Overweight and obesity, characterized conditions by an excessive accumulation of body fat, which can cause serious damage to health. They are caused in most cases by improper lifestyles. On the one hand, an incorrect high-calorie diet and on the other hand a reduced energy expenditure due to physical inactivity. Obesity is therefore a largely preventable condition. So, should obesity be labelled as a disease?

How obesity is measured?

The difference between overweight and obesity lies in the use of a measurement scheme that takes the name of BMI ( Body Mass Index ), that is the Body Mass Index  (BMI), which calculates the percentage of body fat in relation to height of the individual.
BMI, obtained by dividing the weight (expressed in kg) by the square of the height (expressed in meters).
BMI – widely used index, even if it provides incomplete information. It doesn’t give information on the distribution of fat in the body and does not distinguish between fat and lean mass.

The definitions of the World Health Organization (WHO) are:

• overweight = BMI of 25 to 29.99 or more
• obesity = BMI equal to or greater than 30.

Obesity is one of the major public health problems worldwide

The prevalence of obesity is constantly and worryingly increasing, not only in Western countries but also in low-middle-income countries; it also represents an important risk factor for various chronic diseases.

Childhood obesity

Childhood obesity, in particular, is one of the most important challenges due to the consequences it entails, such as the risk of type 2 diabetes, asthma, musculoskeletal problems, future cardiovascular problems, psychological and social problems.

To date, no country has reversed its obesity epidemic. Although there are some signs of positive change that mainly derive from a flattening of the prevalence of childhood obesity. However, even where progress has been made, there is an increase in inequalities in the prevalence of obesity. Socially vulnerable groups are, more affected by obesity because they have less access to education and correct information on lifestyles and health and usually live in areas that do not facilitate an active lifestyle. Very often, moreover, cheaper foods have lower nutritional quality and high energy density, making it difficult to adopt a healthy and balanced diet.

Obesity is a condition characterized by excessive body weight due to the accumulation of adipose tissue, to an extent that negatively affects the state of health. It is a real chronic metabolic disease, which compromises the regulation of appetite and energy metabolism.

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According to the World Health Organization, obesity represents one of the main public health problems in the world. In fact, estimated numbers are in 2008 about 1.5 billion adults were overweight, and of these, 200 million men and about 300 million of women were obese.

Obesity and overweight, previously considered problems only in rich countries, now also on the rise in low- and middle-income countries. Obesity is a real public health problem especially in urban settlements.

According to a study by the World Health Organization in Europe, 25-79% of adults are overweight and 5-30% obese, with varying percentages depending on the country.

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Research shows that obesity constitutes a multifactorial condition, that is, it recognizes several triggering mechanisms:

Genetic factors: 

Scientific research has for some time focused on the study of the genetics of obesity as well as on the mechanisms for regulating appetite and energy metabolism. it is likely that there are combined genetic factors that may or may not favor the ability to lose weight and keep it low; currently known cases of true genetic inheritance of obesity are rare

Socio-environmental factors and sedentary lifestyle:

The most frequent cause of obesity and overweight is an energy imbalance between the calories introduced with food and those consumed. Generally it is associated with an increase in the introduction of calorie foods rich in fats and sugars and a reduction in physical activity in part linked to the increasing sedentary lifestyle

Psychological factors: 

There are often pathological forms of overeating that can be favored by stress or disorders of emotionality, in some cases there are real eating disorders such as nocturnal eating syndrome and some forms of compulsive consumption of food (binge eating, etc)

Pharmacological causes:

Some drugs can contribute to the development of obesity by increasing hunger, reducing energy metabolism or stimulating the proliferation of fat cells. Among the drug classes most frequently involved are antidepressants and corticosteroids

Endocrine and metabolic causes: 

there are some rare hormonal diseases that can lead to obesity such as conditions of excessive cortisol production

Brain damage: 

there are very rare conditions in which brain damage in the hypothalamus area (brain region involved in appetite regulation) can lead to obesity.

Risks for obese patients

So, should obesity be labelled as a disease? Obesity has a wide range of health implications. Obese subjects are in fact at greater risk for the development of various disorders which include metabolic diseases such as diabetes and dyslipidemia (high levels of cholesterol and triglycerides), cardiovascular diseases such as stroke and heart attack, respiratory diseases (such as apneas night), joint problems (pain caused by osteoarthritis in the knees, hips and back), gynecological disorders (menstrual irregularities, polycystic ovary syndrome, complications in pregnancy), infertility, sexual disorders (impotence), predisposition to the development of digestive system diseases (e.g. gastroesophageal reflux, gallbladder stones), mood disorders (e.g. depression).

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Finally, it should be remembered that the presence of obesity increases the risk of developing some cancers such as endometrial cancer (a type of cancer of the uterus), colorectal, gallbladder and breast cancer.

Speaking of health risks, it is good to underline the problem of obesity in children and adolescents, these subjects are in fact exposed since childhood to breathing difficulties, joint problems, reduced mobility, but also digestive system disorders and of a psychological nature. Furthermore, those who are obese in childhood are often obese also as adults: therefore the risk of developing early cardiovascular risk factors such as hypertension and conditions of impaired metabolism, such as type 2 diabetes or hypercholesterolemia, increases.

The risk of developing disease increases as the body mass index increases. In particular, patients with severe obesity often have severe cardiovascular (hypertension, cardiovascular diseases) and respiratory diseases such as dyspnea, i.e. shortness of breath, for even modest efforts, Pickwick’s syndrome (ease of falling asleep during common daily activities), apneas nocturnal (Sleep Apnea Syndrome).

MORTALITY DATA

If we consider the pathologies and health risks associated with obesity, it is clear that obesity can be an important factor in mortality. According to estimates made, every year in Europe 320,000 people die from causes directly linked to obesity; mortality related to excess weight therefore represents a serious public health problem in Europe where approximately 7.7% of all causes of death are attributable to excess weight. Life expectancy in the severely obese population is reduced (we are talking about a shortening of life expectancy of 7-10 years) with a risk of death that increases with increasing body mass index and abdominal circumference.

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QUALITY OF LIFE OF OBESE PATIENTS

Numerous data show that obesity is associated with a worse quality of life. The diseases associated with obesity mentioned above can contribute to reducing the quality of life by reducing the physical capacities of patients (think for example of cardiological, respiratory or osteoarticular problems) and involve chronic drug therapies that can in turn be associated with side effects. Some disorders such as depression, infertility or impotence can further reduce the quality of life of patients in relation to interference in interpersonal relationships. Finally, in the context of social life there is a wide range of repercussions such as discrimination in the workplace, difficulties in everyday situations such as the search for clothing.

How obesity is treated?

The goal of obesity therapy is to achieve weight loss by reducing the number of calories consumed with diet to below the number of calories expended with exercise. The methods of achieving this vary widely, including depending on the degree of obesity. Like all therapies, it requires a preliminary evaluation by a doctor who will select the most appropriate treatment for each individual patient.

The first approach is a dietary one based on the use of a low-calorie dietary regime to be associated with a structured physical activity program tailored to the needs and possibilities of each patient.
As for drugs, scientific research has always been at work to identify new molecules to be associated with the diet. At the moment the doctor has numerous drugs to treat the diseases associated with obesity but as regards the treatment of obesity he has at his disposal only drugs capable of acting on the reduction of fat absorption that can find indications in selected cases. On the market there are also various herbal products, supplements or cocktails of various products that patients can easily find but which are often ineffective if not even in some cases highly harmful to health.

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A further tool of therapeutic approach is constituted by the multidisciplinary rehabilitation of obesity which is often reserved for forms of high degree obesity or with significant complications; this system is based on management by a group of several professionals (internists, nutritionists, psychiatrists, psychologists, dieticians, physiotherapists and nurses, etc.) in the context of multiple settings (clinic, residential rehabilitation, etc.). This approach seeks to rebuild correct eating habits in the patient, improve his ability to manage body weight, reactivate muscle structures and recover joint mobility, improve the cardiovascular and respiratory systems, increase energy expenditure, increase the ratio of lean mass to fat mass. and reduce body weight.

Finally, there is the surgical approach of the so-called bariatric surgery; in recent years, surgical techniques have increasingly evolved and refined and today it is possible to offer this option to selected patients who have not obtained an answer in terms of weight reduction with medical therapies. In accordance with the indications of the main scientific societies, the surgical option should be reserved for third-degree obesity patients or even for second-degree forms of obesity if associated with comorbidities.

So, should obesity be labelled as a disease? Let us know what you think about it in comment.