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
...Diagnosis...
...TOP 10 TAKEAWAY MESSAGES...
...tic Syndromes: Key Examples...
Evaluation
...Eval...
...TOP 10...
...History Body weight...
...Physica...
...utine CBC Comprehensive metab...
...TOP 10 TAKEAWAY MESSAGES:...
...Body Composition...
...nt Fat mass Fat-free mass (water,...
... Compartment Fat mass Lean mass (wate...
...Four Compartment Fat mass To...
...Compartment Fat mass Total body water Bon...
...Measuremen...
...MI in kilograms per meters squared (kg/m2)aN...
...Obes...
...Obesity – Women≥35 inches ...
...Obesity – Men≥40 inches ≥102 ce...
...tion of Percent Body Fat in Adults as A...
...TOP 10 TAKEAWA...
...meostasisRMR has genetic variance, mainly v...
...Energy Expendi...
...Calculat...
...arris-Benedict Equation Male RMR = 88....
...ifflin-St. Jeor Equation Male RMR = (10 × we...
...Energy...
...Energy Expenditure...
...Dire...
...generated by an organism....
...etry FormulaSubstrate (Food) Energy = ~60% L...
...Indirect Calorimetry Me...
...n consumption and carbon dioxide produ...
...Indirec...
...reviated Weir Equation: Resting energy...
...Calculations for...
Non-pharmacologic Treatment
...Non-pharmacologic Trea...
...dult Patients With Overweight or Obesit...
TOP 10 T...
...Principles...
...Choosing Nutrition Ther...
...priate Nutritional Therapy for Weight Loss is On...
...ods that result in a negative caloric balance...
...TOP 10 TAKE...
...Energy Exp...
...nergy Expenditure: Obesity Medicine Association...
...M...
...ity Options Based on Mobility Unable to...
...TOP 10 TAKE...
...T...
...Behavioral Therapy (CBT) Techniques Doable...
Eating Disorders and Obesity
...Eating Disorders...
...Binge-...
...pon episodes per week: Mild = 1–3;...
...Frequent episodes of consuming l...
...ten requires treatment by a qualified clinici...
...Bulimia Nervosa...
Diagnosis Cycle of recurrent binge eating and...
...Screen for Disordered Eating (SDE), Eating Dis...
...ent Cognitive behavior therapy, pos...
...Night-Eating Sy...
...least 25% of daily food consumption (often...
...Behavioral therapy regarding nutritional timing...
...Sleep-Relate...