Makindo Medical Notes

Obesity is a complex medical condition characterized by excessive accumulation of body fat, which poses significant health risks. It is associated with numerous comorbidities and can impact overall well-being. Understanding its causes, clinical features, diagnostic methods, and management strategies is crucial for effective care.

1. Causes of Obesity:genetic, behavioural, and environmental factors

• Genetic Factors: Genetics can influence metabolism, fat storage, and how the body uses energy. Certain genes may predispose individuals to gain weight more easily.
• Dietary Habits: High-calorie diets, frequent consumption of fast food, sugary drinks, and processed snacks contribute significantly to weight gain.Physical Inactivity: A sedentary lifestyle, often compounded by desk jobs and reliance on technology, contributes to obesity by reducing energy expenditure.
• Endocrine Disorders: Conditions such as hypothyroidism, polycystic ovary syndrome (PCOS), and Cushing's syndrome can lead to weight gain.
• Medications: Certain medications like antidepressants, antipsychotics, corticosteroids, and antiepileptics can cause weight gain as a side effect.
• Psychosocial Factors: Emotional stress, depression, or anxiety can lead to overeating or binge eating, contributing to obesity.
• Sleep Deprivation: Lack of adequate sleep is associated with hormonal changes that can increase appetite and lead to weight gain.
• Socioeconomic Factors: Lower-income individuals may have limited access to healthy food options, recreational facilities, or healthcare, increasing the risk of obesity.

Clinical Features of Obesity

• Body Mass Index (BMI): A BMI of 30 or higher is considered obese, and the severity is further classified as Class 1 (BMI 30-34.9), Class 2 (BMI 35-39.9), or Class 3 (BMI ≥40).
• Waist Circumference: Central obesity, indicated by a waist circumference >40 inches (men) or >35 inches (women), is a key risk factor for metabolic syndrome.
• Comorbidities: Obesity is associated with several comorbid conditions including hypertension, type 2 diabetes, dyslipidaemia, cardiovascular disease, sleep apnoea, osteoarthritis, and certain cancers (e.g., breast, colon).
• Physical Symptoms: Shortness of breath, fatigue, joint pain, and reduced mobility are common symptoms due to excess body weight.
• Psychological Impact: Obesity may contribute to depression, low self-esteem, and social isolation.

Diagnostic Tests

• Body Mass Index (BMI): Calculated by dividing weight (kg) by height (m²). A BMI ≥30 indicates obesity.
• Waist-to-Hip Ratio: Helps assess abdominal obesity, which is a stronger risk factor for cardiovascular diseases.
• Blood Tests: To assess for associated conditions:
  • Lipid Profile: To check cholesterol and triglyceride levels, assessing risk for cardiovascular disease.
  • Fasting Blood Glucose and HbA1c: To screen for prediabetes and type 2 diabetes.
  • Thyroid Function Tests: To rule out hypothyroidism as a contributing factor.
  • Liver Function Tests: To check for non-alcoholic fatty liver disease (NAFLD), a common complication of obesity.
  • Hormonal Assays: To evaluate for endocrine disorders like PCOS or Cushing’s syndrome.
• Sleep Studies: May be necessary to evaluate for obstructive sleep apnoea in individuals with obesity and sleep-related symptoms.

4. Management of Obesity: multidisciplinary approach

• Lifestyle Modifications
  • Dietary Changes: A structured, calorie-restricted diet with a focus on whole foods (fruits, vegetables, lean proteins, and whole grains) is essential. Reducing sugar, processed foods, and unhealthy fats is crucial.
  • Physical Activity: Regular exercise, including aerobic activities (e.g., walking, cycling) and strength training, helps burn calories and improve metabolic health. Aim for at least 150 minutes of moderate exercise per week.
  • Behavioural Therapy: Cognitive-behavioural interventions can help patients change unhealthy eating patterns, manage stress, and develop healthier habits.
  2. Pharmacological Management
  • Orlistat: A medication that reduces fat absorption in the gut. It may cause gastrointestinal side effects like diarrhoea or fat malabsorption.
  • GLP-1 Agonists (e.g., Liraglutide): These drugs reduce appetite and promote weight loss in patients with obesity, often also used in type 2 diabetes management.
  • Phentermine/Topiramate: A combination medication that suppresses appetite and increases satiety.
  • Metformin: Commonly used in patients with type 2 diabetes or insulin resistance, helping to reduce weight and improve glucose control.
• Surgical Interventions
  • Bariatric Surgery: Recommended for patients with a BMI ≥40, or ≥35 with comorbid conditions, who have not responded to conservative measures.
    • Gastric Bypass: A procedure that reduces stomach size and alters the digestive process, limiting calorie absorption.
    • Gastric Sleeve: Removal of part of the stomach to reduce its capacity and suppress appetite-regulating hormones.
    • Adjustable Gastric Banding: A less invasive procedure that uses a band to limit food intake.
  • Post-Surgical Management: Requires long-term follow-up to ensure nutritional adequacy, manage complications, and monitor for weight regain.
• Psychological and Social Support
  • Counselling: Psychological support can help address emotional eating, self-esteem issues, and depression that often accompany obesity.
  • Support Groups: Joining weight-loss support groups can provide motivation and a sense of community for individuals undergoing lifestyle changes.