Chronic Disease of Obesity

Publication Date: March 1, 2023

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.
  • 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

"Obesity is defined as a chronic, progressive, relapsing, and treatable multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences."

TOP 10 TAKEAWAY MESSAGES: Obesity as a Disease

  1. The signs, symptoms, and pathophysiology of obesity fulfill the definition of a disease.
  2. Obesity can substantially be due to inheritance (genetic, epigenetic, and/or environmental inheritance).
  3. Obesity may result in cellular and organ anatomic abnormalities.
  4. Obesity may result in cellular and organ functional abnormalities.
  5. Obesity may result in pathogenic adipocyte and/or adipose tissue endocrine and immune dysfunctions that contribute to metabolic disease (adiposopathy or “sick fat” disease).
  6. Obesity may result in pathogenic physical forces from excessive body fat, promoting stress damage to other body tissues (“fat mass disease” [FMD]).
  7. Many diseases are promoted by unhealthful behavior, and obesity is no less of a disease when it is promoted by unhealthful behavior.
  8. Data from 2017–2018 estimate that approximately 42% of U.S. adults have obesity; 19.3% of youths have obesity.
  9. As with other diseases, obesity is best discussed using “people-first” language.
  10. Obesity is promoted by genetic predisposition, and shares similar pathophysiologies as aging.

Top 10 Benefits of Treating Obesity As a Disease

  1. Healthful nutrition and regular physical activity often improves anatomic, physiologic, inflammatory, and metabolic body processes.
  2. Medically managed weight reduction in patients with obesity often improves glucose and lipid metabolism, reduces blood pressure, and reduces the risk of thrombosis.
  3. Medically supervised weight management programs for patients with obesity have the potential for statistically significant and clinically meaningful weight loss maintenance.
  4. Weight loss in patients with obesity may reduce disability and premature mortality.
  5. Weight loss in patients with obesity may have favorable cardiac hemodynamic effects.
  6. Weight loss in patients with obesity may improve obstructive sleep apnea and osteoarthritis.
  7. 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.
  8. 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.
  9. Weight loss in patients with obesity may improve quality of life, improve body image, and improve symptoms of some psychiatric disorders (e.g., depression).
  10. 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

...Diagnosis...

...TOP 10 TAKEAWAY...


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Evaluation

...Evaluati...

...TOP 10...


...History Body w...


...Physical Exam...

...Routine CBC Comprehensive me...


...TOP 10 TAKEA...


...Body Compos...

...tment Fat mass Fat-free mass (water,...

...rtment Fat mass Lean mass (water,...

...Compartment Fat mass Total body water...

...ment Fat mass Total body water...


...Measurements...

...MI in kilograms per meters squared (k...

...Obesity C...

...esity – Women≥35 inches ≥88...

...dominal Obesity – Men≥40 inche...

...lassification of Percent Body Fat...


...TOP 10 TAKEA...


...eight HomeostasisRMR has genetic va...


...Energy Exp...


...Calculating Resting...

...ict Equation Male RMR = 88.362 + (13.397...

...lin-St. Jeor Equation Male RMR = (10 × weight...


...Energy Expendit...


...Energy Expenditure...

...sures heat generated by an organism....

...ct Calorimetry FormulaSubstrate (Fo...

Indirect C...

...ygen consumption and carbon dioxide p...

...In...

...breviated Weir Equation: Resting energy expend...


...C...


Non-pharmacologic Treatment

...Non-pharmacologic Tr...

...atment of Adult Patients With Overweig...


...TOP 10 TAKEAWAY MESSAGE...


...Principles of Healthfu...


...Choosing Nutrition...

...ppropriate Nutritional Therapy for Weight Loss is...

...ourage foods that result in a negative cal...


...TOP 10 TAKEAWAY MES...


...Energy Expendit...


...re: Obesity Medicine Association Ph...


...Medical Evaluation to Ensu...


...tions Based on Mobility Unable to Walk...



...TOP 10 T...


...vioral Therapy (CBT) Techniques D...


Eating Disorders and Obesity

...Binge-Eating...

...ased upon episodes per week: Mild = 1–3; Mo...

...osis Frequent episodes of consuming large...

Treatment Often requires treatment by a qualif...


...Bulimia Nervosa...

...Cycle of recurrent binge eating and compensat...

...ng Screen for Disordered Eating (SD...

...Cognitive behavior therapy, possibly in...


...Night-Eating Syn...

...At least 25% of daily food consumption (o...

...Behavioral therapy regarding nutritional t...


...Sleep-Rel...