World Obesity Day is observed globally on 4 March. Obesity is a growing health problem worldwide, with 13% of adults worldwide considered obese and obesity being the cause of premature death for 4.7 million people in 2017. This was close to three and four times higher than estimated road accidents and HIV/AIDS respectively. While obesity is a growing health concern worldwide, there are still many misconceptions around what exactly obesity is and how to go about treating it.
What is obesity?
Obesity is medical condition whereby a person carries excess weight or body fat that might negatively affect their health. The most common way to test if someone is obese is to use the Body Mass Index (BMI), a tool that doctors use to evaluate whether a person is the appropriate weight for their age, sex, and height.2 BMI is a person’s weight in kilograms divided by the square of their height in metres. A BMI between 25 and 29.9 shows that a person is carrying excess weight, and a BMI of 30 or over indicates a person may have obesity.
Obesity is frequently subdivided into categories:
· Class 1: BMI of 30 to <35. · Class 2: BMI of 35 to < 40. · Class 3: BMI of 40 or higher. This is sometimes categorised as ‘extreme’ or ‘severe’ obesity.3 What causes obesity? The most common misconception about obesity is that it is purely caused by a lack of physical activity and an unhealthy diet. Eating more calories than you burn is a major cause of obesity, however there are other factors that can impact obesity including a lack of sleep and the so-called obesity gene. Research has shown that sleep deprivation significantly impacts weight gain and obesity in both children and adults as it leads to hormonal changes that stimulate appetite. A lack of sleep causes the body to produce more of the ‘hunger’ hormone ghrelin, resulting in an increased appetite. At the same time a lack of sleep also decreases the production of leptin, the hormone that suppresses the appetite. The imbalance in these hormones could cause people to eat more resulting in increased weight gain. A faulty gene called the fat-mass and obesity-associated gene (FTO) is also responsible for some cases of obesity. FTO impacts the amount of ghrelin (hunger hormone) a person produces and this might affect a person’s chances of having obesity. Ghrelin affects how the body stores fat and might even play a role in eating conditions such as binge eating and emotional eating, further impacting a person’s predisposition towards obesity. The FTO gene can also impact people’s eating habits, leading people to prefer high-calorie foods, having a higher intake of food, and an impaired ability to feel full. These are all factors that should be taken into consideration when diagnosing and understanding obesity. Complications related to obesity As obesity is a medical disease, it comes with several complications. Overweight and obesity are major risk factors for a number of chronic diseases including heart disease and stroke which are leading causes of death worldwide. Obesity can further lead to diabetes and the conditions associated with diabetes complications such as blindness, limb amputations and the need for dialysis.Obesity also impacts the skeleton, and carrying excess weight can lead to musculoskeletal diseases including osteoarthritis.5 Obesity and overweight can also lead to other diseases including hypertension, high cholesterol, many types of cancers, and mental illnesses such as clinical depression and anxiety. Eating behaviours and stigma Before obesity and overweight can be treated, the stigma and biases surrounding these conditions need to be understood. In South Africa, weight stigmatisation and discrimination from society and family create psychological obstacles to obesity treatment. Growing evidence shows that weight bias can have a negative impact on people struggling with obesity and weight loss, leading to internalised weight bias and potentially disordered eating behaviours. Understanding the psychological reactions to weight and stigma could play a key role in treating obesity, including the knowledge of what causes obesity and exacerbates it, and how to treat obesity effectively. Treating obesity In terms of treating obesity, there are a variety of treatment methods that can be used to help treat obesity, from changing diets and increasing physical activity to using weight loss medications, prescribed by a medical professional. As obesity is a complex medical condition, it is important that a healthcare professional is consulted when it comes to treating obesity, as each person requires a different approach based on their condition. To start with, a National Institutes of Health study in 2016 found that people with obesity who lose between 5-10% of their body weight, and maintain that weight loss, improve their health and reduce their chance of suffering from any of the diseases or conditions associated with obesity and overweight. This can be used as an initial target for weight loss when treating obesity, and shows that even a small amount of weight loss can be beneficial. Dieting and physical exercise are the most common ways used to lose weight, but should be done carefully. Crash dieting should be avoided as it could cause new health problems or vitamin deficiencies, and can even make achieving weight loss more difficult. Physical activity and exercise should be eased into. It is recommended that people do approximately 150 minutes of moderate exercise a week to have a positive impact on their weight and health. Weight loss medications can also play an important role in losing weight and will be prescribed by healthcare professionals if dietary changes and exercise have not resulted in weight loss, or a person’s weight poses a significant health risk. Weight loss medications are not meant to replace lifestyle changes, however they can supplement weight loss by aiding dietary changes and exercise. Medications can assist weight loss by focusing on the hormones that control hunger and the feeling of fullness. For example, GLP-1 (glucagon-like peptide-1) molecules are naturally occurring and can affect the body’s feeling of hunger after eating. There are studies focused on how synthetic GLP-1 molecules can potentially be used to suppress appetite or increase energy and kickstart potentially long lasting weight loss. As obesity is a medical condition, medication can play a vital role in assisting people with weight loss. A challenge to lose weight One key point to remember when it comes to treating obesity, is the fact that the body reacts to losing weight by trying to regain weight. Once you start losing weight, hormonal changes lead to increased feelings of hunger and decreased feelings of fullness as the levels of satiety hormones decrease and the levels of hunger hormones increase11. These changes also result in fewer calories being burnt. The Set Point Theory states that every person has a certain ‘set’ weight that their body accepts and is genetically disposed to, so any attempts to lose weight results in the body’s survival instincts kicking in to regain weight to stay at that ‘set’ weight. These hormonal changes may last for up to three years and may be part of the reason why most people end up regaining lost weight in the long run. Obesity is a complex medical condition that is the result of a variety of factors, not only a lack of physical exercise and unhealthy eating. Understanding these factors is an important step in tackling obesity and the misconceptions surrounding the disease. All the causes for obesity need to be considered and understood before treatment can occur. Owing to the complex nature of obesity and weight loss, seeking the help of a health care professional, and creating a treatment plan tailored to individual needs is an important step in treating obesity. To help raise awareness and break down misconceptions about obesity and weight loss, Novo Nordisk created the Truth About Weight website. The website provides information on obesity and weight loss, including information on why losing weight can be so challenging. The Truth About Weight website advocates for creating a treatment plan to focus on not only the physical aspects of weight loss but also the psychological and pharmacological aspects to ensure a holistic weight loss plan that works for you.