Chronic Disease of Obesity
Overview
Overview
Key Points
- Multiple factors contribute to the development of obesity and its consequences.
- Biologic:
- Genetic, epigenetic, endocrine, immune, neurohormonal, enterohormonal, neurobehavioral, and gut microbiota.
- Environmental:
- Cultural and social influences, emotional conditions, lifestyle, toxins, and medications.
- Other:
- Infection, trauma, disability, and illness.
- Biologic:
- From 1999–2000 through 2017–March 2020, US obesity prevalence increased from 30.5% to 41.9%.
- During the same time, the prevalence of severe obesity increased from 4.7% to 9.2%.
- According to a projection analysis in 2019, ~50% of U.S. adults will have obesity by 2030, with ~25% of adults having severe obesity (body mass index [BMI] ≥35 kg/m2).
Definition
TOP 10 TAKEAWAY MESSAGES: Obesity as a Disease
- The signs, symptoms, and pathophysiology of obesity fulfill the definition of a disease.
- Obesity can substantially be due to inheritance (genetic, epigenetic, and/or environmental inheritance).
- Obesity may result in cellular and organ anatomic abnormalities.
- Obesity may result in cellular and organ functional abnormalities.
- Obesity may result in pathogenic adipocyte and/or adipose tissue endocrine and immune dysfunctions that contribute to metabolic disease (adiposopathy or “sick fat” disease).
- Obesity may result in pathogenic physical forces from excessive body fat, promoting stress damage to other body tissues (“fat mass disease” [FMD]).
- Many diseases are promoted by unhealthful behavior, and obesity is no less of a disease when it is promoted by unhealthful behavior.
- Data from 2017–2018 estimate that approximately 42% of U.S. adults have obesity; 19.3% of youths have obesity.
- As with other diseases, obesity is best discussed using “people-first” language.
- Obesity is promoted by genetic predisposition, and shares similar pathophysiologies as aging.
Top 10 Benefits of Treating Obesity As a Disease
- Healthful nutrition and regular physical activity often improves anatomic, physiologic, inflammatory, and metabolic body processes.
- Medically managed weight reduction in patients with obesity often improves glucose and lipid metabolism, reduces blood pressure, and reduces the risk of thrombosis.
- Medically supervised weight management programs for patients with obesity have the potential for statistically significant and clinically meaningful weight loss maintenance.
- Weight loss in patients with obesity may reduce disability and premature mortality.
- Weight loss in patients with obesity may have favorable cardiac hemodynamic effects.
- Weight loss in patients with obesity may improve obstructive sleep apnea and osteoarthritis.
- Weight loss in patients with obesity may reduce the onset of certain cancers, improve response to cancer treatments, and reduce the onset/recurrence of new cancers.
- Weight loss in women with obesity may improve polycystic ovary syndrome, as well as improve obesity-related gynecologic and obstetric disorders; weight loss in men may increase testosterone levels in men with hypogonadism.
- Weight loss in patients with obesity may improve quality of life, improve body image, and improve symptoms of some psychiatric disorders (e.g., depression).
- Weight loss in child-bearing women (and men) with overweight or obesity may help mitigate epigenetically transmitted increased risk of obesity and metabolic disease in future generations.
The Obesity Medicine Association (OMA) Obesity Algorithm
Diagnosis
...iagnosi...
...10 TAKEAWAY MESSAGES: Obesity Classifi...
...etic Syndromes: Key ExamplesHaving t...
Evaluation
...luation...
...0 TAKEAWAY MESSAGES: Obesity Evalu...
...ysical Exam
...outine CBC Comprehensive meta...
...MESSAGES: Obesity and Body Composition...
...Composition...
...tment Fat mass Fat-free mass (water, protein,...
...mpartment Fat mass Lean mass (water, protein)...
...rtment Fat mass Total body water Protein...
...ix Compartment Fat mass Total body water Bo...
Measureme...
...I in kilograms per meters squared (kg/m2)aNorm...
...Classification: WCb...
...sity – Women≥35 inches ≥88 centimeters...
...l Obesity – Men≥40 inches ≥102...
...fication of Percent Body Fat in Adult...
TOP 10 TAKEAWAY MESSAGES: Obesity and Energy Ex...
...meostasisRMR has genetic variance, mainly via bo...
...ergy Expenditure: Components Overall...
...ating Resting Metabolic Rate...
...-Benedict Equation Male RMR = 88.362 + (13...
...or Equation Male RMR = (10 × weig...
...Expenditure: Metabolic Rate...
...y Expenditure...
...t Calorimetry Measuremen...
...eat generated by an organism....
...try FormulaSubstrate (Food) Energy...
...irect Calorimetry Meas...
...consumption and carbon dioxide producti...
Indirect Calorimetry...
...ed Weir Equation: Resting energy expenditure = ox...
...r Estimating Physical Activity Energy Expen...
Non-pharmacologic Treatment
...n-pharmacologic Tr...
...of Adult Patients With Overweight or Obesity...
...EAWAY MESSAGES: Nutrition Therapy...
...of Healthful Nutrition...
...sing Nutrition Therapy for Obesity...
...ropriate Nutritional Therapy for W...
...foods that result in a negative caloric bal...
...MESSAGES: Physical Activity...
...ure: 2018 Physical Activity Guidelines f...
...enditure: Obesity Medicine Association Physic...
...aluation to Ensure Safety Before Beginning New Ex...
...Based on Mobility Unable to Walk Seated...
...EAWAY MESSAGES: Motivational Interv...
...P 10 TAKEAWAY MESSAGES: Behavior Therapy...
...ioral Therapy (CBT) Techniques Doable...
Eating Disorders and Obesity
...sorders and Obesity...
...ating Disorder...
Severity based upon episodes per week...
...Frequent episodes of consuming large amount...
...ment Often requires treatment by a qualif...
Bulimia Ner...
...agnosis Cycle of recurrent binge eating an...
...ening Screen for Disordered Eati...
...Cognitive behavior therapy, poss...
...ting Syndrome (NES)...
...At least 25% of daily food consumption (often...
...vioral therapy regarding nutritional t...
...ating Disorder...