Obesity is the epidemic of the 21st century

Obesity is the excessive accumulation of fat in the subcutaneous layer and internal organs. A diagnosis is made when a patient’s body weight exceeds the norm by more than 20%. Obesity is classified as a lifestyle disease and has reached epidemic proportions in the modern world, affecting one-third of the global population to some degree.

Causes of Obesity

In 90% of cases, obesity results from lifestyle factors, dietary habits, and physical inactivity:

• Long intervals between meals and oversized portions
• Evening overeating
• Eating right before bedtime
• High intake of carbohydrates and fats (especially confectionery and animal-based fats) combined with insufficient fiber
• Excess calorie consumption compared to expenditure
• Lack of physical activity to stimulate muscles to metabolize fat

Family predisposition and psychological overeating are also contributing factors.

In 10% of cases, obesity develops due to disruptions in organ and system function, such as:

• Endocrine disorders (dysfunctions in the hypothalamic-pituitary system, thyroid, pancreas, or adrenal glands)
• Hormonal medications (contraceptives, steroids, insulin)
• Genetically determined enzyme deficiencies for fat breakdown
• Brain tumors

Classification of Obesity

Obesity levels are determined by the Body Mass Index (BMI) using the Quetelet formula: weight divided by height squared (in meters):

• BMI over 25: overweight
• BMI over 30: Grade I obesity
• BMI over 35: Grade II obesity
• BMI over 40: Grade III obesity
• Weight more than twice the norm: Grade IV obesity

Types of obesity by fat distribution:

• Gynoid (female, lower body): fat accumulates on the hips and buttocks.
• Android (male, upper body): fat accumulates on the abdomen and sides.
• Mixed: fat is evenly distributed, including on the limbs, neck, and back.

Symptoms of Obesity

• Enlarged body parts and changes in their proportions
• Aesthetic issues: double chin, pseudo-gynecomastia, abdominal “apron”
• Stretch marks (striae)
• Hernias

As obesity progresses, additional symptoms may appear:

• Shortness of breath, rapid heartbeat (due to diaphragm elevation)
• Heartburn, esophageal reflux
• Snoring, sleep apnea (from palatal tissue overgrowth)
• Reduced muscle mass (due to fat tissue dominance)
• Joint pain (from increased load)
• Episodic high blood pressure
• Menstrual cycle disruptions, reduced potency

Over time, functional disorders may evolve into systemic diseases.

Complications of Obesity

• Respiratory and heart failure
• Coronary heart disease
• Hypertension
• Fatty liver disease, potentially leading to gallstones and cirrhosis
• Pancreatic issues (causing pancreatitis and diabetes)
• Esophageal erosion, gastritis, stomach and duodenal ulcers
• Arthritis and arthrosis

Obesity has also been linked to certain cancers, including colorectal, pancreatic, prostate, ovarian, and breast cancers.

Diagnosing Obesity

Individuals with excess weight typically consult an endocrinologist or dietitian. The doctor will:

• Calculate BMI and ideal body weight (using formulas like Broca, Devine, or Robinson)
• Assess fat deposits based on the waist-to-hip ratio: normal values are up to 0.8 for women and 1.0 for men
• Collect the patient’s personal and family medical history, including details about their lifestyle and eating habits
• Evaluate the duration of obesity, weight fluctuations, and any self-directed efforts
• Order lab tests to detect hormonal or enzyme deficiencies, if necessary
• Assess the severity of complications

Treating Obesity

The treatment approach depends on the underlying cause:

• Lifestyle-related obesity:
  A dietitian creates a meal plan and, with a physical therapy specialist, determines an appropriate level of physical activity targeting problem areas.
  Medications may be prescribed to influence metabolism, appetite, and fat absorption.
• Psychogenic obesity:
  Psychologists and psychotherapists provide specialized training and may prescribe antidepressants.
• Symptomatic obesity:
  Treatment focuses on managing the underlying condition; diet and exercise may only offer partial correction.
• Severe obesity (Grade III–IV):
  Bariatric surgery, such as gastric resection or banding, may be necessary.

Prognosis and Prevention

The prognosis depends on the presence of complications, particularly systemic and organ-related diseases. Losing 10% of body weight can reduce the risk of diabetes and obesity-related cancers by 30% and 40%, respectively.

Weight loss also alleviates cardiovascular strain, reduces joint stress, and helps prevent complications like hypertension and joint diseases.

To prevent obesity, it is essential to balance caloric intake with energy expenditure, maintain a consistent daily routine, and engage in at least two hours of moderate physical activity per week.