Obesity-associated morbidity

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Obesity has a number of medical complications which negatively impact peoples' quality of life and are costly to treat.
Gynecomastia as seen in an obese male.

Whether or not obesity should be considered a disease on its own, it is also an important risk factor for many chronic physical and mental illnesses.[1] The generally accepted view is that being overweight causes similar health problems to obesity, but to a lesser degree.

Cardiological

Ischemic heart disease

Obesity is associated with cardiovascular diseases including angina and myocardial infarction.[2][3] A 2002 report concluded that 21% of ischemic heart disease is due to obesity[1] while a 2008 European consensus puts the number at 35%.[4]

Congestive heart failure

Having a BMI greater than 30 doubles one's risk of congestive heart failure.[5][6]

High blood pressure

More than 85% of those with hypertension have a BMI greater than 25.[6] The risk of hypertension is 5 times higher in the obese as compared to those of normal weight. A definitive link between obesity and hypertension has been found using animal and clinical studies, which have suggested that there are multiple potential mechanisms for obesity-induced hypertension. These mechanisms include the activation of the sympathetic nervous system as well as the activation of the renin–angiotensin-aldosterone system.[7] The association between hypertension and obesity has been also well described in children.[8]

Abnormal cholesterol levels

Obesity is associated with increased LDL cholesterol (bad cholesterol) and lowered HDL cholesterol (good cholesterol).[6][9]

Deep vein thrombosis and pulmonary embolism

Obesity increases one's risk of venous thromboembolism by 2.3 fold.[10][11]

Dermatological

Stretch marks on the abdomen.

Obesity is associated with the incidence of stretch marks, acanthosis nigricans, lymphedema, cellulitis, hirsutism, and intertrigo.[12][13]

Endocrine

Diabetes mellitus

One of the strongest links between obesity and disease is that with type 2 diabetes. These two conditions are so strongly linked that researchers in the 1970s started calling it “diabesity”.[6] Excess weight is behind 64% of cases of diabetes in men and 77% of cases in women.[14]

Reproductive system

Polycystic ovarian syndrome (PCOS)

Due to its association with insulin resistance, the risk of PCOS increases with adiposity. In the US approximately 60% of patients with PCOS have a BMI greater than 30.[15]

Infertility

Obesity leads to infertility in both men and women. This is primarily due to excess estrogen interfering with normal ovulation in women[6] and altering spermatogenesis in men.[16] It is believed to cause 6% of primary infertility.[6][17] A review in 2013 came to the result that obesity increases the risk of oligospermia and azoospermia in men, with an of odds ratio 1.3.[18] Being morbidly obese increases the odds ratio to 2.0.[18]

Complications of pregnancy

Obesity is related to many complications in pregnancy including: haemorrhage, infection, increased hospital stays for the mother, and increased NICU requirements for the infant.[19] Obese women have more than twice the rate of C-sections compared to women of normal weight.[20] Obese women also have increased risk of preterm births and low birth weight infants.[21]

Birth defects

Those who are obese during pregnancy have a greater risk of have a child with a number of congenital malformations including: neural tube defects such as anencephaly and spina bifida, cardiovascular anomalies, including septal anomalies, cleft lip and palate, anorectal malformation, limb reduction anomalies, and hydrocephaly.[22]

Intrauterine fetal death

Maternal obesity is associated with an increased risk of intrauterine fetal death.[17]

Gastrointestinal

Gastroesophageal reflux disease

Several studies have show that the frequency and severity of GERD symptoms are higher in those who are obese.[23][24]

Cholelithiasis (gallstones)

[clarification needed][6]

Neurological

Stroke

Ischemic stroke is increased in both men and women who are obese.[6]

Meralgia paresthetica

[clarification needed][25]

Migraines

[clarification needed][26]

Carpal tunnel syndrome

[clarification needed][27]

Dementia

Those who are obese have a rate of dementia 1.4 times greater than those of normal weight.[28]

Idiopathic intracranial hypertension

[clarification needed][29]

Multiple sclerosis

Women that are obese at age 18 have a greater than twofold increased risk of MS.[30]

Oncological

Many cancers occur at increased frequency in those who are overweight or obese. A study from the United Kingdom found that approximately 5% of cancer is due to excess weight.[31] These cancers include: [32]

Al high body mass index (BMI) is associated with a higher risk of developing ten common cancers including 41% of uterine cancers and at least 10% of gallbladder, kidney, liver and colon cancers in the UK.[33]

Psychiatric

Depression

File:Relationship between bmi and suicide.png
Risk of suicide decreases with increased body mass index in the United States.[34]

Obesity has been associated with depression.[6] The relationship is strongest in those who are more severely obese, those who are younger, and in women.[35] Suicide rate however decreases with increased BMI.[34]

Social stigmatization

In the United States, young women who are overweight complete 0.3 year less school, are 20% less likely to get married, and make $6,710 less than their normal weight counterparts.[6][36]

Respirological

Obstructive sleep apnea

Obesity is a risk factor for obstructive sleep apnea.[6][37]

Obesity hypoventilation syndrome

CPAP machine commonly used in OHS

Obesity hypoventilation syndrome is defined as the combination of obesity, hypoxia during sleep, and hypercapnia during the day, resulting from hypoventilation.[38] Based on its definition it occurs only in the obese.

Chronic lung disease

Obesity is associated with a number of chronic lung diseases, including asthma and COPD.[37] It is believed that a systemic pro-inflammatory state induced by some causes of obesity may contribute to airway inflammation, leading to asthma.[39]

Complications during general anaesthesia

[clarification needed][6][40]

Rheumatological and orthopedic

Gout

Compared to men with a BMI of 21–23, men with a BMI of 30–35 have 2.3 times more gout, and men with a BMI of greater than 35 have 3.0 times more gout. Weight loss decreases these risks.[41]

Poor mobility

There is a strong association between obesity and musculoskeletal pain and disability[42]

Osteoarthritis

Increased rates of arthritis are seen in both weight-bearing and non-weight-bearing joints.[6] Those with a BMI greater than 26.4 had rate of osteoarthritis of the knees 6 times greater than those with a BMI of less than 23.4, well rates of osteoarthritis in the hand was about 1.5 times greater.[43]

Low back pain

Obese individuals are twice to four times more likely to have lower back pain than their normal weight peers.[44]

Urological and nephrological

Erectile dysfunction

One third of obese men with erectile dysfunction who lose weight experience an improvement in their sexual functioning.[45]

Urinary incontinence

Urge, stress, and mixed incontinence all occur at higher rates in the obese.[46] The rates are about double that found in the normal weight population.[47] Urinary incontinence improves with weight lost.[48]

Chronic renal failure

Obesity increases one's risk of renal failure by three to four times.[49]

Hypogonadism

[clarification needed][50]

References

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