Obesity

⚖️ Obesity is a chronic, complex condition characterised by excessive accumulation of body fat. It increases the risk of cardiovascular disease, type 2 diabetes, cancers, and premature mortality. 🌍 It results from an interaction of genetic, behavioural, environmental, and metabolic factors. Understanding its causes, features, diagnostics, and management is essential for effective care.

1️⃣ Causes of Obesity

• 🧬 Genetic Factors: Influence metabolism, appetite regulation, and fat storage; certain genes predispose to weight gain.
• 🍔 Dietary Habits: High-calorie diets, processed foods, sugary drinks, and fast food drive positive energy balance.
• 🛋️ Physical Inactivity: Sedentary lifestyle (desk jobs, technology reliance) reduces energy expenditure.
• 🦋 Endocrine Disorders: Hypothyroidism, Cushing’s syndrome, PCOS can contribute to weight gain.
• 💊 Medications: Antidepressants, antipsychotics, corticosteroids, antiepileptics may cause weight gain.
• 🧠 Psychosocial Factors: Stress, depression, anxiety can trigger overeating or binge eating.
• 😴 Sleep Deprivation: Alters ghrelin/leptin → ↑ appetite and caloric intake.
• 💷 Socioeconomic Factors: Limited access to healthy food, exercise facilities, and healthcare increases risk.

2️⃣ Clinical Features

• 📊 Body Mass Index (BMI):
  • Class I: 30–34.9
  • Class II: 35–39.9
  • Class III: ≥40 (morbid obesity)
• 📏 Waist Circumference: Central obesity >40 in (men) or >35 in (women) → ↑ metabolic risk.
• ❤️ Comorbidities: Hypertension, type 2 diabetes, dyslipidaemia, NAFLD, OSA, osteoarthritis, cancers (breast, colon).
• 🤕 Physical Symptoms: Fatigue, breathlessness, joint pain, reduced mobility.
• 🧠 Psychological Impact: Depression, low self-esteem, social stigma, isolation.

3️⃣ Diagnostic Evaluation

• ⚖️ BMI calculation: Weight (kg) ÷ height (m²); ≥30 = obese.
• 📐 Waist-to-Hip Ratio: Detects central obesity, stronger link with CVD.
• 🧪 Blood tests:
  • 🧬 Lipid profile → dyslipidaemia.
  • 🩸 Fasting glucose / HbA1c → screen for diabetes.
  • 🦋 TFTs → rule out hypothyroidism.
  • 🍷 LFTs → assess for NAFLD.
  • ⚡ Hormonal assays → PCOS, Cushing’s.
• 😴 Sleep Studies: If symptoms suggest obstructive sleep apnoea.

4️⃣ Management – Multidisciplinary Approach

• 🥦 Lifestyle Interventions (first-line)
  • 🍎 Dietary Changes: Calorie deficit diet; ↑ fruit/veg, lean protein, whole grains; ↓ sugar, processed foods, saturated fats.
  • 🏃 Physical Activity: ≥150 min/week of moderate exercise + resistance training.
  • 🧠 Behavioural Therapy: CBT for eating behaviours, stress management, relapse prevention.
• 💊 Pharmacological Therapy
  • Orlistat → reduces fat absorption (GI side effects common).
  • GLP-1 agonists (e.g., Liraglutide, Semaglutide) → appetite suppression + weight loss.
  • Phentermine/Topiramate → appetite suppression (US-licensed).
  • Metformin → useful in diabetes/insulin resistance, modest weight benefit.
• 🔪 Surgical Interventions
  • Indications: BMI ≥40, or ≥35 with comorbidities, and failure of conservative therapy.
  • Procedures:
    • Gastric bypass → reduces intake & absorption.
    • Gastric sleeve → reduces stomach size & appetite hormones.
    • Adjustable gastric banding → restricts stomach capacity.
  • Requires lifelong follow-up, nutritional supplementation, and psychological support.
• 🤝 Psychological & Social Support
  • Counselling → addresses body image, mood, emotional eating.
  • Support groups → peer motivation and accountability.

💡 Teaching Pearl

Obesity is not simply excess weight but a chronic disease. Effective management requires a holistic, patient-centred, long-term approach addressing lifestyle, medical, and psychological needs. 🎯 Even modest weight loss (5–10% of body weight) leads to significant improvements in metabolic health.