What is Obesity?
Obesity is a growing health concern that affects millions of people globally. This medical condition is characterized by the accumulation of extra body fat, which can have detrimental effects on a person’s health and well-being throughout their lives.
The percentage of persons who are overweight or obese almost tripled between 1975 and 2016, according to a study. In 2016, around 13% of the world’s adult population was obese, with a percentage of obese males being 11% and obese women being 15%. 
Most people in the world live in countries where there are more overweight and obese people than underweight people. This includes all countries with high and middle incomes. According to the World Health Organization, about 2.8 million people die annually as a result of being overweight or obese, indicating that obesity has reached epidemic proportions worldwide. Obesity is defined as a BMI of 30 or higher, while overweight is defined as a BMI of 25 or higher.  (Overweight and obesity in adults are often measured by Body Mass Index (BMI), which is weight in kilograms divided by height in meters).
However, according to the CDC, “The relationship between BMI and body fat can be affected by factors like age, race, sex, and muscle mass.” Also, BMI doesn’t tell the difference between too much fat, muscle, or bone mass, nor does it show how fat is distributed among different people. Despite these drawbacks, BMI is still frequently used to determine body size.
It is divided into three categories based on (BMI)
- Class 1 obesity refers to having a BMI of 30 to less than 35,
- Class 2 obesity means having a BMI of 35 to less than 40.
- Class 3 obesity, also known as severe obesity, is when someone has a BMI of 40 or higher. 
Doctors use these categories to recommend the best ways to manage weight and prevent health problems.
Causes & Risk Factors of Obesity
Obesity can be caused by a combination of genetic, environmental, and behavioral factors. While the underlying causes of obesity vary from person to person, understanding the common factors that contribute to its development is critical for effectively preventing and managing this condition. Here are some of the main causes of obesity:
Taking in more calories than the body requires for metabolism and daily activities can result in weight gain as the body stores fat, thus obesity.  According to a study, weight discrimination can make people feel bad about themselves. To cope with negative emotions, they may overeat even when they’re not hungry. Thus, overweight people who feel stigmatized are more likely to overeat, even if they don’t need it. 
Obesity and other health problems have been linked to a lack of physical activity or sedentary lifestyles that involve sitting for long periods due to which only fewer calories are burned. According to the study, higher levels of physical activity were linked to a lower prevalence of obesity, whereas spending more time sitting was linked to a higher prevalence of obesity. 
Genetic factors may contribute to obesity by affecting hormones, metabolism and by controlling appetite. The risk of developing obesity is estimated to be as high as 70 percent genetic in origin.  Obesity is caused by a combination of genetic and environmental factors. Furthermore, specific genetic variants such as MC4R and FTO are linked to increased hunger and decreased satiety, leading to an increased likelihood of overeating and obesity. 
Environmental & social factors:
Obesity is influenced by several environmental and social factors, including easy access to unhealthy foods, food marketing, food pricing, the built environment (including city planning, transportation, and schools, as well as inactivity, television and screen-related immobility, video games, and smartphones, agro-alimentary factors including imbalanced ingredients, speed eating, nibbling, portion size, sweet drinks, and junk foods, which are promoted by publicity and supported by ethnic and sociocultural factors. [9,10]
Some drugs, such as various antidepressants (Nortriptyline); antipsychotics (Chlorpromazine, Clozapine, and Haloperidol); diabetic pills (insulin and sulfonylureas); antihypertensives and beta-blockers (Atenolol, Metoprolol, and Propranolol); corticosteroids (Cortisone and Prednisolone); and even some hormonal contraceptives, are known to cause weight gain in some patients. 
Numerous studies point to a connection between sleep deprivation and obesity. One explanation for this might be that insufficient sleep messes with the hormones that control appetite and metabolism, making people feel hungrier and use less energy. Furthermore, individuals who tend to sleep less than 7 hours daily per night were more likely to get obese than those who sleep more time. 
Some medical conditions that can contribute to obesity include: [13,14,15,16]
- Hypothyroidism: The thyroid gland is underactive, leading to an inadequate supply of thyroid hormones. As a result, your metabolism may slow and you may gain weight.
- Cushing’s syndrome: This rare disorder is caused by excessive production of the hormone cortisol, which can cause rapid weight gain, especially in the face, neck, and trunk.
- Prader-Willi syndrome: The hypothalamus, which controls feelings of fullness and hunger, is disrupted. Constant hunger is a symptom of this disorder, which can lead to excessive eating and weight gain.
- Polycystic ovary syndrome (PCOS): Women can experience weight gain, especially around the abdominal area, if they have this hormonal imbalance.
- Depression: Individuals suffering from depression or other mental health disorders may seek comfort in food, resulting in overeating and weight gain.
People of all ages, including children and adults, are susceptible to becoming obese. Abdominal obesity is on the rise and is associated with aging. People’s metabolisms slow down as they become older, which can lead to weight gain. 
Consequences of Obesity
1. Socioeconomic consequences:
Overweight people suffer from public disapproval of their fatness. This stigma exists in employment, education, health care, and elsewhere.  However, it appears that obese women are at a higher risk of psychological dysfunction than obese men, possibly because of the extra pressures women face in today’s society to maintain a slim figure. 
2. Sleep apnea:
Obesity and obstructive sleep apnea have a linear relationship (OSA). Sleep apnea is caused by the narrowing of the airway due to the accumulation of fat in the upper respiratory tract. [20, 21] It is estimated that approximately forty percent of obese people have significant sleep apnea, and approximately seventy percent of OSA patients are obese. 
3. Skin Diseases:
Obesity can lead to various skin diseases due to excessive sweat, skin folding, and irritation due to friction. Skin conditions such as psoriasis (flaky skin with scales), hidradenitis suppurativa (scarring and abscesses on the skin), cellulite (orange-peel appearance), skin ulcers (open sores), intertrigo (bacterial overgrowth leads to bromhidrosis, a persistent sweat gland disorder that causes unpleasant body odor), acanthosis nigricans (hyperpigmented plaques and patches), acrochordons (pedunculated lesions causing discomfort), keratosis pilaris (spiny papules with redness around hair follicles), striae distensae (stretch marks), plantar hyperkeratosis (thickened skin), and dermatitis (skin inflammation) can all get worse with obesity. [23, 24]
4. Bone and Joint Diseases:
Obesity is one of the leading causes of poor bone and joint health.
- Excess weight places additional strain on joints, especially weight-bearing joints such as the hips and knees. This strain raises the likelihood of osteoarthritis (OA) in that joint. In addition, obesity may have metabolic effects that raise the risk of OA. 
- Obesity’s complicated relationship with osteoporosis (OP) is best illustrated by the fact that, while it protects against osteoporosis of the femoral neck, abdominal obesity, and low vitamin D levels, both of which are more common in obese individuals, are risk factors for OP, and pro-inflammatory molecules and leptin from visceral fat may contribute to bone loss.
- Although obesity may increase the risk of various non-spinal fractures, such as upper leg fractures, proximal humerus fractures, and ankle fractures, it may be a protective factor against hip fractures. Obesity increases the risk of fractures, falls, and bone breaks.
- Obesity is linked to increased disease activity and is associated with higher rates of rheumatoid arthritis (RA), as shown by higher levels of circulating visfatin and adiponectin in RA patients. 
5. Cardiovascular Disease:
Obese individuals require more blood to supply their bodies with oxygen and nutrients, thus resulting in increased blood pressure. This increases the risk of developing heart disease.  Obesity is linked to hypertension, dyslipidemia, diabetes, and insulin resistance, making it a global risk factor for CVD.  Patients with obesity experience cardiovascular events at an earlier age, live with cardiovascular disease for a longer period and have a higher prevalence of multiple cardiovascular risk factors. [29, 30] Weight loss results in improvements in metabolic syndrome components such as blood pressure and cardiovascular health. 
6. Type 2 Diabetes:
Being overweight is strongly linked to type 2 diabetes mellitus in both sexes and across all racial and ethnic groups. The likelihood of developing type 2 diabetes mellitus rises with the severity and length of being overweight. It is estimated that being overweight causes up to 65% of type 2 diabetes cases.  According to a study, diabetes risk can be decreased with weight loss i.e. a 5-11 kg weight loss reduced relative risk by nearly 50%, and with a weight loss of more than 20 kg or a BMI below 20 kg/m2, type II diabetes can be eliminated. [33,34]
7. NAFLD (Non-Alcoholic Fatty Liver Disease):
Obesity can cause NAFLD by causing steatosis, which is the buildup of fat in the liver. This can then lead to steatohepatitis, fibrosis, and cirrhosis, which can cause liver problems like hepatomegaly, high liver enzymes, and abnormal liver histology.  Studies have shown that these abnormalities are common in overweight and obese people with abnormal liver biochemistry. This suggests that obesity and NAFLD are related. [36,37]
8. Endocrine Issues:
Overweight people often experience endocrine changes. The alterations to the reproductive system are crucial. Obesity is linked to a variety of reproductive issues, including irregular periods, amenorrhea, and infertility. 
Overweight people have higher rates of certain cancers. Colon, rectum, and prostate tumors are more common in men. Women have more reproductive and gallbladder cancers. Breast cancer may be linked to central body fat more than total body fat. 
How Can We Diagnose Obesity?
The following 7 methods can be used to estimate one’s body fat percentage:
1. Body Mass Index:
Obesity is typically diagnosed by measuring a person’s body mass index (BMI), which is a calculation based on a person’s weight and height. A BMI of 30 or higher is considered obese. But BMI isn’t always a good way to tell if someone is obese. For example, athletes and people with a lot of muscle mass don’t always have a high BMI. 
2. Waist Circumference
A person’s waist circumference can be measured to get a rough idea of how much fat is stored in their abdominal area. For this, take the measurement right above your belly button. Before taking a measurement, make sure the tape is level and take a deep breath out. It is advised to take the average of three measurements.
A male & female waist measurement of more than 40 inches (102 cm) and 35 inches (88 cm), respectively is regarded as excessive and may indicate a higher risk for specific health issues. 
3. Waist-hip ratio:
It compares the size of the waist to the size of the hips. WHR can help you determine how much abdominal fat you have. Take your waist and hip circumference measurements. To calculate your waist-to-hip ratio, divide your waist circumference by your hip measurement. According to WHO, a WHR of 0.8 or above for women and 0.9 or above for men is considered high. 
4. Waist-height ratio:
The waist-to-height ratio measures body fat. A person’s waist measurement divided by their height determines their waist-to-height ratio. The cutoff for the waist-to-height ratio of central obesity in children and adults is 0.5. 
5. Bioelectrical impedance analysis:
Body composition, including skeletal muscle and fat mass, can be measured using bioelectrical impedance analysis (BIA). It is a cheap and safe method that prevents radiation exposure. [44, 45] This method uses a tiny electrical current to measure tissue resistance. Body fat, including subcutaneous and visceral fat, can be estimated with it.
Skinfold calipers measure skin and fat thickness to estimate body fat percentage. The caliper has a scale and two arms with a clamp. 
7. Imaging Test Methods:
Imaging techniques such as MRI, CT scan, and Dual-energy x-ray absorptiometry are used to accurately measure the amount of body fat. These techniques are much better than the above-mentioned techniques, like skinfold thickness measurements and bioelectrical impedance but are expensive and hardly available. These methods provide a detailed image of the body’s internal structures and can accurately measure fat volume in specific areas. They may be more accurate than methods such as skinfold thickness measurements and bioelectrical impedance, but they are also more expensive and may not be widely available. [47, 48]
Treatment of Obesity
Obesity can be treated through a combination of diet, exercise, and lifestyle changes. Here are some ways to treat obesity:
Improve your diet:
Obesity treatment typically includes alterations to one’s diet. Energy restriction, macronutrients, dietary, and food intake patterns can all be combined in several different ways to achieve weight loss. There is no proven weight loss diet. However, reducing total carbohydrate content and eating low-glycemic index foods may assist. This may involve a following dietary pattern
- Including a variety of fruits, vegetables, grains, skim milk or low-fat milk, yogurt, cheese, and oils.
- Includes a variety of foods that are protein in nature such as lean meats, soy-based products, poultry, seafood, eggs, beans, lentils, peas, nuts, and seeds
- Restrict the consumption of foods and beverages that are high in sugars, sodium, and saturated fat.
- Minimize Alcohol consumption.
- Try to fulfill your caloric need on daily basis [49,50]
Behavioral modification is done on-site to a group of 10 to 20 people by registered dietitians, exercise specialists, psychologists, and other health professionals. They help them to control their weight through behavioral changes through goal setting, self-monitoring, stimuli control, and cognitive and motivational therapy. [50,51] Slower eating, smaller plates, no distractions, and food dairy can help with portion control and mindful eating. 
Increase physical activity:
Participate in regular physical activity and exercise to burn calories and reduce body fat., building up to at least 30 minutes of moderate-intensity exercise by doing what you enjoy at a comfortable pace. Aerobic exercise should be included as well. [53,54] Some of the exercises are listed below:
- Strength Training (weight lifting)
Weight loss surgery:
The best intervention for helping obese persons lose weight is bariatric surgery. It alters the digestive system to assist obese people in reducing fat. There is a chance of complications both during and after this invasive procedure. Gastric banding, gastric bypass, and sleeve gastrectomy are among the surgical options for achieving this goal. People with a body mass index (BMI) of 40 or more with serious medical problems that can’t be fixed with traditional weight loss methods are often advised to pursue bariatric surgery as a viable option. [55, 56]
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