Obesity

CAUSES                       COMPLICATIONS                       TREATMENTS

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems.

Obesity is usually defined by measures of excess body fat including BMI and waist circumference or waist hip ratio. These measures are discussed more here.

Over 60% of all Australian adults are now classified as overweight or obese and unfortunately these numbers are rising. Indeed obesity is the leading cause of preventable death worldwide.

What Causes Obesity?

1. Diet and exercise: Obesity is most commonly caused by a combination of poor eating habits (too many calories) and a lack of physical activity or exercise.
2. Genetic susceptibility: While obesity is rarely due solely to genetic makeup, there is no doubt your genes impact on the way your body uses and stores energy
3. Environment: the types of food available and your lifestyle are very much impacted by your surroundings.
4. Medical conditions: Endocrine disorders and certain medications can be the cause of obesity
5. Psychological illness

Complications of Obesity

Obesity increases the likelihood of many diseases including:

• Diabetes
• Arthritis and other joint problems
• High blood pressure
• Heart disease
• Stroke
• Liver disease (Non Alcoholic Fatty Liver Disease (NAFLD) or steatohepatitis (NASH))
• Gallbladder problems
• Certain types of cancer (breast, uterine, colon)
• Digestive disorders (e.g., gastroesophageal reflux disease, or GORD)
• Breathing difficulties (e.g., sleep apnoea, asthma)
• Psychological problems such as depression
• Problems with fertility and pregnancy
• Urinary Incontinence
• Shorter Life Expectancy

There are also impacts on psychological and social wellbeing such as:

• Negative self-image
• Social isolation
• Discrimination

And day to day living becomes a lot harder:

• Normal tasks become harder when you are obese, as movement is more difficult
• You tend to tire more quickly and you find yourself short of breath
• Public transport seats, telephone booths, and cars may be too small for you
• You may find it difficult to maintain personal hygiene

What are the treatment Options?

1. Diet and Exercise

Dieting and exercise have long been regarded as the conventional methods to achieve weight loss. Sometimes, these efforts are successful in the short term, although the average weight loss is usually in the realm of 5-8kg.  However, for people who are obese, the results can be difficult to maintain. Indeed, the majority will regain the most of the weight they lost within a year unless they continue with intensive dietary and physical fitness interventions. Many people will go through multiple of these cycles of weight loss and weight gain with the possibility of serious psychological and health consequences. Given that only 5% of people in weight loss programmes will maintain a healthy weight at 5 years other options are needed.

2. Medications

A number of medications are licensed for weight loss in Australia, including Xenical™ (Orlistat), Reductil™ (Silbutramine) and Duromine™ (Phentermine). These drugs are expensive ($80-150/month) and can have significant side-effects. When used in conjunction with a low calorie diet, weight loss of up to 10kg can be achieved over the course of 18-24 months. Once the drugs are stopped however, the majority of weight is regained within 2-3 years. 

3. Surgical Treatments

Over the years, weight-loss surgery has proven to be a successful method for the treatment of obesity. Options include:

• Laparoscopic Gastric Band
• Sleeve Gastrectomy
• Laparoscopic gastric Bypass
• Stomach stapling or Gastroplasty
• Malabsorptive procedures

Complications of these procedures can be very serious and even fatal, albeit that they occur rarely. Patients need to consider their options carefully before proceeding with weight loss surgery.