Obesity Information

Eating Disorders

Medical Complications of Obesity

Obesity is a serious disease process that can lead to many medical complications. Unfortunately, weight management, which generally improves these complications ("medical co-morbidities") requires long-term intervention to achieve long-term results. Sometimes, relatively simple dietary interventions such as decreasing saturated-fat intake, increasing intake of EPA (eicosapentaenoic acid) and especially DHA (docosahexaenoic acid) , the very-long chain omega-3 fats (found in ActiLean bars and shakes), and limiting sodium (salt) intake will improve these conditions.

The following is a list of some of the more common medical co-morbidities.

Hypertension

One of the most common complications of obesity is hypertension, or high blood pressure. Around 30% of individuals who are at least 30 lbs. overweight have at least mildly elevated blood pressure. The etiology of this increase in blood pressure appears to be related to substances produced by adipose (fat) tissue and to the increase in the hormone insulin that occurs with obesity.

Generally, obese individuals with hypertension should first be treated with dietary methods in an attempt to reduce their weight, reduce their salt intake, and to increase their intake of EPA and especially DHA (docosahexaenoic acid). Incidentally, you do not have to reduce to an "ideal" body weight to control the hypertension; rather a 10% reduction of body weight combined with avoidance of excess salt intake and increasing EPA and DHA can help normalize blood pressure and reduce or eliminate the need for blood pressure medications.

For more information on hypertension, please visit our health education site.

Diabetes (Type II)

There are two types of (sugar) diabetes - Type 1 and Type 2.

Type 1 diabetes ("juvenille diabetes") is generally a disease of childhood or young adults that is related to the pancreas (the organs that produces insulin that controls blood sugar) being unable to produce insulin. The failure of insulin production is probably induced by a viral infection or other immune reaction. These individual ALWAYS require insulin therapy. It is estimated that there are about 2.5 million type 1 diabetics in the U.S.

The predominant type of diabetes is type 2 diabetes, which is (usually) not related to lack of insulin but the inability of the available insulin to adequately lower blood sugar (so-called insulin resistance). Obesity is by far the leading cause of insulin resistance and type 2 diabetes with an estimated 25 million Americans suffering from type 2 diabetes. How obesity causes type 2 diabetes is quite complex, but it appears to result from both fats (free fatty acids) and hormonal substances (cytokines) being released by adipose (fat) tissue, acting to cause the liver to produce more sugar.

Obesity increases the risk of type 2 diabetes in adults by up to 93 fold (93 times the "normal" rate) in women with a BMI > 35 and up to 42 fold in males with a BMI > 35. Diabetes developing in childhood, until about 1980, was virtually always Type 1; however, with the significant increase in childhood obesity, up to 40% (depending on ethnicity) now have type 2 diabetes.

In the majority of obese individuals with type 2 diabetes, reducing body weight by 10% can eliminate or reduce the need for oral medications or insulin injections.

For more information on diabetes (both type 1 and type 2), please visit our health education site.

Elevated cholesterol

Elevated cholesterol (hypercholesterolemia) is commonly associated with obesity. On average, every 10 lbs. of excess fat produces 10 mg. of cholesterol per day. In other words, putting on 25 extra lbs. leads to the equivalent of taking in one extra egg yolk per day. Cholesterol levels are determined by both genetics and diet. Two-thirds of your cholesterol level is genetically determined, while the remaining one-third is related to diet. Most people can improve or control their cholesterol by reducing both their fat intake and weight.

For more information on elevated cholesterol, lipids, and heart disease, please visit our health education site.

Fatty Liver (NASH)

Fatty liver disease, more formally known as Non-Alcoholic Steato-Hepatitis ("NASH" - not "nosh," the Yiddish word for eating a snack) is caused by excessive fat deposition in the liver. Excess calorie consumption ("noshing" – the Yiddish word), can lead to excess fat intake with the fat being stored not only in fat stores, but also in the liver and other vital organs. This excess liver fat results in silent inflammation, usually detected by abnormal liver function tests when a blood panel is performed. In the U.S., this is the most common cause of abnormal liver function tests, with up to 25% of overweight and obese individuals having this condition. It is estimated that 10 to 20% of individuals with this condition, if untreated, will go on to develop cirrhosis or liver failure during their lifetime.

At this time, some anti-diabetic medications along with high doses of EPA and DHA, are used to treat this condition. However, the most effective treatment is weight reduction and increase in physical activity.

Metabolic Syndrome (Syndrome X)

This is a scary name, but it is actually a constellation of conditions. It is commonly found in the obese population, with over 47 million Americans (22%) of the population affected. To be diagnosed with metabolic syndrome, you need three or more of the following criteria:

• Waist circumference> 40 inches in men or 35 inches in women.
  
• Triglycerides > 150 mg/dl.
  
• HDL cholesterol< 40 mg/dl in men or <50 in women.
  
• Blood Pressure > 130/85 mm Hg.
  
• Glucose (fasting) >110 mg/dl.

The most effective treatment of metabolic syndrome is weight reduction; alternatively, the individual conditions are treated with multiple medications and tremendous expense.

Cancer

Obesity also results in an increased risk of cancer. In females, there is up to a threefold increase in the incidence of breast, uterine, cervical, and ovarian cancer. The risk of endometrial cancer (cancer of the inside lining of the uterus) is up to seven times higher. For men, there is an increased incidence of colon and prostate cancer.

Degenerative arthritis

Obesity is frequently complicated by degenerative arthritis, the "wear-and-tear" form, more formally known as osteoarthritis. Increased weight causes more wear and tear on the joints. Adipose tissue also produces substances (cytokines) that "destroy" the normal cartilage in joints. If a person loses weight, the wear and tear gradually diminishes and the amount of cytokines released from adipose tissue diminishes. The arthritic destruction of joints that has occurred over the years does not disappear; however, the joint pain will generally diminish since there is less stress and destruction of the joints.

For more information on the various forms of arthritis, please visit our health education site.

Gallstones

Obesity is frequently complicated by gallstones. Approximately 25% of obese individuals have gallstones, often resulting in surgery. The increase in cholesterol that results from obesity is one of the major reasons for the increased incidence of gallstones.

For more information on gallstones, please visit our health education site.

Heart attacks and strokes

There is an increased incidence of strokes and heart attacks in obese individuals. This increase is both independent of and additive to the increased risk associated with the elevated blood pressure, type 2 diabetes, and elevated cholesterol frequently associated with obesity. This increased risk appears to be partially related to substances produced by adipose (fat tissue) that make it easier for blood clots to form. Overall, obesity results in premature death.

Sleep disorders

As people gain weight, many complain that they feel tired all the time and may have problems obtaining a restful sleep. Problems with sleep may be indicative of a more severe condition referred to as sleep apnea. For people with this problem, it becomes progressively more difficult to breathe (especially at night) as their weight increases. These people typically snore severely and have episodes when they stop breathing completely, sometimes for up to one minute at a time. During these apneic (not breathing) periods, the amount of oxygen in the blood drops, which may cause the heart may beat irregularly. Individuals affected with sleep apnea transiently awaken before they resume breathing. This transient awakening may occur hundreds of times per night, leaving the afflicted individual feeling tired the next day. These individuals may fall asleep while sitting in meetings or driving.

Upwards of 95% of individuals experiencing sleep apnea are obese. Weight reduction is an effective treatment for sleep apnea, however, other measures are available such as CPAP (specialized equipment and masks that prevent the airways from collapsing, improving respirations) are usually used to prevent the irregular heart rhythms that frequently occur with this condition.

For further information on sleep apnea and other respiratory ailaments, please visit our health education site.

Depression

People with lesser degrees of obesity may also have problems sleeping. Sleep disturbances are also associated with anxiety and depression. Depression is not just feeling blue for a day, but is the result of actual chemical changes that take place in the brain, causing profound episodes of sadness, crying, and loss of energy. Depression is a medical condition that requires medical treatment. There are effective non-addicting medications available if depression is complicating obesity.

This is not intended to be a comprehensive list of medical complications related to obesity (obesity affects virtually every organ system). This list, however, provides insight into some of the more common obesity-related medical conditions.