Obesity-associated morbidity

Obesity is an important risk factor for many chronic physical and mental illnesses. The generally accepted view is that being overweight causes similar health problems to obesity, but to a lesser degree.[1]

Obesity-associated morbidity
Obesity has a number of medical complications which negatively impact peoples' quality of life.
SpecialtyEndocrinology(other specialties)

Cardiological
HeartAttack (Myocardial infarct)

Ischemic heart disease

Obesity is associated with cardiovascular diseases including angina and myocardial infarction.[2][3] A 2002 report concluded that 21% of ischemic heart disease is due to obesity[1] while a 2008 European consensus puts the number at 35%.[4]

Congestive heart failure

Having obesity is associated to about 11% of heart failure cases in men and 14% in women.[5]

High blood pressure

More than 85% of those with hypertension have a BMI greater than 25.[5] The risk of hypertension is 5 times higher in the obese as compared to those of normal weight. A definitive link between obesity and hypertension has been found using animal and clinical studies, which have suggested that there are multiple potential mechanisms for obesity-induced hypertension. These mechanisms include the activation of the sympathetic nervous system as well as the activation of the renin–angiotensin–aldosterone system.[6] The association between hypertension and obesity has been also well described in children.[7]

Abnormal cholesterol levels

Obesity is associated with increased LDL cholesterol (bad cholesterol) and lowered HDL cholesterol (good cholesterol).[5][8]

Deep vein thrombosis and pulmonary embolism

Obesity increases one's risk of venous thromboembolism by 2.3 fold.[9][10]

Dermatological

Obesity is associated with the incidence of stretch marks, acanthosis nigricans, lymphedema, cellulitis, hirsutism, and intertrigo.[11][12]

Endocrine
Gynecomastia in an obese male.

Diabetes mellitus

One of the strongest links between obesity and disease is that with type 2 diabetes. These two conditions are so strongly linked that researchers in the 1970s started calling it "diabesity".[5] Excess weight is behind 64% of cases of diabetes in men and 77% of cases in women.[13]

Gynecomastia

Obesity, according to a 2009 review, can be associated with elevated peripheral conversion of androgens into estrogens in some individuals.[14]

Gastrointestinal

Gastroesophageal reflux disease

Several studies have shown that the frequency and severity of GERD symptoms are higher in those who are obese.[15][16]

Cholelithiasis (gallstones)

According to NIH, obesity causes the amount of cholesterol in bile to rise, in turn the formation of stone can occur [5][17]

Reproductive system (or genital system)

Polycystic ovarian syndrome (PCOS)

Due to its association with insulin resistance, the risk of polycystic ovarian syndrome (PCOS) increases with adiposity. In the US approximately 60% of patients with PCOS have a BMI greater than 30. It remains uncertain whether PCOS contributes to obesity, or the reverse.[18]

Infertility

Obesity leads to infertility in both men and women. This is primarily due to excess estrogen interfering with normal ovulation in women[5] and altering spermatogenesis in men.[19] It is believed to cause 6% of primary infertility.[5][20] A review in 2013 came to the result that obesity increases the risk of oligospermia and azoospermia in men, with an of odds ratio 1.3.[21] Being morbidly obese increases the odds ratio to 2.0.[21]

Complications of pregnancy

Obesity is related to many complications in pregnancy including: haemorrhage, infection, increased hospital stays for the mother, and increased NICU requirements for the infant.[22] Obese women have more than twice the rate of C-sections compared to women of normal weight.[23] Obese women also have increased risk of preterm births and low birth weight infants.[24]

Birth defects

Those who are obese during pregnancy have a greater risk of have a child with a number of congenital malformations including: neural tube defects such as anencephaly and spina bifida, cardiovascular anomalies, including septal anomalies, cleft lip and palate, anorectal malformation, limb reduction anomalies, and hydrocephaly.[25]

Intrauterine fetal death

Maternal obesity is associated with an increased risk of intrauterine fetal death.[20]

Neurological
MCA Territory Infarct (stroke)

Stroke

Ischemic stroke is increased in both men and women who are obese.[5]

Meralgia paresthetica

Meralgia paresthetica is a neuropathic pain or numbness of the thighs, sometimes associated with obesity.[26]

Migraines

Migraine and obesity are comorbid. The risk of migraine rises 50% by BMI of 30 kg/m2 and 100% by BMI of 35 kg/m2.[27] The causal connection remains unclear.[28]

Carpal tunnel syndrome

The risk of carpal tunnel syndrome rises 7.4% for each 1 kg/m2 increase of body mass index.[29]

Dementia

Those who are obese have a rate of dementia 1.4 times greater than those of normal weight.[30]

Idiopathic intracranial hypertension

Idiopathic intracranial hypertension, or unexplained high pressure in the cranium, is a rare condition that can cause visual impairment, frequent severe headache, and tinnitus. It is most commonly seen in obese women.[31][32]

Multiple sclerosis

Women that are obese at age 18 have a greater than twofold increased risk of MS.[33]

Cancer (or oncological)
Hepatocellular carcinoma 1
Main article: Obesity and cancer

Many cancers occur at increased frequency in those who are overweight or obese. A study from the United Kingdom found that approximately 5% of cancer is due to excess weight.[34] These cancers include: [35]

A high body mass index (BMI) is associated with a higher risk of developing ten common cancers including 41% of uterine cancers and at least 10% of gallbladder, kidney, liver and colon cancers in the UK.[36] For those undergoing surgery for cancer, obesity is also associated with an increased risk of major postoperative complications compared with those of normal weight.[37]

Psychiatric
Risk of suicide decreases with increased body mass index in the United States.[38]

Depression

Obesity has been associated with depression.[5] The relationship is strongest in those who are more severely obese, those who are younger, and in women.[39] Suicide rate however decreases with increased BMI.[38]

Social stigmatization

A 2011 systematic review indicated that obese people draw negative reactions, furthermore people are less willing to help the affected individual in any situation.[40]

Respiratory system

Obstructive sleep apnea

Obesity is a risk factor for obstructive sleep apnea.[5][41]

Obesity hypoventilation syndrome
CPAP machine commonly used in OHS

Obesity hypoventilation syndrome is defined as the combination of obesity, hypoxia during sleep, and hypercapnia during the day, resulting from hypoventilation.[42]

Chronic lung disease

Obesity is associated with a number of chronic lung diseases, including asthma and COPD.[41] It is believed that a systemic pro-inflammatory state induced by some causes of obesity may contribute to airway inflammation, leading to asthma.[43]

Complications during general anaesthesia

Obesity significantly reduces and stiffens the functional lung volume, requiring specific strategies for respiratory management under general anesthesia.[44]

Obesity and Asthma

The low grade systemic inflammation of obesity has been show to worsen lung function in asthma and increase the risk of developing an asthma exacerbation.[45]

Rheumatological and orthopedic
Gout

Gout

Compared to men with a BMI of 21–23, men with a BMI of 30–35 have 2.3 times more gout, and men with a BMI of greater than 35 have 3.0 times more gout. Weight loss decreases these risks.[46]

Poor mobility

There is a strong association between obesity and musculoskeletal pain and disability.[47]

Osteoarthritis

Increased rates of arthritis are seen in both weight-bearing and non-weight-bearing joints.[5] Weight loss and exercise act to reduce the risk of osteoarthritis.[48]

Low back pain

Obese individuals are twice to four times more likely to have lower back pain than their normal weight peers.[49]

Traumatic injury

In women, class II obesity (i.e. BMI = 35) is a risk factor for osteoporotic fractures in general, as well as for upper arm fractures.[50]

Urological and nephrological
Urinary system

Urinary incontinence

Urge, stress, and mixed incontinence all occur at higher rates in the obese.[51] The rates are about double that found in the normal weight population.[52] Urinary incontinence improves with weight lost.[53]

Chronic kidney disease

Obesity increases one's risk of chronic kidney disease by three to four times.[54]

Hypogonadism

In men, obesity and metabolic syndrome both increase estrogen and adipokine production. This reduces gonadotropin-releasing hormone, in turn reducing both luteinizing hormone and follicle stimulating hormone. The result is reduction of the testis' production of testosterone and a further increase in adipokine levels. This then feeds back to cause further weight gain.[55]

Erectile dysfunction

Obese men can experience erectile dysfunction, (as well as, in association with diabetes), however weight loss causes an improvement in their sexual functioning.[56][57]

See also

References
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