Obesity

⚖️ Obesity is a chronic, complex condition characterised by excessive accumulation of body fat. It increases the risk of cardiovascular disease, type 2 diabetes, cancers, and premature mortality. 🌍 It results from an interaction of genetic, behavioural, environmental, and metabolic factors. Understanding its causes, features, diagnostics, and management is essential for effective care.

1️⃣ Causes of Obesity

• 🧬 Genetic Factors: Influence metabolism, appetite regulation, and fat storage; certain genes predispose to weight gain.
• 🍔 Dietary Habits: High-calorie diets, processed foods, sugary drinks, and fast food drive positive energy balance.
• 🛋️ Physical Inactivity: Sedentary lifestyle (desk jobs, technology reliance) reduces energy expenditure.
• 🦋 Endocrine Disorders: Hypothyroidism, Cushing’s syndrome, PCOS can contribute to weight gain.
• 💊 Medications: Antidepressants, antipsychotics, corticosteroids, antiepileptics may cause weight gain.
• 🧠 Psychosocial Factors: Stress, depression, anxiety can trigger overeating or binge eating.
• 😴 Sleep Deprivation: Alters ghrelin/leptin → ↑ appetite and caloric intake.
• 💷 Socioeconomic Factors: Limited access to healthy food, exercise facilities, and healthcare increases risk.

2️⃣ Clinical Features

• 📊 Body Mass Index (BMI):
  • Class I: 30–34.9
  • Class II: 35–39.9
  • Class III: ≥40 (morbid obesity)
• 📏 Waist Circumference: Central obesity >40 in (men) or >35 in (women) → ↑ metabolic risk.
• ❤️ Comorbidities: Hypertension, type 2 diabetes, dyslipidaemia, NAFLD, OSA, osteoarthritis, cancers (breast, colon).
• 🤕 Physical Symptoms: Fatigue, breathlessness, joint pain, reduced mobility.
• 🧠 Psychological Impact: Depression, low self-esteem, social stigma, isolation.

3️⃣ Diagnostic Evaluation

• ⚖️ BMI calculation: Weight (kg) ÷ height (m²); ≥30 = obese.
• 📐 Waist-to-Hip Ratio: Detects central obesity, stronger link with CVD.
• 🧪 Blood tests:
  • 🧬 Lipid profile → dyslipidaemia.
  • 🩸 Fasting glucose / HbA1c → screen for diabetes.
  • 🦋 TFTs → rule out hypothyroidism.
  • 🍷 LFTs → assess for NAFLD.
  • ⚡ Hormonal assays → PCOS, Cushing’s.
• 😴 Sleep Studies: If symptoms suggest obstructive sleep apnoea.

⚠️ Topiramate is teratogenic and subject to UK pregnancy-prevention restrictions. It is contraindicated in pregnancy for migraine prophylaxis and should not be used in women of childbearing potential unless the conditions of the Pregnancy Prevention Programme are fulfilled.

4️⃣ Management – Multidisciplinary Approach

• 🥦 Lifestyle Interventions (first-line)
  • 🍎 Dietary Changes: Calorie deficit diet; ↑ fruit/veg, lean protein, whole grains; ↓ sugar, processed foods, saturated fats.
  • 🏃 Physical Activity: ≥150 min/week of moderate exercise + resistance training.
  • 🧠 Behavioural Therapy: CBT for eating behaviours, stress management, relapse prevention.
• 💊 Pharmacological Therapy
  • Orlistat → reduces fat absorption (GI side effects common).
  • GLP-1 agonists (e.g., Liraglutide, Semaglutide) → appetite suppression + weight loss.
  • Phentermine/Topiramate → appetite suppression (US-licensed).
  • Metformin → useful in diabetes/insulin resistance, modest weight benefit.
• 🔪 Surgical Interventions
  • Indications: BMI ≥40, or ≥35 with comorbidities, and failure of conservative therapy.
  • Procedures:
    • Gastric bypass → reduces intake & absorption.
    • Gastric sleeve → reduces stomach size & appetite hormones.
    • Adjustable gastric banding → restricts stomach capacity.
  • Requires lifelong follow-up, nutritional supplementation, and psychological support.
• 🤝 Psychological & Social Support
  • Counselling → addresses body image, mood, emotional eating.
  • Support groups → peer motivation and accountability.

💡 Teaching Pearl

Obesity is not simply excess weight but a chronic disease. Effective management requires a holistic, patient-centred, long-term approach addressing lifestyle, medical, and psychological needs. 🎯 Even modest weight loss (5–10% of body weight) leads to significant improvements in metabolic health.