OBESITY: WHEN FAT HALTS LIFE!

Human body systems function, dependently on the energy (ATP) supplied by the breakdown of the foods we eat. Same human body is designed to store up energy, in excess of our immediate body demands, as Triglycerides inadipose tissue (fat cells); such that, when energy is needed, the stored Triglycerides are broken down into free fatty acids (FFA) for use, as source of energy. However, when the energy stored up is extremely in excess, caused by some factors to be later discussed, adverse health consequences follow, when not quickly managed or treated, lead to death, thus, inhibiting the fulfillment of destiny. Remember that ‘hope only exists when breathe is ascertained’

Obesity is a state of excess adipose tissue mass/body fat; although, by numerical standards, even, lean, but very muscular individuals may be overweight or obese, with no excessive body fat. Numerically, by standards, Body Metabolic Index (BMI) between 16 – 24.9 kg/m² is considered normal; 25 – 30kg/m² (overweight); >30kg/m² (Obese). But often times, BMI between 25 and 30 are considered important and therapeutic interventions are taken, especially in a patient with previous history of Hypertension and Glucose Intolerance.

Excessive abdominal or intraabdominal fat deposition is of more concern in the definition of obesity; thus, most times, an easier way for self-observation is measuring the waist-to-hip ratio; with a ratio >0.9 in women; and >1.0 in men being abnormal (taking into consideration that women have more fat than men). Thus, ‘gone are the days when protruded bellies are evidential of wealth; but in truth, every big tummy (bar pregnancy) that is not yet confirmed to be pathological, is a potential pathology ‘doing push-ups’. This is further confirmed, as statistics have shown mortality to rise with increase in obesity, particularly, with increased intraabdominal fat. Life expectancy of a moderately obese individual is also reported to be shortened by 2-5years; while, a 20 – 30-year-old male with a BMI >45kg/m² may lose 13years of life.

The following are few complications of obesity, after which we will discuss some etiologies of Obesity and the general rule of thumb in its management!

• INSULIN RESISTANCE AND TYPE II DIABETES MELLITUS (TYPE II DM)

All eaten carbohydrates are metabolized into simpler molecules, notably glucose, which are the form in which carbohydrates are absorbed and utilized by our body cells, with the aid of ‘Glucose Transporters’, some of which need insulin (body hormone) to function. Thus, without appropriate insulin sensitivity, glucose is hardly transported into the body cells. Now, Obesity is principally characterized by Insulin resistance, thus, preventing glucose transport into the body cells. Resultantly, glucose excessively accumulates in the bloodstream (Hyperglycemia), and by glycosylation, destroysthe blood vessels (hardening of blood vessels), nerves (neuropathy), eyes (often causes cataract and blindness), etc; and secondarily, also destructive to the Heart, Kidneys (nephropathy), Liver, Stomach (gastroparesis), Limbs (wounds don’t heal due to loss of blood supply and nerves; often ends in amputation to prevent further spread of infection to the whole body), etc; all of which are also characteristic of Type II DM. But it should also be noted that, despite the prevalence of Insulin resistance, most obese individuals do not necessarily develop Type II DM, suggesting that DM requires an interaction between obesity-induced Insulin resistance and other factors, such as impaired insulin secretion; however, obesity is a major risk factor for Type II DM; and about 80% of Type II DM patient are obese.

**Remembering that one of the major complications of Type II DM is worsening wounds (even with treatment), especially of the lower limbs (legs), as explained above. Also, noting that Type II DM is often tagged ‘the disease of the Rich’ (who eat and drink all foods and beverages, since they can afford them, thus, becoming obese). Thus, a lot of the rich folks are diabetic; but some of us (from my part of the world) grew up, erroneously thinking all rich men with worsening wounds are suffering from the repercussions of their money rituals; though I am not denying such, in truth, exists; but not all!

• REPRODUCTIVE DISORDERS.

Mostly in females, obesity is associated with few reproductive abnormalities, secondary to the constant biochemical interplay between reproductive hormones and fat cells in our bodies, as fat is being converted to androgens (sex hormones). In males, reproductive malfunctions, secondary to obesity, seem to be limited to Hypogonadism (a diminished functional activity of the gonads (the testes) in males that may result in diminished sex hormone biosynthesis), Increased estrogen (thus, possible gynecomastia(female-like breast)); but masculinization, libido, potency and spermatogenesis are reportedly preserved.

In females, obesity is associated with menstrual abnormalities, due to excessive female hormones produced; thus, Oligomenorrhea and Polycystic Ovarian Syndrome (PCOS) (associated with its anovulation and ovarian hyperandrogenism), which cause infertility, have been continually reported.

**Note that PCOS also occurs in non-obese women, but in most of such cases, Insulin resistance is also characteristic. Weight loss and increased insulin sensitivity often restores normal menses in women with PCOS.

• CARDIOVASCULAR DISEASES

Obesity independently also increases the formation of atheroma (degeneration of the walls of the arteries caused by accumulated fatty deposits and scar tissue, and leading to restriction of the circulation and a risk of thrombosis) within the blood vessels. This can lead to atherosclerosis (a disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls), causing the narrowing of blood vessels which increases blood pressure, causing hypertension. Consequently, the patient develops congestive heart failure and dies. Also, atherosclerosis and hypertension are also high risk factors for Stroke. Also, venous stasis (reduced blood flow in veins) has been found to increase in, but not limited to, obese individuals. This increases the formation embolus and thrombus, that in turn, increases the risk of Deep Vein Thrombosis and Pulmonary Embolism, that often cause sudden death, due to complete obstruction of blood flow!

• PULMONARY DISEASES

Few Pulmonary complications include:

• Pulmonary hypertension (a high blood pressure in the pulmonary artery). Often caused by Hypertension and Left Heart Failure, amongst others. Symptoms include Shortness of breath with minimal routine activity (e.g. climbing two flights of stairs), Tiredness, Chest pain, racing heartbeats, Pain on the upper right side of the abdomen, Decreased appetite, etc. You may find it hard to do any physical activities as it worsens.
• Sleep apnea (a common disorder characterized by one or more pauses in breathing or shallow breaths during sleep). Breathing pauses can last from a few seconds to minutes, then, normal breathing then starts again, sometimes with a loud snort or choking sound. This may occur 30 times or more in one hour. Though there is Central Sleep Apnea, the most common type of sleep apnea is obstructive sleep apnea, as the airway is blocked or collapsed. It is often characterized by loud snoring (which is typical of fat individuals). Obstructive sleep apnea is often found in overweight or obese individuals and children with enlarged tonsils. Sleep apnea, if not treated, increases the risk early death. **Sleep apnea is also associated with Hypertension.

• CANCER, HEPATOBILIARY BONE/JOINT DISEASES
• Cancer: Obesity in males is also associated with higher mortality from cancers of the esophagus, colon, rectum, pancreas, liver and prostate; but higher mortality from cancer of the gallbladder, bile ducts, breasts, endometrium, cervix and ovaries have been recorded in females (note that most malignancies in females are hormone-dependent).
• Hepatobiliary disease: Non-Alcoholic Fatty Liver Disease (in which there is fatty infiltration and deposition in the liver, causing an inflammatory Non-Alcoholic Steatohepatitis) has also been reported in Obesity. Non-Alcoholic Fatty Liver Disease, though rarely, also causes Liver Cirrhosis and Liver cancer. Also, obesity has been found to increase the risk of symptomatic gallstone formation.
• Bone/Joint diseases: Obesity is also associated with increased occurrence of Osteoarthritis (due to the trauma of added weight bearing on the body joints, most importantly, the knees). Also, occurrence of gout (painful swelling in joints) increases with obesity.
• Also, of significance is the increasing association of obesity with Hernias, Low back pain, Depression/Low self-esteem, Body image disturbance, Striae distensae (stretch marks), metabolic syndrome, etc.

Common Etiologies of Obesity include:

• Genetic factors (hereditary)
• Environmental factors (notably quantity and quality of foods eaten)
• Hypothyroidism: Disorder Of The Endocrine System in which the thyroid gland does not produce enough thyroid hormone, resulting in decreased Basic Metabolic Rate (BMR) of the body. Thus characterized by fatigue, weight gain, cold intolerance, sluggishness, etc.
• Insulinoma (tumor of the pancreas).
• Cushing syndrome: This includes signs and symptoms from extensive exposure to cortisol (hormone). It can be present with hypertension, abdominal obesity (but with thin arms and legs) stretch marks, a round red face, a fat lump between the shoulders, weak muscles, weak bones, etc.

Conclusively, a rule of thumb for the management of Obesity is weight loss, through exercise, dieting and sometimes, bariatric surgery, etc. And reports have also shown that most pathologies from obesity improve with minimal weight loss. Thus, it should be noted that not all ‘early-morning joggers’ you see are jobless, they are just staying healthy. Besides weight loss, your primary care physician manages and treats as appropriate. Let me encourage us to find time for some exercise, some jogging, take a walk; gyms are not for sinners either; and control your diet!

Written by :’Boluwaji Lasehinde drgabriel001@yahoo.com