Definition

Obesity is defined as the accumulation of excess fat within the body of an individual. It can affect people of all ages, ethinicities and socio-economic backgrounds and is fast emerging as a major health risk in today’s world.

Causes of Obesity

The causes of obesity are multifactorial and complex. There has been an increasing incidence and prevalence of obesity in the last 3-4 decades especially amongst the developed countries of the world. This has majorly because of increased affluence amongst the people and the related lifestyle changes which have led to increased caloric intake with decreased caloric expenditure. The resultant effect has been progressively increasing body weight and BMI in the general population. Besides lifestyle factors, there are a number of other causes of obesity

Hypothyroidism

Pituitary insufficiency

Cortisol excess

Medications such as steroids and antidepressants

PCOD

Stress and depression

Genetic factors

Types of Obesity

Body fat can accumulate in different parts of the body including beneath the skin( subcutaneous fat), around and within the internal organs like liver, kidneys, pancreas and intestines (visceral fat).

The accumulation of excess subcutaneous fat is also known as peripheral obesity whereas the excess of visceral fat is called as central obesity. Of these two types, visceral obesity imposes a greater health risk to an individual because it is linked to increase in blood sugar and cholesterol and greater risk of diabetes

Measurement of Obesity

There are different parameters to define and measure obesity. These include skin fold thickness, body composition analysis by electric impedance, body mass index (BMI) and whole body MRI.

Skin fold thickness-

This is a useful tool and can be measured using callipers at various sites of the body such as the arm , waist and infra scapular area of back. The sum total and average of these measurements can give an estimate of the total body fat percentage. This is a simple test which can be performed in the OPD with the help of a skin callipers.

Body composition analysis-

This makes the use of specialised machines which can accurately measure the total percentage of body fat and also the break up area wise using the principle of electric impedance. These machines can also calculate the lean body mass, BMI and the daily caloric expenditure (DCI) based on this technology which is useful for dietary planning.

Whole body MRI scan-

This is the most accurate measure of the total body fat using MRI scanner which can measure both the subcutaneous as well as visceral fat. The disadvantage of this test is that it takes a long time to perform and can be uncomfortable for the patient besides adding significantly to the expenditure.

BMI-

Body Mass Index is one of the most useful and commonly used tools for measurement of obesity. It is calculated by the ratio of weight in Kgs and the height in meters squared. This can be easily done in the OPD without any specialised equipment. It provides a reasonably accurate measurement of obesity and has been used to categorise obesity into mild , moderate and severe categories. However, it may provide a flawed assessment in cases of people having a high muscle mass, those with generalised swelling and in the paediatric age group.

Health risks associated with obesity

Obesity is associated with a number of health risks. These include

Diabetes mellitus
Hypertension
High blood cholesterol
Joint pains and osteoarthritis
Obstructive sleep apnea
GERD
Cardiac disease and stroke
PCOD and infertility
Depression
Stress urinary incontinence

Besides the health risks, it is associated with social stigmatisation and a poor quality of life. Obese people are often looked down upon and get alienated from society and suffer from poor self esteem and depression.

Treatment of obesity

The treatment of obesity depends upon causative factors and the severity of obesity. If an underlying cause is identified, it needs to be corrected first either by medication or lifestyle modification. The treatment involves a multidisciplinary approach with the help of physicians, psychologists, Dieticians, endocrinologists and fitness trainers. Most cases of mild to moderate obesity can be managed by this approach but it requires dedicated effort by the patient as well as the team. Severe or morbid obesity is usually not treatable by such measures alone. It requires a more invasive treatment in the form of Bariatric surgery for long term sustainable weight loss.