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...
...MESSAGES: Obesity Classification and Conseq...
...es: Key ExamplesHaving trouble viewing table...
Evaluation
Evaluat...
...Y MESSAGES: Obesity Evaluation...
...istory...
...sical Exam...
...utine CBC Comprehensive metabolic p...
...AY MESSAGES: Obesity and Body Composition...
...Composition...
...artment Fat mass Fat-free mass (water, protein...
...partment Fat mass Lean mass (wa...
...Compartment Fat mass Total bod...
...partment Fat mass Total body water Bone mine...
...easurements
...ms per meters squared (kg/m2)aNormal Weight...
...esity Classification: WCb...
...ominal Obesity – Women≥35 inche...
...esity – Men≥40 inches ≥102 centimeters...
...of Percent Body Fat in Adults as Assessed by DX...
...OP 10 TAKEAWAY MESSAGES: Obesity and Ener...
Body Weight HomeostasisRMR has genetic varian...
...xpenditure: Components Overall...
...lculating Resting Metabolic...
...nedict Equation Male RMR = 88.362...
...eor Equation Male RMR = (10 × weight in kg) +...
...ture: Metabolic Rate...
...nergy Expenditure
...alorimetry Measureme...
...es heat generated by an organism.
...Calorimetry FormulaSubstrate (Food) Energ...
Indirect Calorimetry Measur...
...oxygen consumption and carbon dioxide produc...
...t Calorimetry Formulas...
...r Equation: Resting energy expenditure =...
...s for Estimating Physical Activity Energy...
Non-pharmacologic Treatment
...harmacologic Treatment...
Treatment of Adult Patients With Overweight or O...
...EAWAY MESSAGES: Nutrition Therapy...
...ciples of Healthful Nutrition...
...hoosing Nutrition Therapy...
...Appropriate Nutritional Therapy for Wei...
...ods that result in a negative caloric balance to a...
...P 10 TAKEAWAY MESSAGES: Physical Ac...
...ture: 2018 Physical Activity Guidelines for...
...xpenditure: Obesity Medicine Associatio...
...uation to Ensure Safety Before Beginni...
...Options Based on Mobility Unable to Walk...
...10 TAKEAWAY MESSAGES: Motivational Inte...
...KEAWAY MESSAGES: Behavior Therapy...
...ognitive Behavioral Therapy (CBT) Techniques Do...
Eating Disorders and Obesity
...ing Disorders and Obe...
Binge-Eating Disord...
...ed upon episodes per week: Mild...
Diagnosis Frequent episodes of consuming larg...
...Often requires treatment by a qualified...
Bulimia Ne...
...is Cycle of recurrent binge eating and...
...reen for Disordered Eating (SDE), Eating Disorder...
...itive behavior therapy, possibly in combinati...
...Eating Syndrome (NES)...
...least 25% of daily food consumption (often greate...
...vioral therapy regarding nutritional timing and c...
...Related Eating Disorder...