Persons
with obesity are at risk of developing one or more serious
medical conditions, which can cause poor health and
premature death.
The morbidity and mortality risk from being overweight is proportional to its degree. Individuals with morbid obesity, therefore, have the highest risk for developing numerous illnesses that often reduce mobility and quality of life due to their excess weight.
In particular, type 2 diabetes, gallbladder disease and osteoarthritis have been found to increase concurrently with higher BMI. Premature death, a 20-year shorter life span, has also been found in individuals with morbid obesity.
All of the systems that make the body function are affected by morbid obesity. Morbid obesity can also cause or worsen depression. Some individuals with morbid obesity have low self-esteem and other psychological difficulties attributed to feeling "shunned, insulted and ridiculed by outsiders."
Obesity-Related
Medical Conditions
The prevalence of various medical conditions increases
with overweight and obesity for men and women as shown
in Tables 1 and 2.
Table1.
Prevalence of Medical Conditions by Body
Mass Index (BMI) for Men
Medical
Condition
Body
Mass Index
18.5
to 24.9
25
to 29.9
30
to 34.9
>40
Prevalence
Ratio (%)
Type
2 Diabetes
2.03
4.93
10.10
10.65
Coronary
Heart Disease
8.84
9.60
16.01
13.97
High
Blood Pressure
23.47
34.16
48.95
64.53
Osteoarthritis
2.59
4.55
4.66
10.04
Source:
NHANES III, 1988 - 1994
Table2.
Prevalence of Medical Conditions by Body
Mass Index (BMI) for Women
Medical
Condition
Body
Mass Index
18.5
to 24.9
25
to 29.9
30
to 34.9
>40
Prevalence
Ratio (%)
Type
2 Diabetes
2.8
7.12
7.24
19.89
Coronary
Heart Disease
6.87
11.13
12.56
19.22
High
Blood Pressure
23.26
38.77
47.95
63.16
Osteoarthritis
5.22
8.51
9.94
17.19
Source:
NHANES III, 1988 - 1994
Arthritis
Osteoarthritis (OA)
- Obesity is associated with the development of OA
of the hand, hip, back and especially the knee. At
a Body Mass Index (BMI) of > 25, the incidence
of OA has been shown to steadily increase. Modest
weight loss of 10 to 15 pounds is likely to relieve
symptoms and delay disease progression of knee OA.
Rheumatoid
Arthritis (RA) -Obesity has been found related
to RA in both men and women.
Birth
Defects -Maternal obesity (BMI > 29) has
been associated with an increased incidence of neural
tube defects (NTD) in several studies, although variable
results have been found in this area. Folate intake,
which decreases the risk of NTD's, was found in one
study to have a reduced effect with higher pre-pregnancy
weight.
Cancers
Breast Cancer -Postmenopausal women with obesity have
a higher risk of developing breast cancer. In addition,
weight gain after menopause may also increase breast
cancer risk. Women who gain nearly 45 pounds or more
after age 18 are twice as likely to develop breast
cancer after menopause than those who remain weight
stable. High BMI has been associated with a decreased
risk of breast cancer before menopause. However, a
recent study found an increased risk of the most lethal
form of breast cancer, called inflammatory breast
cancer (IBC), in women with BMI as low as 26.7 regardless
of menopausal status. Premenopausal women diagnosed
with breast cancer who are overweight appear to have
a shorter life span than women with lower BMI. The
risk of breast cancer in men is also increased by
obesity.
Cancers
of the Esophagus and Gastric Cardia -Obesity
is strongly associated with cancer of the esophagus
and the risk becomes higher with increasing BMI. The
risk for gastric cardia cancer rises moderately with
increasing BMI.
Colorectal
Cancer -High BMI, high calorie intake, and
low physical activity are independent risk factors
of colorectal cancer. Larger waist size (abdominal
obesity) is associated with colorectal cancer.
Endometrial
Cancer (EC) -Women with obesity have three
to four times the risk of EC than women with lower
BMI. Women with obesity and diabetes are reported
to have a 3-fold increase in risk for EC above the
risk of obesity alone. Body size is a risk factor
for EC regardless of where fat is distributed in the
body.
Renal
Cell Cancer -Consistent evidence has been
found to associate obesity with renal cell cancer,
especially in women. Excess weight was reported in
one study to account for 21% of renal cell cancer
cases.
Cardiovascular
Disease (CVD) -Obesity increases CVD risk
due to its effect on blood lipid levels. Weight loss
improves blood lipid levels by lowering triglycerides
and LDL ("bad") cholesterol and increasing HDL ("good")
cholesterol. Weight loss of 5% to 10% can reduce total
blood cholesterol. The effects of obesity on cardiovascular
health can begin in childhood, which increases the
risk of developing CVD as an adult. Overweight and
obesity increase the risk of illness and death associated
with coronary heart disease. Obesity is a major risk
factor for heart attack, and is now recognized as
such by the American Heart Association.
Carpal
Tunnel Syndrome (CTS) -Obesity has been established
as a risk factor for CTS. The odds of an obese patient
having CTS were found in one study to be almost four
times greater than that of a non-obese patient. Obesity
was found in one study to be a stronger risk factor
for CTS than workplace activity that requires repetitive
and forceful hand use. Seventy percent of persons
in a recent CTS study were overweight or obese.
Chronic
Venous Insufficiency (CVI) -Patients with
CVI, an inadequate blood flow through the veins, tend
to be older, male, and have obesity.
Daytime
Sleepiness -People with obesity frequently
complain of daytime sleepiness and fatigue, two probable
causes of mass transportation accidents. Severe obesity
has been associated with increased daytime sleepiness
even in the absence of sleep apnea or other breathing
disorders.
Deep
Vein Thrombosis (DVT) -Obesity increases
the risk of DVT, a condition that disrupts the normal
process of blood clotting. Patients with obesity have
an increased risk of DVT after surgery.
Diabetes
(Type 2) -As many as 90% of individuals with
type 2 diabetes are reported to be overweight or obese.
Obesity has been found to be the largest environmental
influence on the prevalence of diabetes in a population.
Obesity complicates the management of type 2 diabetes
by increasing insulin resistance and glucose intolerance,
which makes drug treatment for type 2 diabetes less
effective. A weight loss of as little as 5% can reduce
high blood sugar.
End
Stage Renal Disease (ESRD) -Obesity may be
a direct or indirect factor in the initiation or progression
of renal disease, as suggested in preliminary data.
Gallbladder
Disease -Obesity is an established predictor
of gallbladder disease. Obesity and rapid weight loss
in obese persons are known risk factors for gallstones.
Gallstones are common among overweight and obese persons.
Gallstones appear in persons with obesity at a rate
of 30% versus 10% in non-obese.
Gout
-Obesity contributes to the cause of gout
-- the deposit of uric acid crystals in joints and
tissue. Obesity is associated with increased production
of uric acid and decreased elimination from the body.
Heat
Disorders -Obesity has been found to be a
risk factor for heat injury and heat disorders. Poor
heat tolerance is often associated with obesity.
Hypertension
-Over 75% of hypertension cases are reported to be
directly attributed to obesity. Weight or BMI in association
with age is the strongest indicator of blood pressure
in humans. The association between obesity and high
blood pressure has been observed in virtually all
societies, ages, ethnic groups, and in both genders.
The risk of developing hypertension is five to six
times greater in obese adult Americans, age 20 to
45, compared to non-obese individuals of the same
age.
Impaired Immune Response -Obesity
has been found to decrease the body's resistance to
harmful organisms. A decrease in the activity of scavenger
cells, that destroy bacteria and foreign organisms
in the body, has been observed in patients with obesity.
Impaired
Respiratory Function -Obesity is associated
with impairment in respiratory function. Obesity has
been found to increase respiratory resistance, which
in turn may cause breathlessness. Decreases in lung
volume with increasing obesity have been reported.
Infections
Following Wounds -Obesity is associated with
the increased incidence of wound infection. Burn patients
with obesity are reported to develop pneumonia and
wound infection with twice the frequency of non-obese.
Infertility
-Obesity increases the risk for several reproductive
disorders, negatively affecting normal menstrual function
and fertility. Weight loss of about 10% of initial
weight is effective in improving menstrual regularity,
ovulation, hormonal profiles and pregnancy rates.
Liver
Disease -Excess weight is reported to be
an independent risk factor for the development of
alcohol related liver diseases including cirrhosis
and acute hepatitis. Obesity is the most common factor
of nonalcoholic steatohepatitis, a major cause of
progressive liver disease.
Low
Back Pain -Obesity may play a part in aggravating
a simple low back problem, and contribute to a long-lasting
or recurring condition. Women who are overweight or
have a large waist size are reported to be particularly
at risk for low back pain.
Obstetric
and Gynecologic Complications -Women with
severe obesity have a menstrual disturbance rate three
times higher than that of women with normal weight.
High pre-pregnancy weight is associated with an increased
risk during pregnancy of hypertension, gestational
diabetes, urinary infection, Cesarean section and
toxemia. Obesity is reportedly associated with the
increased incidence of overdue births, induced labor
and longer labors. Women with maternal obesity have
more Cesarean deliveries and higher incidence of blood
loss during delivery as well as infection and wound
complication after surgery. Complications after childbirth
associated with obesity include an increased risk
of endometrial infection and inflammation, urinary
tract infection and urinary incontinence.
Pain
- Bodily pain is a prevalent problem among persons
with obesity. Persons have reported greater disability,
due to bodily pain, with obesity compared to persons
with other chronic medical conditions. Obesity is
known to be associated with musculoskeletal or joint-related
pain. Foot pain located at the heel, known as Sever's
disease, is commonly associated with obesity.
Pancreatitis
-Obesity is a predictive factor of outcome in acute
pancreatitis. Obese patients with acute pancreatitis
are reported to develop significantly more complications,
including respiratory failure, than non-obese. Patients
with severe pancreatitis have been found to have a
higher body-fat percentage and larger waist size than
patients with mild pancreatitis.
Sleep
Apnea -Obesity, particularly upper body obesity
is the most significant risk factor for obstructive
sleep apnea. There is a 12 to 30-fold higher incidence
of obstructive sleep apnea among morbidly obese patients
compared to the general population. Among patients
with obstructive sleep apnea, at least 60% to 70%
are obese.
Stroke
- Elevated BMI is reported to increase the risk of
ischemic stroke independent of other risk factors
including age and systolic blood pressure. Abdominal
obesity appears to predict the risk of stroke in men.
Obesity and weight gain are risk factors for ischemic
and total stroke in women.
Surgical
Complications -Obesity is a risk factor for
complications after a surgery. Surgical patients with
obesity demonstrate a higher number and incidence
of hospital acquired infections compared to normal
weight patients.
Urinary
Stress Incontinence -Obesity is a well-documented
risk factor for urinary stress incontinence, involuntary
urine loss, as well as urge incontinence and urgency
among women. Obesity is reported to be a strong risk
factor for several urinary symptoms after pregnancy
and delivery, continuing as much as 6 to 18 months
after childbirth.
Other
- Several other obesity-related conditions
have been reported by various researchers including:
abdominal hernias, acanthosis nigricans, endocrine
abnormalities, chronic hypoxia and hypercapnia, dermatological
effects, depression, elephantitis, gastroesophageal
reflux, heel spurs, hirsutism, lower extremity edema,
mammegaly (causing considerable problems such as bra
strap pain, skin damage, cervical pain, chronic odors
and infections in the skin folds under the breasts,
etc.), large anterior abdominal wall masses (abdominal
paniculitis with frequent panniculitis, impeding walking,
causing frequent infections, odors, clothing difficulties,
low back pain), musculoskeletal disease, prostate
cancer, pseudo tumor cerebri (or benign intracranial
hypertension), and sliding hiatil hernia.
________________________________________
Source: American Obesity Association
Persons
with obesity are at risk of developing one or more serious
medical conditions, which can cause poor health and
premature death. 
