Obesity: More than being overweight

The majority of the population is aware of the well-known health effects of obesity, such as high blood pressure (hypertension), high blood sugar (diabetes), high blood lipids or cholesterols, and increased risk of heart diseases. The increase in awareness of this condition is expected considering that the estimated number of people dealing with this ailment worldwide is more than 600 million. Although mentioned complications of the disease are well studied and widely covered by the media, there are some other effects of obesity that are not as much emphasized but could still substantially affect the life quality of these patients.

It is now well known that obesity is about increased fat accumulation in the body and systemic disease. Although most of the time, the waist preserves the fat, abnormal fat tissue can trigger disease states in other organs and tissues far away, e.g., blood vessels of the brain, heart, neck, intestines, and limbs. Having extra fat tissue puts the body in an 'inflammatory state.' Inflammation is what happens when tissue is damaged or a microbe enters the body. It is the natural response of the body to prevent intruders from the outside world from replicating inside. Specific blood cells and chemicals are released to stop any infection from spread inside the body. Although it is a beneficial system when microbes attack the body, when this system is overly active, it starts to damage its tissues. This mechanism is thought to be the underlying cause of some problems associated with obesity, such as heart attacks or strokes.

The joints of the human body, such as knees or hips, can bear only specific amounts of weight. If they are overloaded for a long time – which is the obesity case – they start to degenerate, and after a while, even moving the legs around starts to feel painful. Patients begin to move less recognizant of the pain and discomfort. After some time, this creates a vicious circle: the patient gains more weight due to inactivity, which increases the load on joints. At that point, surgery might be the only option to fix the joints, but because obese patients are more prone to risks related to surgery and anesthesia, undergoing such a procedure might put the patient at risk of serious complications.

The natural processes of a healthy person might pose significant challenges for an obese patient. Even the single act of going to sleep is a struggle for obese patients with sleep apnea. In sleep apnea, they are breathing adherently stops during sleep, which causes the person to wake up in the middle of the night without even realizing it. This results in interrupted sleep – even if the patient spends eight to nine hours in bed, he still might not feel rested in the morning. Daytime sleepiness, occasional doze offs and difficulties in concentration accompany this condition. Although sleep apnea may or may not be related to obesity, obese patients are at increased risk because they have more fat tissue around their neck that compresses their airway, therefore causing the apneas during the night.

Obese patients are affected not only physically but also psychologically by their conditions. The condition is a reason for social stigmatization; patients report feeling distanced, depressive and anxious. These psychological states might cause the patient to overeat, further aggravating their condition. Feeling guilty and putting the responsibility on themselves, obese patients might be reluctant to seek help because of the apatite-related side effects of medications used to treat these psychiatric conditions. Treatment of obese patients might pose a challenge to the clinician. Ongoing studies are trying better to understand the relation of obesity to mental health. 

The risk of cancer is also increased in obese patients compared to the healthy population. It is known that fat tissue is not merely a non-functional storage tissue but also a hormonally active endocrine organ. Changes in the amount of fat can also affect the amount and activity of certain hormones. These changes can put a patient at increased risk for certain types of cancers such as endometrial, ovarian, and breast cancers. Other cancers that were shown to be related to obesity to date are the esophagus, stomach, liver, pancreas, kidney, and intestinal cancers. 

As is apparent from the discussion so far, obesity is not a simple state of being overweight. Still, it is a complicated chronic disease that has detrimental effects on numerous body systems. Increasing the awareness of this fact is essential both for the general population and policymakers. Considering obesity as a public health issue, endorsing preventive measures, raising the understanding of the disease burden, and establishing rehabilitative health programs should treat it. It is vital to catch the disease early in its progress and intervene accordingly to stop the patient from falling into the vicious cycle in which obesity and its complications advocate each other, progressively lowering the quality of life.

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