Obesity

The symptoms of obesity can vary from person to person. Some of the most common symptoms include:

• A history of weight gain
• Excess body fat, particularly around the waistline
• Shortness of breath or chest pain
• Snoring while sleeping
• Insomnia or trouble sleeping
• Sleep apnea (irregular breathing that periodically stops during sleep)
• Excessive sweating
• Tiredness or fatigue ranging from mild to severe
• Inability to perform simple physical tasks that were previously manageable
• Osteoarthritis in weight-bearing joints, especially the knees
• Joint pain, particularly in the back and knees
• Swelling and varicose veins in the legs
• Skin infections due to moisture accumulation in skin folds
• Stretch marks
• Psychological issues such as low self-esteem, depression, and social isolation

The root cause of obesity is not restricted to a single cause but many different factors. The leading factors that contribute to obesity are lack of exercise, excessive calorie intake, genetics, emotional stress, and sedentary lifestyle. Obesity is also caused by energy imbalance (between energy intake and expenditure). This means that there is more food energy coming in than going out. If this continues, the person will gain weight until they are obese or overweight. Many factors may contribute to obesity such as:

1. Genetic factors
   Obesity tends to run in families. A child with a single obese parent has a 3-fold risk of becoming obese, while a child with obese parents has a 10-times higher risk of obesity in the future. Genes can affect appetite and thus, how much food you consume. They also control how quickly the body burns calories at rest and during exercise. Genes influence fat regulation and areas of body fat accumulation, particularly in the abdomen and around the waist. Very rarely, mutations in the following genes can cause obesity:
   • The ob gene: This gene controls the production of leptin, a hormone made by fat cells and the placenta. Leptin controls weight by signaling the brain to eat less when body fat stores are very high. A mutation in the ob gene prevents leptin production and results in severe obesity in a very small number of children.
   • The gene for the melanocortin 4 receptor: Melanocortin 4 receptors are located mainly in the brain and play a key role in the regulation of energy. A mutation in this gene may account for obesity in 1 to 4% of children.
   However, it should be noted that families not only share genes but also environment, making it difficult to separate the two factors. You could be genetically predisposed to being overweight, but your genes may not be activated if you have the right environment and lifestyle.
2. Aging
   Obesity can occur at any age, even in children and teenagers. However, obesity becomes more common with age as the amount of muscle tissue decreases. The result is a higher percentage of body fat and a lower basal metabolic rate (because muscle burns more calories). These changes also reduce the need for calories. If you don't consciously control what you eat and become more physically inactive as you age, you are most likely to gain weight.
3. Physical inactivity
   A major factor that contributes to obesity is inactivity or lack of physical activity. Technological advances such as elevators, cars, remote controls, and online shopping have reduced the amount of calories burnt. More time is spent doing sedentary activities such as watching television, using computers, smartphones, and playing video games. Many people have desk jobs where they sit for hours without breaks. This can lead to obesity in some people because their bodies are not burning enough calories when they remain seated for extended periods.
4. Unhealthy diet
   Modern diets have significantly shifted to energy-dense foods, which have a large number of calories in a relatively small amount. Most of these foods contain more processed carbohydrates and trans fats, and less fiber. Fats are inherently energy-dense. Carbohydrates increase blood glucose levels, which stimulate the pancreas to release insulin. Insulin promotes the growth of fat tissue and can cause weight gain. More food advertisements promote high-fat, high-sugar junk foods like biscuits, namkeen, candy, fizzy drinks, soda, and packaged foods than healthier options like whole grains, vegetables, and fruits. Advertised products are designed to be cheap, have a long shelf-life, and are specifically engineered to be addictive and irresistible. These convenience foods significantly contribute to obesity.
5. Frequency of eating
   It has been observed that people who eat small meals four or five times daily have lower cholesterol levels and lower weight and/or more stable blood sugar levels than those who eat two or three large meals daily. Hence, larger and fewer meals can predispose you to gain weight.
6. Eating disorders
   The following eating disorders are associated with obesity:
   • Binge eating disorder is characterized by binging, i.e., eating large amounts of food during a short period and usually feeling guilty or out of control.
   • Night-eating syndrome involves not eating enough during the day and consuming a lot of food or calories in the evening. It also involves awakening in the middle of the night to eat.
7. Medical conditions
   Certain medical conditions can lead to weight gain and eventually obesity. These include:
   • Cushing syndrome: Caused by excessive levels of cortisol in the body, leading to fat accumulation in the face (moon face) and behind the neck (buffalo hump).
   • Polycystic ovary syndrome (PCOS): Causes obesity in affected women due to increased levels of testosterone and other male hormones, resulting in fat accumulation in the waist and abdomen.
   • Hypothyroidism: Makes the body use less energy from food, leading to obesity as the extra energy is stored as fat.
   • Insulin resistance: A precursor for developing type 2 diabetes that can also predispose to obesity.
   • Osteoarthritis: Causes joint pain that may lead to reduced physical activity and subsequent obesity.
   • Prader-Willi syndrome: A rare condition present at birth that causes uncontrolled hunger.
8. Certain drugs
   Many drugs used to treat certain diseases increase the risk of weight gain. These include:
   • Antidepressants
   • Antiseizure drugs, such as carbamazepine
   • Antihypertensives, such as beta-blockers
   • Corticosteroids
   • Some anti-diabetics
   • Oral contraceptives
   If this issue concerns you, discuss your medications with your doctor rather than discontinuing them, as this could have serious side effects.
9. Pregnancy and menopause
   Gaining weight during pregnancy is normal and necessary. However, some women find this weight difficult to lose after childbirth, which may predispose them to obesity. Having several children close together may compound the problem. If a pregnant woman is obese or smokes, weight regulation in the child can be disturbed, leading to weight gain during childhood and later. Many women tend to gain weight after menopause due to reduced activity and hormonal changes that may cause fat to be redistributed and accumulated around the waist.
10. Gut microbiota
    Normally, gut bacteria or gut flora help in food digestion among other functions. However, an altered gut microenvironment, such as long-term use of antibiotics, may increase the risk of obesity. Changes in the number and types of bacteria in the digestive system may affect how the body processes food.
11. Exposure to chemicals
    Obesogens are chemicals that disrupt normal development and metabolism. Exposure to obesogens early in life can increase the risk of developing obesity. These include cigarette smoke, bisphenol A, air pollution, flame retardants, phthalates, and polychlorinated biphenyls.
12. Psychological factors
    Many people eat excessively in response to emotions such as boredom, sadness, stress, anxiety, or anger. Adverse childhood events or a history of verbal, physical, or sexual abuse are also associated with a higher risk of obesity.
13. Lifestyle factors
    Sleep deprivation or lack of adequate sleep can result in weight gain. Sleeplessness causes hormonal changes that increase appetite and cravings for energy-dense foods. Cessation of smoking usually results in weight gain, as people tend to eat more food and their metabolic rate decreases, leading to increased body weight and potential obesity.
14. Socioeconomic factors
    Obesity and socioeconomic issues are related. Lack of money to buy healthy foods or familiarity with healthy cooking can increase the risk of obesity, as can the absence of safe places to walk or exercise.

Obesity is a disease diagnosed by a physician who measures the patient's height, weight, and body mass index. The physician may also conduct a physical examination, a laboratory test for thyroid function, and other tests to determine the cause of obesity. There are different methods for diagnosing obesity.

Body Mass Index (BMI)

The most common way to diagnose obesity is through body mass index (BMI). It is calculated by dividing weight in kilograms by height in meters squared. If your BMI is greater than 30 kg/m², you are considered obese. Being overweight or obese increases the chance of various diseases and chronic conditions. The BMI categorizes people as follows:

• Underweight: < 18.5 kg/m²
• Normal weight: 18.5-24.9 kg/m²
• Overweight: 25-29.9 kg/m²
• Obese: 30-34.9 kg/m²
• Morbidly obese: 35-39.9 kg/m²

However, BMI is considered an outdated method for diagnosing obesity because it does not yield accurate results for tall individuals or those with significant muscle mass.

Waist Circumference

A newer method for diagnosing obesity involves measuring waist size (waist circumference) instead of BMI. This method is more accurate as it does not rely on height or muscle mass. A waist circumference greater than 40 inches (102 centimeters) in men and 35 inches (89 centimeters) in women is classified as obese. Individuals with a larger waistline are at higher risk for cardiovascular disease, diabetes, stroke, and cancer. It is important to note that obesity is distinct from being overweight. A body mass index (BMI) of 30 or more classifies an individual as obese, while a BMI of 27-29.9 classifies them as overweight.

Lab Tests

Several lab tests can be conducted to diagnose obesity. In most cases, an examination by a doctor or blood work is required. You may also need to take specific steps to prepare for the testing process. Some of these tests for obesity include:

• Fasting lipid tests: These tests assess the build-up of fats in your body.
• Liver function tests: This test determines whether the liver is functioning properly and assesses if obesity is caused by liver disease.
• Thyroid function tests: These tests check for hyperthyroidism.

In the past few years, there has been a rise in obesity rates all around the world. Therefore, it is crucial to be educated on how we can prevent this issue and lower the rates of obesity. The question of how to prevent obesity is complex in today's society. Many factors contribute to the onset and progression of obesity. While it is not an easy problem to solve, there are ways to prevent or at least mitigate it.

1. Dietary Changes

• Healthier Food Choices
• A safe and practical long-term weight reduction and maintenance diet should include balanced, nutritious foods to avoid vitamin deficiencies and other diseases of malnutrition.
• Adopt a "rainbow diet" rich in fruits, vegetables, whole grains, nuts, seeds, and lean proteins like fish and chicken breast, along with vegetable proteins like soy. Include low-fat or fat-free dairy, which is rich in Vitamin D.
• Consume "low energy density" foods that contain relatively few calories per unit weight. For example, large amounts of cucumbers or carrots can be eaten without consuming many calories, helping to reduce hunger pangs.
• Choose foods with a low glycemic index to maintain stable insulin levels.
• Switch to healthy fats such as monounsaturated fats (olive and canola oil) and polyunsaturated fats (deep-sea fish and vegetable oil).
• Cutting Down Calories
• The first step is to review and record daily calorie intake. Generally, 1,200 to 1,500 calories for women and 1,500 to 1,800 for men are recommended.
• Consult with a doctor, dietitian, or nutritionist for guidance on daily calorie intake. Educate yourself on reading food labels and estimating calories and serving sizes.
• Restricting Certain Foods
• Avoid or limit sugar intake, including table sugar, sweets, cookies, pastries, doughnuts, cakes, muffins, and sugar-sweetened beverages.
• Limit "energy dense" foods that are high in calories but low in nutrition, such as red meat, deep-fried foods, and sweets.
• Avoid empty calories from foods that provide calories but little nutrition, such as alcohol and soft drinks.
• Steer clear of food items containing harmful fats, particularly saturated and trans fats.
• Healthier Lifestyle Habits
• Eat small, regular meals and carefully choose snacks.
• Never skip breakfast, as it can lead to overeating later in the day.
• Avoid quick fixes; resist the temptation of crash diets that promise fast weight loss.
• Consistency is key. Adopt healthier habits that can be maintained long-term to lose weight and keep it off.

2. Increased Physical Activity

Exercising can help individuals lose weight healthily and maintain weight loss. Those who do not exercise while dieting are more likely to regain lost weight. Physically active individuals tend to have stronger muscles, better cardiovascular fitness, lower body fat, and stronger bones. Recommended exercises include:

• Engage in 20 to 30 minutes of moderate exercise five to seven days a week, which can include activities like stationary bicycling, brisk walking, jogging, swimming, biking, tennis, skating, and skiing.
• Exercise can be broken into smaller sessions of 10 minutes.
• Start slowly and progress gradually to avoid injury or excessive fatigue, aiming for 30-60 minutes of moderate to vigorous exercise daily.
• Incorporate daily activities, such as taking the stairs instead of the elevator and walking instead of driving, to burn additional calories.
• It is never too late to start exercising; even elderly individuals can improve strength and balance through regular exercise. Always consult a healthcare provider before beginning a new exercise regimen.
• Encourage children to participate in low-intensity physical activities lasting 20 to 30 minutes daily to help them maintain a healthy weight throughout childhood and adulthood.

3. Get Enough Sleep

Ensure that you are getting sufficient sleep each night, as inadequate sleep can affect metabolism and appetite control, potentially leading to weight gain or obesity over time.

4. Reduce Screen Time

Adults and children spend over seven hours a day on screens, including smartphones, tablets, television, video games, and laptops. Excessive screen time is a significant obesity risk factor, associated with low physical activity and poor sleep. It also exposes individuals to marketing for unhealthy packaged foods and sugary drinks.

Parents! Here are some valuable tips to manage your children’s dietary habits and avoid common traps:

• Do not reward good behavior or punish bad behavior with candies or treats, as it can make children value junk food over healthier options.
• Avoid labeling foods as "bad" or completely banning sweets and junk food. Instead, serve healthy foods most of the time and offer treats occasionally.
• Do not enforce an empty-plate policy. If children feel full, do not force them to continue eating. Teach them to eat only when hungry and to stop when full.

To learn more about simple tips for preventing obesity in children, read here.

Obesity is a chronic and complex disease with significant health consequences. If lifestyle changes are ineffective, consult your healthcare provider to evaluate the need for further treatment options, including medications and surgery.

Medications

The drugs used to treat obesity are known as anti-obesity drugs. These medications function by decreasing appetite, increasing calorie expenditure, or reducing food absorption. The following drugs are prescribed for obesity:

• Orlistat: Reduces the absorption of fats from food in the gut, decreases appetite, and promotes a feeling of fullness, leading to weight loss. It is a prescription medication suitable for long-term use.
• Rimonabant: A cannabinoid receptor agonist that reduces appetite and body weight, contributing to a decrease in body mass index (BMI).
• Phentermine: Slows brain activity to reduce appetite and increases energy expenditure during physical activity, resulting in higher calorie burn.
• Lorcaserin: Suppresses appetite and enhances weight loss through serotonin activity in the brain.

These medications are used in conjunction with behavioral therapy and lifestyle changes to facilitate weight loss or prevent weight gain. However, they may cause side effects such as nausea, vomiting, dizziness, and dry mouth.

Recent Advances

• Semaglutide: Reduces appetite and promotes significant weight loss when combined with diet and exercise.
• Tirzepatide: Aids in weight loss by enhancing satiety and balancing energy intake while effectively controlling blood sugar levels.

Tirzepatide has shown an additional 5% weight loss and a greater reduction in type 2 diabetes risk compared to semaglutide, highlighting its potential for effective weight management and diabetes prevention.

These medications are utilized alongside behavioral therapy and lifestyle modifications to reduce weight gain or improve weight loss. Side effects may include nausea, vomiting, dizziness, and dry mouth.

Bariatric Surgery

Bariatric surgery reduces stomach size, limiting food intake. It may be recommended for the following obese patients:

• Patients with a BMI greater than 40.
• Patients with a BMI greater than 35 who have serious medical conditions, such as sleep apnea, that could improve with weight loss.

Currently, the following types of bariatric surgeries are advised:

• Restrictive surgeries: These procedures limit stomach size and slow digestion.
• Malabsorptive/restrictive surgeries: These surgeries reduce stomach size and bypass or remove parts of the digestive system to decrease food absorption.

Here are some tips that can help you take care of obese people at home:

• Monitor their diet and exercise habits by maintaining a diet journal.
• Educate them on the risks posed by obesity.
• Take steps to promote healthy living.
• Improve their self-esteem.
• Encourage them to eat healthily.
• Plan the meals together.
• Exercise together by going on a walk or doing some other physical activity you both enjoy.
• Give them enough time to rest and sleep every day.
• Stop their unhealthy habits like smoking or drinking alcohol.
• Keep them hydrated by drinking plenty of water throughout the day.

The complications of obesity are many and varied. The risks range from several serious medical conditions to a poor quality of life. It also has negative effects on the person’s social, physical, mental, and emotional health. There are many complications of being obese. These include:

• Hypertension (high blood pressure)
• Abnormal levels of cholesterol and other fats (lipids), called dyslipidemia
• Coronary artery disease
• Heart failure
• Diabetes or prediabetes
• Metabolic syndrome, which includes insulin resistance, abnormal levels of cholesterol and other fats in the blood, and high blood pressure
• Cancer of the breast, uterus, ovaries, colon, prostate, kidneys, or pancreas
• Gallstones and other gallbladder disorders
• Gastroesophageal reflux (GERD)
• Obstructive sleep apnea
• Skin infections
• Varicose veins
• Fatty liver and liver cirrhosis
• Blood clots (deep vein thrombosis and pulmonary embolism)
• Osteoarthritis, gout, low back pain, and other joint disorders
• Low testosterone levels, erectile dysfunction, and reduced fertility in men
• Menstrual disorders, infertility, and increased risk of miscarriage in women
• Depression and anxiety

Many medicinal plants that aid in weight loss include:

• Triphala
• Brahmi
• Garcinia cambogia
• Fresh curry leaves
• Turmeric
• Mint
• Ginger
• Cinnamon
• Black pepper (kalimirch)

Guggul, a gum resin derived from the Commiphora mukul tree, is a well-known natural ingredient that, once refined and processed properly, can be used to treat fat metabolic issues. It has been demonstrated in studies to break down fat cells. Other well-known herbs used in Ayurvedic weight loss treatments include kalonji (black cumin) and vijaysar (Kino tree).

Homeopathic Treatment for Obesity

Homeopathic remedies for the treatment of overweight and obesity can be divided into two categories:

• For adults: Ammonium bromatum, calcarea arsenicosa, fucus vesiculosus, phytolacca decandra, and thyroidinum.
• For children: Baryta carbonica, calcarea carbonica, and kalium bichchromicum.

Before prescribing a treatment, a homeopathic doctor evaluates a patient's physical and mental features, as well as symptoms and miasms (tendency to suffer from an illness).

Yoga for Obesity

Because every asana in yoga aims to work deeply on the core and the entire body, the following positions are some of the easier ones, especially for beginners. These will aid in the elimination of stomach-related ailments such as constipation, indigestion, and bloating, as well as strengthen the abdomen to minimize fat. Some of the yoga asanas to help reduce fat in the body are:

• Bhujangasana (Cobra pose)
• Dhanurasana (Bow pose)
• Kumbhakasana (Plank pose)
• Naukasana (Boat pose)
• Ustrasana (Camel pose)
• Adho mukha svanasana (Downward-facing dog pose)

The word ‘Yoga’ is derived from Sanskrit and means to unite, symbolizing the union of body and mind.

Weight is frequently a very personal and sensitive subject because of our attitudes around body image. As a result, dealing with the issue of weight might be difficult. Overweight individuals often experience low self-esteem, so suggesting they need to lose weight is typically unhelpful. Instead, encourage them to join you in making healthier lifestyle choices.

Obesity, particularly in women, can significantly impact sexual quality of life. Effective obesity management strategies that can enhance self-esteem, sexuality, and overall quality of life include:

• Lifestyle modifications
• Nutrition
• Medications
• Behavioral therapy
• Weight loss surgery

The key to managing obesity is a commitment to making lifestyle changes. Although these changes can be challenging initially, they will eventually become second nature. It's essential not to let difficulties hinder your success because you are worth it!

Regular exercise can aid in weight loss and help maintain a healthy weight. Exercise releases endorphins, which improve mood and reduce appetite. Find an exercise that you enjoy or can tolerate. Effective forms of exercise for weight reduction include aerobic exercises, strength training, and high-intensity interval training (HIIT).

Here is a quick overview of some key aspects of obesity that everyone should be aware of, emphasizing that ending weight stigma is crucial in the fight against obesity.