Obesity

1. Introduction

Obesity: Comprehensive Guide for Healthcare Professionals and Patients

• Definition: Obesity is defined as excessive fat accumulation that presents a risk to health, typically measured by Body Mass Index (BMI) ≥ 30 kg/m².
• Epidemiology: A global public health crisis affecting over 650 million adults. Increases risk of cardiovascular diseases, diabetes, cancers, and musculoskeletal disorders.
• Significance: Obesity shortens lifespan, reduces quality of life, and burdens healthcare systems. Prevention and treatment are essential at both individual and policy levels.

2. Causes and Risk Factors

• Causes:
  • Positive energy balance (calories in > calories out).
  • Genetic predisposition (e.g., MC4R mutations).
  • Hormonal imbalances (e.g., hypothyroidism, Cushing’s syndrome).
• Risk Factors:
  • Sedentary lifestyle.
  • High-calorie diet rich in processed foods.
  • Psychological factors: stress, depression, binge eating disorder.
  • Socioeconomic factors: poor access to healthy foods.
  • Certain medications: corticosteroids, antidepressants, antipsychotics.

3. Pathophysiology

• Excess calorie intake leads to adipocyte hypertrophy and hyperplasia.
• Adipose tissue secretes inflammatory cytokines (TNF-α, IL-6), leading to insulin resistance.
• Chronic low-grade inflammation disrupts metabolic regulation, increasing risk of T2DM, atherosclerosis, and NAFLD.

4. Symptoms and Features

• Physical: Weight gain, excessive fat around abdomen, breathlessness, fatigue, joint pain.
• Psychological: Low self-esteem, social isolation, depression, body image dissatisfaction.
• Metabolic: Hypertension, dyslipidaemia, insulin resistance, hyperglycaemia.

5. Complications

• Cardiovascular: Hypertension, coronary artery disease, stroke.
• Endocrine/Metabolic: Type 2 diabetes, PCOS, dyslipidaemia, gout.
• Gastrointestinal: NAFLD, gallstones, reflux disease.
• Musculoskeletal: Osteoarthritis, back pain.
• Respiratory: Obstructive sleep apnoea.
• Reproductive: Infertility, complications during pregnancy.
• Cancers: Increased risk of breast, colon, prostate, and uterine cancers.

6. Diagnosis

• BMI Classification:
  • Overweight: 25–29.9 kg/m²
  • Obese: ≥30 kg/m²
  • Morbid obesity: ≥40 kg/m²
• Waist Circumference:
  • 102 cm (men), >88 cm (women) indicates central obesity.
• Blood Tests:
  • Fasting glucose, HbA1c, lipid profile, liver enzymes.
• Thyroid Function Test: Rule out hypothyroidism.

7. Management Overview

• Goals: Achieve sustainable weight loss (5–10%), reduce comorbidities, improve quality of life.
• Approach:
  • Lifestyle modifications.
  • Pharmacotherapy for eligible patients.
  • Bariatric surgery for severe or refractory obesity.

8. Treatment Options with Cost (USD)

• Dietitian/Nutritionist Consultation: $50–$150/session.
• Exercise Program: $30–$100/month.
• Weight Loss Medications: $100–$1,300/month depending on the drug.
• Cognitive Behavioural Therapy (CBT): $70–$200/session.

9. Advanced Treatment Options with Cost (USD)

• Bariatric Surgery:
  • Sleeve gastrectomy: $10,000–$20,000.
  • Gastric bypass: $15,000–$30,000.
  • Adjustable gastric banding: $8,000–$15,000.
• Endoscopic options (e.g., gastric balloon): $5,000–$8,000.

10. Pharmacological Treatment

• Indications: BMI ≥30, or ≥27 with comorbidities.
• First-line:
  • Orlistat.
  • GLP-1 receptor agonists (e.g., liraglutide, semaglutide).
• Second-line:
  • Phentermine-topiramate.
  • Bupropion-naltrexone.

11. Medication Tables

Table 1: Doses and Side Effects

Drug	Dose	Common Side Effects
Orlistat	120 mg TID with meals	Oily stools, flatulence, diarrhoea
Liraglutide (Saxenda)	3.0 mg SC daily (titrated)	Nausea, vomiting, constipation
Semaglutide (Wegovy)	Up to 2.4 mg SC weekly	Nausea, diarrhoea, fatigue
Bupropion/Naltrexone	8/90 mg BID	Headache, nausea, increased BP

Table 2: Brand Names and Approximate Costs (USD)

Drug	Brand Names	Approx. Monthly Cost
Orlistat	Xenical, Alli	$100–$200
Liraglutide	Saxenda	$1,200–$1,300
Semaglutide	Wegovy	$1,000–$1,300
Bupropion/Naltrexone	Contrave	$600–$800

12. Lifestyle Interventions

• Diet: Caloric deficit of 500–750 kcal/day; high-fibre, low-fat foods.
• Physical Activity: ≥150 minutes/week of moderate aerobic exercise.
• Sleep Hygiene: Aim for 7–9 hours/night.
• Behavioural Therapy: Goal-setting, meal planning, food journaling.

13. Monitoring Parameters

• Weight, BMI, waist circumference.
• Blood pressure.
• HbA1c and fasting glucose.
• Lipid profile.
• Liver and thyroid function tests.

14. Patient Counseling Points

• Obesity is a chronic, relapsing disease, not a personal failure.
• Encourage realistic goals: 5–10% weight loss = significant health gains.
• Lifestyle change is long-term, not a quick fix.
• Address emotional triggers, stress eating, and stigma.

15. Special Populations

• Children: Use age and sex-specific growth charts; avoid weight-loss drugs.
• Pregnancy: Focus on healthy weight gain; obesity increases risk of GDM, preeclampsia.
• Elderly: Evaluate sarcopenic obesity; ensure nutritional adequacy.

16. Prevention

• Promote healthy diet and activity in early life.
• Implement school and workplace wellness programmes.
• Community-level interventions: taxes on sugary drinks, food labelling.
• Early screening for weight gain trends and counselling.

17. FAQs

1. What causes obesity? → Chronic imbalance between calorie intake and expenditure, influenced by genetics, lifestyle, and environment.
2. Is obesity a disease? → Yes, it’s recognised as a chronic disease requiring medical management.
3. Can obesity be reversed? → Yes, with sustained lifestyle changes and/or medical or surgical treatment.
4. Do diet pills work? → Some are effective, especially newer GLP-1 agonists, but must be part of a comprehensive plan.
5. How much weight loss is beneficial? → 5–10% body weight improves blood pressure, blood sugar, and cholesterol.
6. Is obesity inherited? → Genetics can predispose, but lifestyle factors are key.
7. Are all obese people unhealthy? → Not necessarily; some may be metabolically healthy but still at risk long-term.
8. How is obesity treated? → Through diet, exercise, behavioural therapy, medications, and surgery.
9. Can children take weight-loss medications? → Not routinely; lifestyle changes are first-line.
10. What is BMI and how is it used? → A weight-for-height index to classify obesity.
11. Does sleep affect weight? → Poor sleep increases hunger and lowers metabolic rate.
12. Can obesity cause infertility? → Yes, especially in women with PCOS.
13. Are meal replacement shakes effective? → Useful short-term but not a permanent solution.
14. Is bariatric surgery safe? → Yes, when done at experienced centres, but it carries risks.
15. How can I maintain weight loss? → Continued monitoring, lifestyle adherence, and support.