Grateful to have another contribution from our friends at Healthcare Evoloution. This week Dr. Ivana Anusic writes for us to give a rundown on obesity, and the options available to deal with this affliction
What is Obesity?
Obesity is a complex progressive chronic disease that involves abnormal or excessive adipose tissue or fat which may negatively affect your health. Adipose tissue however is not just “dead” weight we carry around, it’s an organ which produces certain substances that can have a negative effect on the body.
According to Statistics Canada around 60% of adults are overweight or obese, rates which have been rising from previous years for both adults and children.
What causes obesity?
The most common misconception about obesity is that it is due to excessive eating and limited exercise - to cure it we just need to eat less and move more. This is a major component of it, but we’re missing part of the picture.
Nutrition and activity levels can certainly play a role; however, this issue is much more complicated. Unlike many other conditions, which can often be kept private, obesity is very public. It’s a disease you wear, and your triumphs as well as your failures are on display for the world to see.
The topic of Weight Bias in our society is a blog for another day but, because obesity is a very visible disease, there are several misconceptions and beliefs that often contribute to it.
One common perception is that obesity is completely self inflicted and it’s just laziness or a lack of willpower that’s the reason an individual remains obese. However, I can assure you that no one has tried more diets, weight-loss fixes, and programs than an overweight individual. Willpower, starvation, and suffering will only go so far. So if it‘s not a matter of eat less and move more, what is it then?
Obesity is a chronic condition involving many contributing factors such as our environment, social aspects, genetics, medical conditions, medications, and mental health which all contribute to its progression and management.
From an evolutionary standpoint, our bodies were designed for a world that existed 30,000 years ago where food was scarce, and we might not have known when our next meal was coming. So, when we did eat, our bodies did everything to have us consume as much as possible and store the most energy (in the form of fat) as they could.
But our world today is vastly different from the food scarcity we evolved for, and we have an overabundance of food in western society. Despite this, our bodies are fundamentally the same fat storing machines they were 30,000 years ago.
Complex mechanisms prevent our bodies from losing weight quickly, and as weight-loss progresses we often hit a plateau as our body adapts to slow down our metabolic processes. This can mean that the same efforts we were using previously for weight-loss are no longer as effective. We must carry out more dietary restriction and more activity in order to achieve further weight-loss.
Our bodies continually adapt and slow their metabolic processes down even further. Eventually, as the scale stops moving and ‘the stubborn fat’ will not budge most people throw up their hands and quit, because the suffering is no longer worth it.
As such, most individuals revert back to their previous lifestyle and gain back the weight they’d lost. Unfortunately, our metabolic processes don’t adapt as our weight returns to what it was previously, and many individuals often gain even more weight then they had previously lost… and the cycle continues…
How is it measured?
There are two measures used to determine obesity, one is BMI (Body Mass Index) which uses height and weight to classify the size of an individual, and the second is the Edmonton Obesity Staging System (EOSS) which looks at the impact of obesity on an individual's overall health.
BMI (Body Mass Index) uses height and weight in the formula below to determine the size of a person placing them into categories:
BMI = weight (kg)/ height (meters) 2
Normal Range 18.5 - 24.9
Overweight 25 -29.9
Severe Obesity >40
BMI does not factor in sex, ethnicity, body shape, age or muscle mass and doesn’t factor in the health of the person.
2) The Edmonton Obesity Staging System (EOSS) looks at the clinical assessments of medical, mental and functional impact that obesity has on an individual to determine their obesity-related health risks and is a far better predictor of overall health than just BMI alone. EOSS has 5 categories encompassing the progression of organ damage with Stage 0 being no apparent risk factors all the way up to stage 4 with end stage organ failure.
Impact on health:
Impact on health can be described by the 4 M’s
1. Mechanical - Obstructive sleep apnea, Gastroesophageal reflux disease (heartburn), Osteoarthritis (mostly of the knees), Plantar fasciitis, Urinary/fecal incontinence, Intertrigo (skin-fold infections) and other skin issues such as stretch marks, skin tags, acanthosis nigricans (roughened darker skin patches often found on the back of the neck, armpits and groin area)
2. Mental - depression, bipolar disorder, anxiety, low self-esteem, negative self-talk, body dissatisfaction, disordered eating/eating disorders. Some of these leading to obesity for example due to medications that are taken to manage these conditions, and some of these are contributing factors as to why an individual is unable to manage their obesity.
3. Metabolic - Type 2 diabetes, hypertension and elevated cholesterol which can increase the risk of heart attacks, gout, gallstones, fatty liver disease, infertility and increased risk of complications during pregnancy, and increased risk for certain cancers.
4. Monetary - Education and Employment (higher education and income tends to have lower rates of obesity), Obesity can lead to an increased cost of living (e.g., clothing, mobility aids), and the potential cost of weight-management programs.
The first goal of therapy is to stop further weight gain. For some individuals, this is all that’s possible. There is no specific amount of weight which needs to be lost, the aim of obesity treatment is to reach our Best Weight - which is the weight we reach when we’re living the healthiest lifestyle possible!
Weight loss doesn’t have to be drastic in order to see positive improvements in health. A loss of 3-5% of your original body weight can have marked improvements on your health status, and further losses can lead to further health benefits. Most clinicians aim for an initial weight-loss goal of 5-10% of your original body weight.
Current treatment options include:
Lifestyle modifications: Diet, physical activity and behavioral modifications fall into this category. The overall goal being to properly nourish the body and create a caloric deficit by decreasing the energy coming into the body (food) and increasing the energy spent by the body (activity). This component should be the foundation of any weight loss treatment.
Medications: Health Canada approved treatment options include: Saxenda (liraglutide), Contrave (naltrexone/bupropion) and Xenical(Orlistat), affecting appetite, cravings and fat absorption. Medications are officially approved for individuals with a BMI over 30, or those with a BMI of 27 with type 2 diabetes, high cholesterol or high blood pressure.
Bariatric surgery: Surgery is an option for individuals who have a BMI greater than 40, or those with a BMI above 35 with other compounding medical conditions. Surgery involves reducing the size of the stomach and/or rearranging parts of the intestines. This allows us to decrease the volume of food the body can take in, and/or the amount of food the body can absorb.
So, it’s inarguable, obesity is complex! Strategies have no choice but to be progressive if there is to be any impact on the problem. Otherwise, its impact on health, on physical disease burdens, and on mental wellbeing are a tidal wave that not only the individual, but also society will pay for dearly.
Will every individual that has excess weight develop health complications as a result? No. In the same sense, not every individual who has excess weight needs to lose that weight either! Ultimately, ones focus should be on living the healthiest and happiest life you possibly can. If that leads to weight-loss, wonderful! If it doesn’t there is absolutely nothing wrong with that either!
If you’re considering making lifestyle changes it can certainly be challenging to do it on your own. I would encourage you to reach out to your family physician or other trusted healthcare professional for advice and support on the best way to go about it!