The Medical Consequences of Obesity

Carrying excess weight places a number of stresses on our bodies.  Many of the commonly treated medical conditions in the United States have a strong link to obesity.  Although the physical effect of obesity is obvious, the physiologic effect is just as striking.  Obesity leads to inflammation and dysfunction at the cellular level.  As a result every organ system is affected, the end result becoming gradual deterioration of normal physiology and eventually the development of many common diseases.

The Metabolic Syndrome

The metabolic syndrome refers to a group of risk factors that increase a person’s chance of developing heart disease, diabetes and suffering a stroke.  There are five conditions that are used to define the presence of metabolic syndrome.   The presence of any three of the five conditions estblishes the diagnosis of metabolic syndrome.

1. Larger waistline (>40 inches in men, >35 inches in women)
2. Elevated triglyceride (>150 mg/dl)
3. Abnormally low HDL (<40 mg/dl in men, <50 mg/dl in women)
4. Elevated fasting glucose (>100 mg/dl)
5. High blood pressure (>130 systolic or > 85 diastolic)

Approximately 30% of the country has metabolic syndrome.  The cause is strongly associated with obesity.  Metabolic syndrome leads to accelerated atherosclerosis (hardening of the arteries from plaque build-up) and increased potential for heart attacks, strokes and early death.

Hypertension

Hypertension, commonly referred to as high blood pressure, is an elevation of pressure within the arteries.  Elevated blood pressure places an increased workload on the heart and is a major risk factor for heart attack, stroke, aneurysm and chronic kidney disease.

Dyslipidemia

Dyslipidemia is a term used to describe abnormal levels of various blood lipids (fats).  Elevated blood levels of cholesterol, LDL and triglycerides and abnormally low levels of HDL are major risk factors for the development of coronary artery disease, stroke and diabetes.

Diabetes

Diabetes is an abnormal elevation in blood glucose levels.  Obesity is strongly linked to insulin resistance and non-insulin dependent diabetes (Type 2 diabetes).  Uncontrolled diabetes accelerates the development of atherosclerosis and is a major risk factor for heart disease, circulatory issues, kidney failure and early death.  Diabetes is a leading cause of blindness, need for amputation and need for dialysis.

Obstructive sleep apnea

Obstructive sleep apnea (OSA) is a condition often associated with obesity that results in upper airway obstruction during periods of sleep.  The fatty soft palate obstructs the passage of air into the upper respiratory tract.  The more common symptoms include snoring, restless sleep, awakening during sleep and extreme daytime exhaustion.  The limited air (oxygen) movement can lead to pulmonary hypertension and eventual heart failure.

Hypo-ventilation syndrome

As body mass increases the ability of the chest wall to expand during normal breathing is reduced and therefore there is a reduced exchange of oxygen and CO2 (carbon dioxide) leading to an increase in blood CO2. Hypoventilation syndrome refers to a state of hypercarbia or elevated blood levels of CO2 (carbon dioxide) that can have major metabolic consequences.

Fatty liver disease (NASH-non-alcohol steatohepatitis)

Excess calories are readily converted to a storage form of energy that can be tapped into during severe calorie restriction.  This energy source is fat, specifically triglycerides.  As body fat mass increases the ability to process and manage the triglycerides becomes impaired leading to large accumulations of fat within cells.  The liver is particularly susceptible to this process.  Hepatic steatosis or “fatty liver” can induce inflammation and cause significant liver damage, a condition known as steatohepatitis.  Steatohepatitis has a similar course to alcoholic hepatitis and can lead to the development of cirrhosis.

Osteoarthritis

Osteoarthritis is a process in which the articular cartilage and cortical bone of the joints are mechanically worn down leading to mechanical instability.  Symptoms commonly include joint pain, tenderness, stiffness and joint swelling.  Although there are a number of conditions that can lead to osteoarthritis obesity is a major causative factor.  The weight bearing joints like the hips, knees and ankles are particularly vulnerable.  Osteoarthritis is the leading cause of chronic disability in the US.

Chronic back pain

Pain in the upper, mid and lower back that is persistent and profoundly affects a person’s life is referred to as chronic back pain.  Increased chest and abdominal mass is a major contributor in the development of chronic back pain.

Urinary incontinence

Stress urinary incontinence is the loss of bladder control during periods of increased intra-abdominal pressure such as coughing, sneezing, laughing and heavy lifting.  Increased body mass leads to even higher intra-abdominal pressures and exacerbates the condition.  Women are far more susceptible to this condition then men.

Gout

Gout is a medical condition associated with inflammatory arthritis in which the joints become red, tender and hot.  The joint most commonly affected is the big toe, followed by the knees, ankles, wrist and fingers.    The cause is an elevation of uric acid levels in the blood and obesity or metabolic syndrome is a major risk factor.  Gout can also lead to kidney stones and eventual loss of kidney function.

Infertility/fetal loss

Obesity can interfere with the ability to conceive or carry a pregnancy to term. Polycystic ovarian syndrome (PCOS) is a leading cause of infertility and is strongly associated with obesity, diabetes and high cholesterol.   Obesity is also a common factor in “complicated” pregnancy and increases the risk of miscarriage.

Cancer

Although the mechanism is not completely understood the link between obesity and cancer has been convincing.  The SEER study demonstrated that of all new cancers diagnosed in 2007, 34,000 men (4%) and 50,500 women (7%) were the result of obesity.  It is estimated that if the current trend in obesity continues that by 2030 there will be 500,000 new cases of cancer as the result of obesity. Cancers that have demonstrated a strong correlation with obesity:

• Esophageal
• Pancreas
• Colon & Rectum
• Breast (post-menopause)
• Endometrial  (lining of uterus)
• Thyroid
• Kidney
• Gallbladder

Mood disorders

Depression, anxiety and poor self-image are identified much more frequently in overweight and obese individuals as compared to normal weight individuals.  It has been well documented that overweight/obese individuals are less likely to be hired, given raises or promotions.  Social discrimination of the obese is prevalent in all forms of media has become widely accepted.