Considered a condition that can cause serious damage to health, it has reached “epidemic proportions”, according to the WHO. It is associated with more than 5 million deaths per year worldwide. Know causes and treatments of the disease. By affecting millions of people around the world and becoming a chronic disease, obesity has become a major health problem. The disease has spread to almost every corner of the planet to the point of “reaching epidemic proportions”, according to the World Health Organization (WHO). More than 5 million people die each year from the illnesses and ill effects associated with the condition. By 2035, more than half of the world’s population − more than 4 billion people − could be obese or overweight, according to the 2023 Atlas of the World Obesity Federation. But what exactly is obesity? Obesity is a complex disease that can occur at any age and affects both adults and children. The WHO defines obesity as “abnormal or excessive accumulation of fat that poses a risk to health”. In essence, obesity occurs when a person consumes excess calories, which the body converts into fat. This imbalance between calories eaten and calories burned – such as when exercising – can be caused by many factors, including social, lifestyle, physical, psychological, biological and genetic factors. Contrary to what is still believed, obesity is not a choice or the result of a lack of willpower, but a chronic disease that must be treated as such. Obesity is one of the main risk factors for early death, as it increases the danger of developing other diseases. It is associated with cardiovascular and respiratory diseases, mental health problems, some types of cancer and metabolic diseases, such as type 2 diabetes, among others. What causes the illness? “We know that appetite and satiety are inherited and that up to 70% of weight is genetically determined. There is every reason to treat obesity as a chronic and recurrent disease,” said John Wass, professor of endocrinology at the University of Oxford, to the scientific journal The Lancet. There are many reasons why a person may start consuming more calories than they burn, leading to obesity. These factors can be divided into two categories: internal factors, such as the person’s body, biology and genetics; and external factors such as environmental and social conditions such as income, access to health care, access to a park, etc. Genetic aspects, lack of exercise, bad eating habits, psychological problems, health problems, social and economic conditions, drugs, pollutants and other factors related to the body can contribute to the development of obesity. Medical conditions like Cushing’s disease and certain medications, including steroids and some antidepressants, can also cause weight gain or obesity. More recently, it has been shown that gut flora may be playing an important role in relation to obesity. The intestinal flora or microbiota concerns all the microorganisms that live inside the intestine and to which part of health and well-being is attributed. How problem affects the body? Obesity can affect almost every part of the body and lead to many health problems. Researchers estimate that for every 5 increases in Body Mass Index (BMI) above 25, there is about a 30% increase in mortality. Symptoms related to excess body fat and weight include difficulty performing physical activities, pain in different parts of the body, such as the back, and even osteoarthritis. Being overweight can also make it difficult to breathe at night, which is called sleep apnea. Obesity can cause type 2 diabetes, increase blood pressure, cholesterol and blood sugar, and lead to cardiovascular disease such as strokes and heart attacks due to increased accumulation of fat in the arteries. The disease has also been associated with certain types of cancer, such as endometrial, esophageal, liver, kidney and colon, among others. And she can still seriously affect a person’s mental health, causing anxiety, low self-esteem and increasing the risk of depression. How is obesity detected? Determined primarily by measuring a person’s Body Mass Index (BMI), obesity is diagnosed when a person’s BMI is above 30. BMI is calculated by dividing weight in kilograms by the square of height in meters. It can be calculated, for example, in this calculator from the government of Rio de Janeiro. (If the person measures 1m80 and weighs 75 kg, his BMI is 23, which is considered healthy. But, according to the WHO, if the BMI is greater than 25, the person is overweight; and, if it is greater than 30, so this is a person with obesity. But this can vary from country to country and between ethnic groups. However, BMI is not a direct measure of the amount of fat, as age, gender, ethnicity and muscle mass can affect the relationship between BMI and body fat. For example, a weight lifter with a lot of muscle mass can have a high BMI, over 30, and not have excess fat. There are other tools to measure the amount of fat more accurately, such as bioimpedance electrical or DXA scans, but they are not widely available.”The best way to measure body fat is using MRI,” Alexander Miras, professor of endocrinology at the University of Ulster, UK, told DW. Magnetics are expensive and are primarily used to determine body fat for research purposes. Abdominal fat content is associated with higher health risks than the rest of the body. Therefore, medical guidelines recommend using waist circumference to determine waist circumference. How can it be treated and prevented? At an individual level, the best way to prevent obesity is through a balanced diet, with less fat and sugar and more fruit, vegetables, cereals and nuts, and staying active, doing constant physical activity with regular physical exercise, about 20 minutes a day, recommends the WHO. But this can only work fully in conjunction with political, public health, social and food industry interventions. “There has actually been a lot of emphasis on blame and personal responsibility, including on the part of doctors,” Francesco Rubino, chair of metabolic and bariatric surgery at King’s College London, told The Lancet. As in a chronic disease, the doctor must provide a long-term treatment plan that may include changes in lifestyle, eating habits, choosing a more balanced diet and modifying the way people move, promoting physical activity. . Regular follow-ups are important. Weight loss doesn’t have to be extreme in the beginning. Studies have shown that even a 10% reduction in body weight can significantly decrease the threat of obesity-related risk factors and that this can be achieved within six months with well-designed treatment programs. After that, more intense weight loss programs can be discussed with the doctor. It can be difficult for patients to stay motivated, or they may face mental health problems because of the disease, and precisely for this reason psychological monitoring and constant motivation are essential. What medications and surgeries are there? If diet and exercise don’t work, there are few drugs approved to treat obesity that can help, but they can also have side effects. The last to be approved was semaglutide. The medication, sold under the brand name Ozempic (injectable version) or Rybelsus (tablet version), was approved by Anvisa, in Brazil, and also in the United States and by the National Institute for Health and Care Excellence (Nice) in the United Kingdom. It can lead to more than 10% weight loss. The drug must be self-injected once a week and can cause side effects such as nausea, vomiting, diarrhea and constipation. Semaglutide reduces appetite by mimicking the hormone GLP-1, which is released after we eat. If diet and exercise fail for severely obese people, usually those with a BMI over 40, bariatric surgery such as gastric bypass can be an effective treatment for weight loss and improved health. It is important to discuss with the doctor the benefits, risks and implications of this procedure. People respond very differently to different interventions, so the best possible treatment should be carefully discussed with a doctor. Key disease statistics In 2016, 1.9 billion − or 39% of adults worldwide − were living with overweight, and 650 million − or 13% − were obese. Obesity is a growing global problem. The proportion of obese adults has nearly tripled since 1980, according to the WHO Global Health Observatory. According to the Global Obesity Observatory, the percentage of people with obesity is: 43% in the United States, 20% in Saudi Arabia, about 5% in India, 35% in Brazil, and in European countries the numbers are around 20 %. These percentages do not include overweight people. Children are not exempt from the problem. According to the WHO, around 38 million children under 5 years old are overweight or obese, while in the 5 to 19 age range there are 340 million worldwide. Author: Esteban Pardo
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