Obesity is a complex health condition characterized by an excess of body fat, which can significantly impact overall health and well-being. It’s usually defined by a body mass index (BMI) of 30 or higher. Here’s an overview of the causes, diagnosis, differential diagnosis, and management of obesity.
Causes of Obesity
- Genetic Factors: Certain genetic predispositions can affect metabolism and fat storage.
- Dietary Habits: High caloric intake, especially from processed and high-fat foods.
- Physical Inactivity: Sedentary lifestyle contributes significantly to weight gain.
- Psychological Factors: Stress, depression, and other mental health issues can lead to overeating.
- Medical Conditions: Such as hypothyroidism, polycystic ovary syndrome (PCOS), and Cushing’s syndrome.
- Medications: Some medications can lead to weight gain or make it difficult to lose weight – antipsychotics, mood stabilisers, anticonvulsants, corticosteroids, insulin, TCAs, mirtazipine.
- Environmental Factors: Lack of access to healthy foods, high-stress environments, and societal norms.
Diagnosis
- Body Mass Index (BMI): BMI = weight (kg) / [height (m)]^2. A BMI of 30 or higher is considered obese.
- Waist Circumference: Measures abdominal fat. A waist circumference of > 94cm in men and > 80cm in women indicates a higher risk of obesity-related conditions.
- Medical History and Physical Examination: To evaluate for obesity-related conditions like hypertension, diabetes, and cardiovascular disease.
Differential Diagnosis
- Polycystic Ovary Syndrome (PCOS): In women, associated with weight gain and hormonal imbalances.
- Hypothyroidism: Can cause weight gain and fatigue.
- Cushing’s Syndrome: Characterized by weight gain, particularly in the trunk, and other specific features.
- Fluid Retention: Can cause rapid weight gain due to fluid buildup, not fat.
- Genetic Syndromes: Certain syndromes, like Prader-Willi, are associated with obesity.
Management of Obesity
- Lifestyle Modifications: The cornerstone of obesity management; includes diet changes, increased physical activity, and behavioral changes.
- Dietary Changes: Focusing on calorie reduction, balanced diet, and portion control.
- Exercise: Regular physical activity, both aerobic and strength training.
- Psychological
- CBT (Cognitive-behavioral therapy) may be beneficial for addressing emotional and psychological aspects of obesity.
- Behavioral Therapy: Counseling to address emotional eating and develop healthier habits.
- Social support from peers and healthcare providers can help individuals maintain motivation and achieve their weight loss goals.
- Medical
- Pharmacotherapy: Medications may be prescribed for weight loss in certain individuals.
- Xenical (Orlistat)
- Duromine (Phenteramine) 15-45mg OD
- Contrave (Buproprion/Naltrexone)
- Saxenda (Liraglutide)
- Off label: Metformin, GLP-1, SGLT2
- Bariatric Surgery: Considered for people with severe obesity (BMI >40 or >35 with comorbidities) who haven’t achieved results with lifestyle changes and medication.
- Bariatric surgery options include gastric bypass, sleeve gastrectomy, and adjustable gastric banding. These procedures reduce the size of the stomach and may limit calorie intake.
- Nutrient deficiencies can occur with bariatric surgery
- Pharmacotherapy: Medications may be prescribed for weight loss in certain individuals.
Monitoring and Follow-up
- Regular follow-ups for monitoring weight loss progress, and management of comorbidities.
- Continuous support and counseling to maintain lifestyle changes.
Conclusion
Obesity is a multifactorial disease requiring a comprehensive approach to management, including lifestyle modification, medical treatment, and possibly surgery. Addressing obesity effectively not only focuses on weight loss but also on reducing the risk of associated health conditions and improving overall quality of life.