, we focus on osteoarthritis. Osteoarthritis is the most common type of arthritis, affecting more than 30 million adults in the United States (Zhang and Jordan, 2010). The prevalence of symptomatic osteoarthritis can vary based on the specific joint (e.g., the knee, hand, hip) studied, but prevalence rates will likely increase due to the obesity epidemic. Globally, 10% of men and 18% of women older than age 60 suffer from osteoarthritis (Zhang and Jordan, 2010).

Osteoarthritis is characterized by the degradation of cartilage, the layer of tissue that lines the joints of our bones. As the cartilage within joints break down, the bones between the joints rub against each other; this can lead to pain and inflammation (Kane, 2017). Osteoarthritis can be caused by increased stress placed on the joints, creating consistent wear-and-tear damage in the cartilage. Excess weight associated with obesity might play a role in the increased stress within joints that leads to osteoarthritis. In American adults with arthritis, obesity is 54% more prevalent compared to adults without arthritis, resulting in a positive association between a high BMI and arthritis (Kane, 2017; Hottman et al, 2011). Each pound obtained from excess weight can provide an extra four pounds of pressure in major joints, like the hips and the knees (Kane, 2017). The pressure and arthritic pain placed in knees and hips of patients with overweight or obesity can lead to a need for surgical replacement of these joints (to improve function and alleviate pain). Due to the increased sensitivity in arthritic-induced

strained joints, health-care providers typically advise strength-building physical therapy for patients with both conditions, to properly promote joint health and weight loss. Arthritis can be a difficult barrier to overcome for those with obesity. An individualized and properly managed weight-loss approach allows you to take significant steps to overcome both chronic conditions.

Osteoarthritis

What is osteoarthritis?

This is a type or chronic arthritis that develops after long periods of wear and tear or trauma to the cartilage (a type of tissue) in the joints. Commonly involved areas are the back and knees. Excess body weight will place an excess load on many joints of the body. If your joints are holding more weight than they were designed to, this will lead to eventual wear and tear in the long run.

How common is osteoarthritis?

Osteoarthritis is the most common joint disorder in the United States. It affects 10% of men and 13% of women ages 60 and older.

What are the symptoms or signs of osteoarthritis?

You might have chronic pain in the affected joint, that can be worse when you use that joint more. Sometimes, there is swelling of the joint and difficulty moving it due to pain or stiffness.

How is osteoarthritis diagnosed?

It is usually diagnosed by symptoms along with X-rays.

How is osteoarthritis treated?

Osteoarthritis is not reversible, so controlling pain from the disease and preventing further damage are the main focus of treatment. Pain control is a step-up therapy and is individualized to each person. Pain control usually involves several different therapies including rest, heat or ice, physical therapy, topical agents, over-the-counter analgesics or anti-inflammatory medications, or prescription pain medications. When osteoarthritis is severe and debilitating, your doctor might refer you to an orthopedist for steroids or hyaluronic acid injections into the joint, or for joint replacement surgery. Preventing further injury is the goal of the exercise that you will do to lose weight; this will also help your joints strengthen and improve your mobility, so it’s more reason to put on your exercise gear and get going!

Gout

As you just read in the previous section, osteoarthritis is described as a condition characterized by the degradation of cartilage that lines one’s joints. Another type of arthritis is inflammatory arthritis, which is marked by inflammation of the joints, which leads to pain, swelling, and stiffness. Gout is one type of inflammatory arthritis, and it is the most common form of inflammatory arthritis in adult men in the United States (Cho et al, 2005). According to a 2007–2008 NHANES report, approximately 4% of American adults have gout, with a significantly higher incidence and prevalence found in men as compared to women (Kuo et al, 2015). Gout is caused by elevated levels of uric acid in the bloodstream, which can lead to the formation and accumulation of uric acid crystals in the joint spaces. The presence of uric acid crystals in joints can trigger painful inflammatory attacks, which can be worse for people with overweight or obesity.

To understand how gout attacks occur, we must understand the disease and its association with obesity. Uric acid is a byproduct of the breakdown of purine compounds in the liver (Choi et al, 2005). Purine compounds are either synthesized naturally in the body or ingested in our food. They are found in high concentrations in specific meats and seafood. Thus, diets high in meat and seafood are often associated with high uric acid concentrations in the bloodstream. Normally, uric acid is filtered by the kidneys and excreted through the urine. However, excess adipose (fat) tissue can slow down the filtration of uric acid by the kidneys, elevating uric acid levels in the bloodstream and potentially causing gout attacks (Kane, 2017; Choi et al, 2005).

Excess weight can also cause kidney dysfunction due to its role in insulin production. As mentioned in the section “Type 2 Diabetes Mellitus” earlier in the chapter, excess weight can induce insulin resistance in the body’s cells, which leads to elevated levels of both blood glucose and insulin levels (Kahn et al, 2006). The high levels of insulin in the circulation inhibit the proper filtration and excretion of uric acid by the kidneys (Becker, 2016). In summary, excess adipose (fat) tissue in the body due to overweight or obesity plays an important role in insulin resistance, which indirectly leads to high uric acid levels and to the presentation of gout. Thus, it is important to identify and treat any of the underlying conditions (obesity or type 2 diabetes) that might contribute to the gout attacks (Becker, 2016).

What is gout?

Gout is also a type of arthritis, but it is different from osteoarthritis in many ways. The mechanism behind gout involves formation and deposit of uric acid crystals into the joints. Uric acid is the product of the breakdown of purines in the body. Purines are found in high amounts in organ meats, red meats, and seafood, which are consumed in higher amounts in Western diets. Alcohol, especially beer, also raises uric acid levels in the blood, and this also tends to be consumed in higher amounts in the Western diet. Therefore, obese patients have a higher incidence of gout. The first joint often affected is the big toe, a condition called podagra. Other commonly affected joints include the elbows and knees.

What are the symptoms and signs of gout?

Gout usually presents as acute episodes called gout flares or “attacks” in which there is redness, increased warmth, swelling, and significant pain in one or more joints. The most commonly affected joints are in the toes, other joints in the foot, ankles, knees, and elbows. The pain can cause inability to use the joint.

How is gout treated?

You should avoid foods that can lead to gout (organ meats, red meats, and seafood), and alcohol as much as possible. Changing your diet can prevent gout attacks, and this should be something you do along with taking medications that your doctor recommends. Your doctor will prescribe certain anti-inflammatory medications or a steroid injection into the affected joint during a flare. If you have more than a few attacks a year, your doctor will put you on a daily maintenance medication to prevent future gout flares. This is important because recurrent gout flares can damage the joints and lead to chronic arthritis and pain. If you experience what you believe is a gout flare, you should see a doctor immediately to first make sure it is gout and to get treatment quickly. Another condition, called septic arthritis (infection of a joint), can look like gout, but have serious consequences if it is not recognized promptly.

Which Gastrointestinal Conditions Are Worsened by Obesity?

Cholelithiasis

What is cholelithiasis?

This is when gallstones form in the biliary system (organs and ducts that make, store, and secrete bile). The part of the biliary system they most commonly form in is the gallbladder, which is an organ located just under the liver. Obesity significantly increases the risk of developing cholelithiasis. Gallstones are partially made of cholesterol, and obesity increases the formation of them.

How common are gallstones?

It is estimated that about 20 million adults (Everhart & Ruhl, 2009) and about 2% of children (Wesdorp et al, 2000) in the United States have cholelithiasis.

What are the symptoms and signs of gallbladder disease?

Gallstones often sit undetected. When a gallstone causes inflammation of the gallbladder or blocks the duct that leads out of the gallbladder, it can lead to symptoms, such as upper-right or middle abdominal pain, nausea, and/or vomiting. This pain can be noticeably worse after eating. If you notice symptoms like these, make an appointment with your doctor immediately. If your symptoms are severe, or you cannot keep food or water down, go to the emergency room immediately.

How are gallstones diagnosed?

Gallstones can be diagnosed with an ultrasound of your gallbladder. If gallstones are not clearly seen on the ultrasound, further testing, such as with a hepatobiliary iminodiacetic acid (HIDA) scan, might be needed.

How are gallstones treated?

Treatment will depend on the level of disease you have as well as whether the gallstones are causing symptoms. If the gallstones are not causing symptoms, your doctor will likely opt for routine follow-up and monitoring of symptoms. If the gallstones are causing symptoms, you will likely need your gallbladder removed by a surgical procedure, called a cholecystectomy.

Is there anything else I should know about gallbladder disease?

When cholelithiasis leads to inflammation of the gallbladder, it is called cholecystitis. Cholecystitis is a condition that requires urgent evaluation and treatment, which can include medications and/or surgery. Cholelithiasis is also a risk for pancreatitis, which is an acute inflammation of the pancreas.

Non-Alcoholic Fatty Liver Disease

The liver, one of the largest organs in the body, is responsible for the metabolic break-down of nutrients such as fat (fatty acids), carbohydrates, and proteins. The liver also receives toxic substances from the blood and detoxifies them into harmless substances that can properly be excreted from the body. Abnormalities in the liver’s metabolic functions can lead to a variety of conditions, including non-alcoholic fatty liver disease (NAFLD). NAFLD is characterized by a buildup of extra fat in liver cells due to the liver’s difficulty in breaking down those fats. A diagnosis of NAFLD is made when up to 10% of the liver’s weight is composed of fat. When the rate of fat uptake is greater than the rate of fat breakdown and release by liver cells, fats accumulate and cause abnormalities in the metabolic functions of the liver (Fabbrini et al, 2010).

NAFLD is the most common chronic liver condition in the United States, and it is highly influenced by excess weight and by a high BMI (Fabbrini et al, 2010). Recent studies reveal that NAFLD affects nearly one-third (30%) of the general population of Western nations. NAFLD occurs in every age and race group, but it is more commonly found in middle-aged men (40–50 years old) with overweight/obesity. Rates of NAFLD are also higher in African-Americans (48.3%) compared to rates in Caucasians (32.1%) and Hispanics (17.5%) (Le et al, 2017; Lopez-Velazquez et al, 2014). Although persons with NAFLD often lack prominent symptoms, the chronic condition is associated with a high mortality rate due to its associated risk factors, such as cirrhosis of the liver (permanent damage to liver cells), coronary artery disease (CAD), and type 2 diabetes (insulin resistance).

NAFLD is exacerbated in those with overweight or obesity. We know that obesity is notable for excess adipose tissue throughout the body. This excess fat tissue releases extra fatty acid molecules that trigger an increased uptake of fat into the liver (Fabbrini et al, 2010). An increase in liver fat contributes to defects in fat metabolism, which leads to fat accumulation (NAFLD) and other adverse medical consequences. Like many of the complications previously discussed, NAFLD is treated by targeting the underlying disease, which is obesity, through therapies (e.g., eating a healthy diet, exercising regularly, taking prescribed weight-loss medications, undergoing weight-loss surgery [the most effective for the treatment of severe obesity]) that lead to weight loss (Sasaki et al, 2014).

What is NAFLD?

NAFLD is what develops when fat builds up in the liver without any relationship to alcohol.

How common is NAFLD?

It is very common, estimated to affect nearly 30% of adults in the United States and nearly 80% to 90% of adults with obesity. NAFLD is reported to be as high as 70% in children with obesity (Bellentani et al, 2010).

What are the symptoms and signs of NAFLD?

There might be none early in the disease. Sometimes, people feel pain in the upper-right side of their abdomen, and your doctor might feel that your liver is large. In advanced stages, you can have yellowing of the skin or eyes (known as jaundice), swelling in your abdomen or legs, fatigue, and breast enlargement (in men).

How is NAFLD diagnosed?

Because there are usually no symptoms, the condition might first be suspected through abnormalities of liver tests on routine blood work. These abnormalities will prompt your doctor to order further tests, which will include an ultrasound of your liver. Other tests might follow, including more blood work, or further imaging with a CT scan, MRI scan, or more advanced testing. If these tests do not help to make the diagnosis, a liver biopsy might be needed.

How is NAFLD treated?

Treatment will depend on the stage of your disease. Weight loss is recommended if you are overweight or obese. You will also need to protect your liver from harmful substances such as alcohol. Your doctor will recommend medication if you need it for treatment of high cholesterol levels or diabetes, which can contribute to NAFLD. If you are in advanced stages of the disease, you might need a liver transplant.

Is there anything else I should know about NAFLD?

NAFLD can lead to non-alcoholic steatohepatitis (NASH) (i.e., inflammation of the liver), cirrhosis (permanent damage to the liver leading to dysfunction), or hepatocellular carcinoma (liver cancer).

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a naturally occurring process in which the gastric content from the esophagus is regurgitated back into the esophagus (food pipe), as shown in Figure 6-3 (Marks, 2017). As a brief review, the esophagus and stomach are part of the digestive system. Normally, chewed food travels down from the throat to the muscular esophageal tube into the stomach, which releases an acidic solution of gastric juice that aids in food digestion. Although gastroesophageal reflux is a normal process, it becomes a disease (GERD) when the reflux occurs regularly, causing damage to the esophageal lining and producing a painful burning feeling in the chest that is typically called heartburn (Definition & Facts for GER and GERD, 2017).

GERD is a chronic digestive disease that is diagnosed in approximately 20% of the United States population, with a similarly high prevalence in both white and black races (Definition & Facts for GER and GERD, 2017). GERD greatly affects a person’s quality of life due to the persistent irritation and reflux that can occur after every meal, with feelings of heartburn lasting from minutes to hours. GERD is also a potential co-morbidity for those with overweight or obesity. Persons with an increased distribution of adipose tissue around their abdomen have an increased likelihood of having GERD because the surrounding body fat can increase the pressure on the stomach, which can lead to movement of the stomach’s contents into the esophagus (Kahrilas, 2016). Recent studies have also demonstrated that weight gain, even in normal-weight individuals, increased the likelihood of GERD, regardless of one’s BMI (El-Serag, 2008). Continuous heartburn and acid reflux into the esophagus can lead to other conditions, such as the development of ulcers (holes in the digestive lining) and esophageal cancer. Like many of the complications previously discussed, the causal relationship between obesity and GERD suggests that treatments that target both chronic conditions (e.g., behavioral changes, weight-loss surgery) will be effective (Kahrilas, 2016; El-Serag, 2008; El-Hadi, 2014).

What is GERD?

More commonly known as “heartburn,” this is when there is reflux of the contents of the stomach, including acid traveling back into the esophagus. Obesity and the so-called “Western diet” are the main causes of this disease.

How common is GERD?

Heartburn is a very common complaint at the doctor’s office. GERD is thought to be linked to Western diets, as is obesity, and many obese patients experience GERD. It affects approximately 18% to 28% of the adult population in the United States (El Seraj et al, 2014).

What are the symptoms and signs of GERD?

Symptoms can include a burning sensation in your chest or throat, a sour taste or sensation that there is something in the back of your mouth, coughing (without producing phlegm), hoarse voice, sore throat, feeling acid or food coming up into your mouth, difficulty or discomfort with swallowing.

How is GERD diagnosed?

Your doctor will usually diagnose GERD based on your symptoms. The doctor might do a trial of antacid medications to see whether they improve your symptoms. Occasionally, further testing is needed for a diagnosis, such as a pH monitoring test or an esophagogastroduodenoscopy (EGD or upper endoscopy).

What is the treatment for GERD?

Because GERD is related to the “Western diet” and lifestyle, changing these are of utmost importance in the treatment and cure of this disease. These changes include avoiding caffeine, alcohol, greasy foods, and any other foods that trigger heartburn for you. Keeping a food diary can help you identify these foods. You should try to lose weight, eat small meals, avoid eating at least a few hours before bedtime, and avoid laying down after meals. Treatment will depend on your symptoms and can consist of a step-up treatment from common fast-acting antacids, to histamine (H2) blockers, to proton pump inhibitors. These are all available over the counter in some form now; however, you might need a prescription-strength medication to control your symptoms. It is important to follow-up with your doctor to make sure your symptoms are controlled and that you do not need further testing.

Is there anything else I should know about GERD?

Smoking also contributes to GERD, so if you’re a smoker, this is another reason for you to quit. GERD is important to recognize and treat because untreated, it leads to the esophagus being exposed to the acid from the stomach for long periods of time, which can lead to pre-cancerous changes in the esophagus. This is called Barrett’s esophagus, which requires regular follow-up with EGDs to make sure there isn’t progression to cancer.

Which Oncologic (Cancer) Conditions Are Linked with Obesity?

The word cancer can strike us with fear, and most of us probably know someone who has had cancer. It is important to know that although obesity is a risk factor for many cancers there are many other contributors, including tobacco use, alcohol use, genetics, and more. The best thing you can do is cut down on the risk factors that you can control.

To go into the details of each of the cancers that obesity is linked to is beyond the scope of this book. It is, however, important to note the significant link between obesity and cancer and understand that excess fat in the body can influence cancer growth. Table 6-3 presents a chart that lists some of the known cancers linked to obesity.

Endometrial Cancer

In the female human body, the uterus (womb) is the reproductive organ located in the pelvic cavity. The uterus receives a fertilized egg that later develops into a fetus, which exits the womb through the vaginal canal upon childbirth. The inner layer of the uterus is composed of an epithelial tissue called the endometrium. An increase in the proliferation (division) of endometrial cells can be a sign of endometrial cancer, given that cancer is typically marked by high cellular proliferation (Plaxe and Mundt, 2016). Endometrial cancer is currently the fourth most common cancer in women, and it is a strongly established complication of obesity. Endometrial cancer mainly affects women 60 years or older (post- menopausal), with a higher prevalence seen in Caucasian women. According to the American Cancer Society, there were more than 60,000 endometrial cancer diagnoses made in 2017, with an estimated fatality count of 10,920 patients in the same year (Key Statistics for Endometrial Cancer? 2017). Multiple studies have determined that there is a positive correlation between an increase in BMI and an increase in a woman’s risk for developing endometrial cancer (Schmandt et al, 2011). The factors that are associated with obesity and endometrial cancer involve changes in certain hormone levels, specifically, estrogen, a hormone that promotes the growth of the uterine endometrium lining. Although female reproductive organs are abundant normal sources for estrogen, adipose tissue can also produce estrogen, further inducing endometrial growth (Schmandt et al, 2011). Additionally, insulin resistance, which was previously mentioned to have been linked with excess fat tissue and type 2 diabetes, often leads to an increase in insulin in the bloodstream. Elevated insulin levels can indirectly increase proliferation of endometrial cells (Key Statistics for Endometrial Cancer? 2017). Estrogen and insulin play vital roles in promoting natural endometrial growth, but an increase in adipose tissue due to overweight or obesity can negatively alter the rate of growth to the extent that erratic growth can lead to endometrial cancer. Effective therapies that can prevent endometrial cancer caused by obesity include use of oral contraceptives (that regulate estrogen levels), anti-diabetic medications (that lower the cancerous impact of insulin resistance), and behavioral changes (Plaxe and Mundt, 2016; Schmandt et al, 2011).

Other Complications

Besides the medical complications we mentioned, obesity increases your risk of complications if you need surgery for any reason. There are increased risks with getting anesthesia, and with having a complication during or after surgery. Infections, risk of bleeding, and risk of clots after surgery all increase with obesity. Therefore, many doctors require that you be under a certain BMI to even perform a surgery, unless it is an emergency. If you need emergency surgery, there is not much you can do to control this; however, most of us should anticipate that we might need surgery at some point in our life for various reasons, so decreasing your risk beforehand for a better outcome is the goal.

Reproductive Issues

We do not go into details regarding the reproductive organ system, but it is important to know that in men, obesity is linked to erectile dysfunction. In women, it is related to infertility as well as to higher rates of pregnancy complications (including elevated blood pressures and diabetes during pregnancy and Cesarean-sections). Babies of obese mothers have higher rates of health problems during and after birth. Knowing this will give you the power of foresight and make weight loss a central part of your pre-pregnancy planning. If you are planning on becoming pregnant, it is advised that you have a pre-natal appointment with your obstetrician so that you can discuss ways to improve your pre-pregnancy health, for you and your future baby.

What Problems Arise with Anesthesia in Those with Obesity?

When treating obesity, behavioral changes in diet and exercise are commonly prescribed, as these should be the core of any program to achieve and/or maintain a healthy weight. Bariatric (weight-loss) surgery is becoming an increasingly popular alternative method for promoting weight loss in those with moderate to severe obesity, and it might reverse many co-morbidities of obesity. However, patients with obesity can have challenges when responding to anesthesia. Specifically, the physiological changes associated with obesity (like increased respiratory rate, increased total blood volume for circulation, and increased total body weight) often leads to a need for a higher dosage of anesthetic drugs administered, with concomitant increases in the amount of oxygen and blood that are needed during surgery (Schumann, 2016). For example, those with both obesity and obstructive sleep apnea (OSA) might have breathing problems (hypoventilation) during operations. Therefore, the increased sensitivity to long-acting sedatives by those with obesity is another challenge in surgery. Proper (and individualized) planning of the anesthesia (general or local) must be done to prevent the occurrence of any problems linked with anesthesia in those with obesity. If you have obesity and OSA, it is important to make sure that your OSA is well treated prior to general surgery.

Treatment of Obesity

To achieve and remain at a healthy weight is the purpose of obesity treatment. The overall health of the population is improved as well as the risk of developing obesity-related complications is reduced.

If you want to change your eating habits and make changes to your activities, you will need professional help – such as a dietitian, behavioral counselor or obesity specialist.

A modest weight loss goal is usually the first treatment goal – between 5 and 10% of your total weight. Therefore, you would only need to lose ten to twenty pounds (4.5 to 9 kilograms) if you weigh 200 pounds (91 kilograms) for your health to begin to improve. In addition, losing more weight offers greater health benefits.

Almost all weight-loss programs require you to make dietary and exercise changes. Your treatment methods will depend on, among other things, your weight-loss plan’s success, the severity of your obesity, and your health.

Some people might try to rely on a single food or supplement to burn fat. That’s impossible. You shouldn’t believe the exaggerated claims of most dietary supplements

Weight-loss medications also may not work for everyone, and the effects may wear off over time. Taking a weight-loss medication causes you to lose weight, but you may eventually regain much or all of it.

That said, when used as part of a healthy diet and lifestyle, some natural fat burners may accelerate weight loss by either increasing metabolism or decreasing appetite. Your daily calorie burn may go up slightly, but that’s all they’re capable of.

Resurge is of the most popular weight loss supplements that promise to help you shed pounds and sleep better. Because studies have shown that sleep deprivation is associated with deficiencies of growth hormone and elevated levels of cortisol, both of which contribute to obesity.

While other supplements promote nutritional factors, meal replacement forms, appetite suppression, or similar effects, Resurge boosts your body’s metabolism by increasing your core temperature. 

Before making any purchases, you might want to read some Resurge reviews because the supplement industry is rife with scams.

In general, the key to losing weight is reducing the amount of calories you consume. Your first step should be to examine your usual food and drink consumption habits and see what you can make changes to. A typical amount for women and men to lose weight is 1,200 to 1,500 calories. Your doctor can determine how many calories you need each day.

Those with obesity should also engage in at least 150 minutes of moderate-intensity physical activity every week to prevent further weight gain or to maintain a modest weight loss. As your endurance and fitness improve, you can gradually increase the amount you exercise.

Conclusion

We have taken time to explore some of the common co-morbidities of obesity (Table 6-4). Some of the described diseases interact with other chronic diseases to further exacerbate the presentation of obesity. For example, type 2 diabetes can occur with both hypertension and gout, leading to a variety of symptoms and to reduced quality of life. The hallmark therapies consistently suggested to be most effective in decreasing these complications are behavioral changes (eating a high-quality diet, conducting physical activity, having high-quality sleep and duration, and reducing stress levels). If behavioral interventions alone are ineffective, you might need to consider weight-loss medications or surgery to help you achieve a healthy weight and better quality of life.

We hope that this chapter provided you with some background information regarding diseases that are linked to obesity. We also hope that it will motivate you and your family to prevent the medical diseases associated with obesity, or if you already have been diagnosed with any, to improve the state of your health. Remember that you are not alone, and that there and many people who are in need of information, just as yourself, and you are brave for seeking help. We hope you can use the information and resources provided to help lead you and your loved ones to a healthier life.

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